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Hypotension and pulmonary edema in HOCM – Cardiology MCQ
Hypotension and pulmonary edema in severe hypertrophic obstructive cardiomyopathy (HOCM) is treated with: a) Dobutamine b) Nitroglycerine c) Metoprolol and noradrenaline d) All of the above Correct answer: c) Metoprolol and noradrenaline Treatment with inotropes and vasodilators may be life threatening in those cases of severe HOCM presenting with hypotension and pulmonary edema. Instead betablockers and vasoconstrictors like phenylephrine or noradrenaline should be used to improve the hemodynamic status in HOCM. The post Hypotension and pulmonary edema in HOCM – Cardiology MCQ appeared first on Cardiophile MD. (S...
Source: Cardiophile MD - May 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Ventricular septal myectomy for HOCM – Cardiology MCQ
Ventricular septal myectomy for relieving left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy (HOCM) is known as: a) Maron procedure b) Morrow procedure c) Braunwald procedure d) Cox procedure Correct answer: b) Morrow procedure Ventricular septal myectomy is useful in abolishing the LVOT gradient in up to ninety percent of the cases. It also reduces the mitral regurgitation due to systolic anterior movement (SAM) of anterior mitral leaflet. There is long term improvement in exercise capacity in up to eighty percent, with long term survival similar to the general population. More i...
Source: Cardiophile MD - May 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ: Alcohol septal ablation
Most important complication after alcohol septal ablation for hypertrophic obstructive cardiomyopathy (HOCM) is: a) Heart failure b) Incomplete resolution of left ventricular outflow gradient c) Complete heart block requiring permanent pacemaker d) None of the above Correct answer: c) Complete heart block requiring permanent pacemaker Alcohol septal ablation is popular in Europe as a less invasive form of septal reduction therapy than surgical myectomy for relief of left ventricular outflow obstruction in hypertrophic obstructive cardiomyopathy. But the procedure has a seven to twenty percent risk of permanent complete at...
Source: Cardiophile MD - May 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ: Drug not useful for treatment of HOCM
Which of the following is not useful in the treatment of hypertrophic obstructive cardiomyopathy (HOCM)? a) Verapamil b) Metoprolol c) Isoprenaline d) Disopyramide Correct answer: c) Isoprenaline Isoprenaline is an inotropic agent which will increase the myocardial contractility and thereby the obstruction in hypertrophic obstructive cardiomyopathy. The post Cardiology MCQ: Drug not useful for treatment of HOCM appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Drug contraindicated in HOCM – Cardiology MCQ
Drug contraindicated in hypertrophic obstructive cardiomyopathy (HOCM): a) Digoxin b) Metoprolol c) Disopyramide d) All of the above Correct answer: a) Digoxin Digoxin should be avoided in HOCM because of its positive inotropic effect, which can exacerbate the left ventricular outflow tract obstruction. Metoprolol and disopyramide are useful in alleviating symptoms of HOCM due to their negative inotropic effect. Caution has to be exerted while using verapamil for its negative inotropic effect in this situation as its vasodilatory effect can sometimes be deleterious in those with dynamic left ventricular outflow tract obs...
Source: Cardiophile MD - April 30, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Is this Type 2 Brugada syndrome/ECG pattern?
ConclusionIn fact, this ECG is either:1) a typical athlete's mimic of type 2 Brugada, or 2) a too-high recording, or 3) BOTH. Case 2Here is a patient who presented with recurrent pre-syncope and palpitations. Here is lead V2 blown up:The base of the triangle is about 3.5 mm, and it meets the other criteria.The electrophysiologist was worried enough about type 2 Brugada that he placed an implantable loop recorder.Case 3This 40-something patient presented with dizziness and chest pain. The dizziness seemed to be vertigo more than pre-syncope.Here the lines are drawn: The base is greater than 3.5 mm, and...
Source: Dr. Smith's ECG Blog - March 26, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Vasovagal syncope, and hypertrophic obstructive cardiomyopathy
The Swansea City footballer Bafetimbi Gomis collapsed during their recent game against Tottenham Hotspur, and was taken off the pitch on a stretcher, on oxygen. After spending some time in the dressing room he was taken to hospital for tests and later released.For those watching, and especially those on the pitch, it brought back memories of the collapse a few years ago at the same ground of Fabrice Muamba, who recovered but had to retire from the game. Muamba's collapse was due to hypertrophic obstructive cardiomyopathy. The wall of the heart thickens, and the heart cannot pump blood efficiently. P...
Source: Browsing - March 11, 2015 Category: Databases & Libraries Tags: heart disease syncope Source Type: blogs

