What is the significance of a PFO? Cardiology Basics
PFO is short form for patent foramen ovale. Usually foramen ovale closes soon after birth so that there is no communication between the two atria in most persons. But occasionally, a small opening may persist and then it is called PFO. PFO is a valvular opening through the interatrial septum.
When the pressure in the left atrium rises after birth as the lungs become functional and increases pulmonary venous return, it presses on the left side of the foramen ovale and closes it. Even if there is a residual opening, most of the time there is no shunting of blood across the PFO because left atrial pressure is higher than tha...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQs
Which of the following is NOT a drug used for metabolic modulation in heart failure?
Trimetazidine
Ranolazine
Perhexiline
Sacubitril-valsartan
Correct answer: 4. Sacubitril-valsartan
Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase. Latter three are metabolic modulators while sacubitril-valsartan is a hemodynamic modulator in heart failure [Ashrafian H, Neubauer S. Metabolic modulation in heart failure: high time for a definitive ...
Source: Cardiophile MD - July 4, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Ebstein ’ s anomaly and pregnancy
Ebstein’s anomaly and pregnancy
Ebstein’s anomaly of tricuspid valve was first described by Wilhelm Ebstein in 1866 [1]. It is characterized by distal displacement of the septal and posterior leaflets of tricuspid valve. Anterior leaflet is elongated and sail like. A portion of the right ventricle is ‘atrialized’ due to the distal displacement of the tricuspid valve. Right atrium is often grossly dilated. Right to left shunting occurs across a patent foramen ovale producing cyanosis of variable extent. Ebstein’s anomaly is one of the cyanotic congenital heart diseases in which survival to adul...
Source: Cardiophile MD - May 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Embolic stroke of undetermined source (ESUS)
Cryptogenic Stroke/ESUS International Working Group defined embolic stroke of undetermined source (ESUS) as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation [1]. They presumed that as emboli are more likely to be thrombi, recurrence may be better prevented by anticoagulation rather than antiplatelet agents. Randomized trials with directly acting oral anticoagulants were suggested to test this hypothesis.
But two randomised trials testing this aspect, NAVIGATE ESUS (Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention...
Source: Cardiophile MD - February 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
A young woman with epigastric pain. ECG Crochetage sign? What is the significance?
A former resident texted me this ECG, done for epigastric pain in an 18 year old. The pain resolved immediately with treatment for acid reflux, and in the clinician ' s opinion was clearly GI in origin, but he wanted to know what the strange waves in the QRS were:See the unusual notching in II, III, aVF, and V2-V4.I had no idea what they were. They reminded me of theDelayed Activation Wave associated with circumflex acute MI.See this case: https://hqmeded-ecg.blogspot.com/2018/05/is-there-delayed-activation-wave.html.But they are clearly different from this.I put it on Facebook EKG club and this is th...
Source: Dr. Smith's ECG Blog - January 7, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Gore CARDIOFORM ASD Cleared in Europe for Atrial Septal Defects
Gore won the European CE Mark for its GORE CARDIOFORM ASD Occluder, a device designed for percutaneous, transcatheter closure of ostium secundum atrial defects (ASDs). The occluder recently completed a clinical study involving 125 patients with ASD, ranging from 2 to 84 years of age, all of whom were successfully implanted with the GORE CARDIOFORM ASD and maintained closure six months later.
The device is made of two discs that make contact with the tissue walls on both sides of the opening and, when engaged, come together to block the passage of blood between the atria. It was recently approved by the FDA for ASD, as ...
Source: Medgadget - October 8, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
The ECG was correct. The angiogram was not.
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina. If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI. If that is a result of plaque rupture, then it is a type I MI. The clinical presentat...
Source: Dr. Smith's ECG Blog - August 12, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
GORE CARDIOFORM Approved by FDA to Treat Atrial Septal Defects
The GORE CARDIOFORM Septal Occluder has been approved by the FDA to treat ostium secundum atrial septal defects (ASD) via percutaneous closure procedures. In a clinical study of the device in 125 patients with ASD, ranging in age from 2 to 84, all who successfully received the implant maintained the closure when evaluated six months later.