What is the mechanism of dyspnea in HOCM ?
The major mechanism of exertional dyspnea in HOCM is due to Hypercontractile LV LVOT obstruction Diastolic dysfunction Mitral regurgitation Unrelated to HOCM Answer : 3* *This has been proven by a simple fact , dyspnea continues to be a prime symptom in both obstructive as well as non obstructive HCM Though LVOT obstruction appears to be the core issue , the myocardial disarray is a global one and lies scattered .That is why , myomectomy , septal reduction , may not reduce the symptoms grossly as one would expect. Paradoxically , preload reduction with diuretics (That works well for most dyspnea with raised L...
Source: Dr.S.Venkatesan MD - January 22, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized mechanism of dyspnea of in hocm Source Type: blogs

What is cardiomyopathy?
Cardiomyopathy Diseases involving the heart muscle are called cardiomyopathy (‘cardio’ stands for heart, ‘myo’ stands for muscle and ‘pathy’ for disease). In general, the term is used to denote primary disease of the heart muscle and not damage to the heart muscle secondary to diseases of the blood vessels or the heart valves. Common types of cardiomyopathy Cardiomyopathies are generally classified into three: Restrictive Hypertrophic Dilated Restrictive cardiomyopathy In restrictive cardiomyopathy, there is restriction of filling of the affected ventricle (lower muscular chambers of t...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Heart Disease FAQ Source Type: blogs

Hypertrophic obstructive cardiomyopathy – echocardiographic profile
Hypertrophic cardiomyopathy is an autosomal dominant disorder with 50% involvement of first degree relatives, though the extend of involvement is variable. The hall mark of the disorder is severe hypertrophy of the left ventricle, even though biventricular forms may be seen rarely. In the obstructive variety of hypertrophic cardiomyopathy, asymmetric hypertrophy of the interventricular septum compared to the posterior wall is the predominant feature. The hypertrophied septum impinges on the left ventricular outflow tract producing obstruction. Diastolic frame of echocardiography in parasternal long axis view in hypertrophi...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs

Cardiology MCQ 375: Commonest cause of SCD
Commonest cause of SCD: a) Coronary artery disease b) Hypertrophic obstructive cardiomyopathy c) Severe aortic stenosis d) Brugada syndrome ["Click here for the answer with explanation", "Correct Answer:"] a) Coronary artery disease Commonest cause of SCD is coronary artery disease, contributing to 80% of cases. Read more on SCD… The post Cardiology MCQ 375: Commonest cause of SCD appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - November 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs

Prolonged (63 minutes) Ventricular Fibrillation, Followed by Unusual Cardiogenic Shock
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - September 19, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

History of Hypertrophic Cardiomyopathy (HOCM), with Tachycardia and High Lactate
A patient under 40 with h/o HOCM and implantable cardioverter-defibrillator (for secondary prevention of VF arrest that occurred during exertion) presented with chest pain, diaphoresis, and tachycardia. Earlier in the day, the patient had been physically active, which resulted in dizziness, SOB and diaphoresis. Then later, there was alcohol consumption associated with further physical exertion. The patient presented clutching the chest, dizzy, SOB, diaphoretic. BP was 165/109 (a good example of shock in which the BP is maintained by high systemic vascular resistance).Here is her ED ECG:There is a na...
Source: Dr. Smith's ECG Blog - June 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

A 16 year old girl has syncope while playing basketball.....
A 16 yo Female with no previous medical history had a syncopal event while playing basketball. She arrived to the ED in severe respiratory distress, awake but agitated. She was tachypneic in the 40s-50s. She was intubated shortly after arrival, and had an ECG recorded: Sinus tachycardia with massive ST elevation in I, aVL, V5 and V6, with extreme ST depression in V3 and V4, and reciprocal ST depression in II, III, aVF. This is diagnostic of a very acute posterolateral STEMI.The ECG was briefly inspected by a pediatric emergency physician unaccustomed to diagnosing acute MI. He did not ...
Source: Dr. Smith's ECG Blog - May 6, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Bisferiens pulse (Pulsus bisferiens)
Bisferiens pulse may be seen in all of the following except: 1. Free aortic regurgitation 2. Combination of aortic regurgitation and stenosis 3. Hypertrophic obstructive cardiomyopathy 4. Fallot’s tetralogy Correct answer: 4) Fallot’s tetralogy Bisferiens pulse (pulsus bisferiens) has two systolic peaks and is seen in both free (severe) aortic regurgitation and a combination of aortic regurgitation and stenosis, especially when the regurgitation is dominant. In severe aortic stenosis, the pulse is low volume and slow peaking – pulsus parvus et tardus. In hypertrophic obstructive cardiomyopathy (HOCM), soo...
Source: Cardiophile MD - April 16, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ Source Type: blogs