The GORE CARDIOFORM is made of two discs that make contact with the tissue walls on both sides of the opening and, when activated, come together to block the passage of blood between the atria. It was approved by the FDA last year for patent foramen ovale closures, as a way of reducing ...
Source: Medgadget - June 7, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
ECG in Ebstein ’ s anomaly of tricuspid valve
ECG in Ebstein’s anomaly of tricuspid valve
ECG in Ebstein’s anomaly of tricuspid valve
ECG in Ebstein’s anomaly of tricuspid valve showing right axis deviation of QRS, notched R waves in II, III, aVF and V1 suggesting fragmented QRS. Peaked P waves indicate a right atrial abnormality, though the typical voltage criteria for right atrial enlargement (more than 0.25 mV) is not satisfied.
Fragmented QRS occurs in Ebstein’s anomaly due to abnormal conduction in the atrialised right ventricle [1]. A portion of the right ventricle is atrialised because of distal displacement of the septal and posterior ...
Source: Cardiophile MD - January 26, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library fragmented QRS Source Type: blogs
The Evidence Crisis: Causal Inference – Don ’ t be a chicken (Part 3)
By ANISH KOKA
Part 1
Part 2
Physicians have been making up numbers longer than people have been guessing weights at carnivals. How much does this statin lower the chances of a heart attack? How long do I have to live if I don’t get the aortic valve surgery?
In clinics across the land confident answers emerge from doctors in white coats. Most of the answers are guesses based on whatever evidence about the matter exists applied to the patient sitting in the room. The trouble is that the evidence base used to be the provenance of experts and anecdotes that have in the past concluded leeches were good for pneumonia...
Source: The Health Care Blog - June 29, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain. She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG. This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - May 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
GORE CARDIOFORM Septal Occluder Approved by FDA for PFO Closure
The FDA has approved the GORE CARDIOFORM Septal Occluder for patent foramen ovale (PFO) closure procedures that have shown to reduce the chance of stroke in some patients. The CARDIOFORM is already being used in the U.S. for closing of atrial septal defects up to 17 millimeters in size.
The catheter-delivered device consists of two discs that make contact with the tissue walls on both sides of the PFO and come together to block the passage of blood between the atria.
“The soft and conformable design of Gore’s device is ideal for providing long-term repair of PFOs of any shunt size,” said John Rhodes, MD, Medical...
Source: Medgadget - April 6, 2018 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
Cardiovascular causes of stroke
>>>Cardiology MCQs from Cardiophile MD Paperback, Free Look Inside
Cardiovascular causes of stroke
Atrial fibrillation / flutter
Patent foramen ovale (PFO) with right to left shunt or atrial septal aneurysm
Cardiomyopathy
Aortic arch atheroma
Valvular heart disease with intracardiac thrombi or vegetations
Atrial myxoma and fibroelastoma
Mural thrombus in myocardial infarction
Two recent trials (Gore REDUCE and CLOSE) [1,2] and long term outcome results of RESPECT trial [3] provide clear evidence for PFO closure for stroke prevention in those below 60 years with high risk – PFO. High risk PFO is...
Source: Cardiophile MD - January 15, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Young people, stroke and a hole in the heart (PFO)
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)
***
We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may be the worst outcome in all of medicine. That’s because stroke can permanently remove basic functions of being human, things such as speech, thought, personality, movement, swallowing, and many others.
Stroke is not supposed to happen in young people. But sometimes it does. And in some of t...
Source: Dr John M - September 28, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
Interatrial septum in subcostal view
In an earlier post it was shown that false echo dropouts can occur in the interatrial septum as the ultrasound beam is parallel to the structure being imaged. It was also mentioned that subcostal view is best for imaging the interatrial septum. This picture in subcostal view gives an excellent image of the interatrial septum (IAS) between the right atrium (RA) above and the left atrium (LA) below. LV: Left ventricle. Most echocardiographers use this orientation for subcostal view, though it is anatomically an inverted view as the transducer is kept below the structures being imaged. On the contrary, most paediatric echoca...
Source: Cardiophile MD - December 15, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs
