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 the ...
Source: Dr. Smith's ECG Blog - January 8, 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 13, 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 f...
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,...
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 ris...
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 ...
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 ec...
Source: Cardiophile MD - December 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Quiz on pulmonary embolism
Short quiz on pulmonary embolism Quiz on pulmonary embolism Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Congratulations - you have completed Quiz on pulmonary embolism. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers are highlighted below. Question 1Risk of intracranial bleed for tenecteplase in acute pulmonary...
Source: Cardiophile MD - December 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Subcostal four chamber view – Echocardiography
Subcostal four chamber view is excellent for visualization of interatrial septum (IAS). If an atrial septal drop out is seen in the apical four chamber (4C) view, it need not be an atrial septal defect as the IAS is parallel to the ultrasound beam in the apical 4 C view. Structures are imaged well only if they are perpendicular to the ultrasound beam. In case of Doppler, the signals are better when it is parallel to the beam. If the beam is perpendicular to the flow, there is hardly any Doppler signal picked up. Subcostal four chamber view shows right atrium (RA), left atrium (LA), right ventricle (RV) and the left ventric...
Source: Cardiophile MD - November 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

AMPLATZER PFO Occluder OK ’ed by FDA to Reduce Risk of Recurrent Ischemic Stroke in Patients with PFO
Patent foramen ovale (PFO) is present in up to 25 percent of the general population. Although it’s asymptomatic for most people with the condition, and most don’t even know they have it, some with PFO can suffer from repeat ischemic strokes. St. Jude Medical won FDA approval to introduce its AMPLATZER PFO Occluder that can help prevent recurrent ischemic strokes by closing the passageway between the atria. This is the first device to be approved for PFO closure in order to prevent recurrent stroke in the U.S. Previous surgical interventions required open heart procedures, but the AMPLATZER PFO Oc...
Source: Medgadget - November 1, 2016 Category: Medical Equipment Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs

The Politics of Hillary ’s Pneumonia
By SAURABH JHA, MD It is selfish of a leader of a nation to drop dead during office. Jawaharlal Nehru, India’s first prime minister, died suddenly at 74, apparently from a ruptured aneurysm. His aneurysm, allegedly, had something to do with Edwina Mountbatten – the wife of Lord Mountbatten, the last Viceroy of India. Shortly after Nehru’s death, Pakistan attacked India. Nehru’s replacement, Lal Bahadur Shastri, died mysteriously in Tashkent two years after Nehru’s death, and was succeeded by Indira, Nehru’s daughter. India’s future was forever changed by a burst aneurysm or, if ru...
Source: The Health Care Blog - September 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

A Hole In the Heart, Part I
By ANISH KOKA, MD Strokes are the third leading cause of death in the United States. 800,000 people suffer a stroke every year, and the consequences are frequently devastating. Lives are not just lost, but changed forever – speech permanently silenced, arms and legs turned into useless appendages. The brain is very expensive real estate and it is little surprise that a clot the size of a pinhead lodged in a blood vessel feeding the brain is all that is needed to wreak a devastation most fear worse than death. Most of the time the source of the debris that results in a stroke can be readily identified, but at least on...
Source: The Health Care Blog - September 6, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Surgical embolectomy in pulmonary embolism – Cardiology MCQ
Surgical embolectomy in pulmonary embolism is indicated in: a) Impending paradoxical systemic embolism b) Hypotension with contraindication for thrombolysis c) Failed thrombolysis d) All of the above Correct answer: d) All of the above By impending paradoxical systemic embolism, it is meant that a thrombus in transit has been caught in the patent foramen ovale and is extending to both atria. Reference 1. Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010; 137 (1): 164-70. (Source: Cardiophile MD)
Source: Cardiophile MD - September 3, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 19
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 19. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 15
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 15. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 9, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 12
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 12. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 4, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 11
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 11.You scored %%SCORE%% out of %%TOTAL%%.Your performance has been rated as %%...
Source: Cardiophile MD - February 3, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 7
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

Atrial septal defect (ASD)
Illustrated Review with ECG, CXR, Echo Video, Cath Images X-ray chest in atrial septal defect X-ray chest PA view in atrial septal defect with pulmonary hypertension (Click on the image for an enlarged view) The main pulmonary artery (MPA) is grossly dilated. The right pulmonary artery (RPA) is also quite enlarged. Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine. Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen. Apex is upwards, suggesting a right ventricular configuration. All features suggest a large secundum atrial septal defect with a l...
Source: Cardiophile MD - November 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology X-ray ECG / Electrophysiology Echocardiography Structural Heart Disease Interventions ASD Crochetage Sign ASD ECG ASD echo ASD Echo Video ASD X-Ray Chest PA Colour Doppler Echo in ASD ECG in A Source Type: blogs

Patent foramen ovale – PFO
Patent foramen ovale (PFO) is a valvular opening in the fossa ovalis region of the interatrial septum. In fetal life, the foramen ovale shunts relatively more saturated inferior vena caval blood coming from the umbilical vein to the left atrium from the right atrium. This blood with higher oxygen level reaches the left ventricle and gets pumped to the upper part of the body including the brain. Superior vena caval blood streams to the right ventricle from the right atrium and reaches the pulmonary artery. Since the lungs are non functional, the blood from the pulmonary artery is shunted to the descending thoracic aorta thr...
Source: Cardiophile MD - November 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiography PFO Source Type: blogs

Echocardiography in pulmonary embolism
Brief Review Echocardiography in acute pulmonary embolism is useful in several ways. Visualization of thrombi within the right heart or pulmonary arteries would be the most direct way of diagnosing acute pulmonary embolism by echocardiography. Mobile thrombi in the right heart detected during echocardiography also carries a poor prognosis with higher association with right ventricular dysfunction and mortality. In general, the chance of detection of mobile right heart thrombi in acute pulmonary embolism is about four percent, though up to eighteen percent have been detected in certain intensive care settings. Trans esopha...
Source: Cardiophile MD - May 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiography Source Type: blogs

Is stroke more common in PFO or ASD?
Short Notes Abstract: Stroke is more likely because of the potential for  R> L shunt in strain phase in PFO. In ASD the shunt is left to right and hence paradoxical embolism is less likely. Paradoxical embolism can cause stroke in the presence of an interatrial communication. Emboli originating in the systemic  veins usually travel to the pulmonary circulation causing pulmonary embolism. But in the presence of an interatrial communication, emboli originating from the systemic veins, usually from the deep veins of lower limb and pelvic veins, can traverse the interatrial septum and reach the lef...
Source: Cardiophile MD - January 5, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Cardiology MCQ: Platypnea-orthodeoxia
Platypnea-orthodeoxia has been described in: a) Pulmonary arteriovenous malformation b) Cirrhosis liver c) Aortic aneurysm d) All of the above Correct answer: d) All of the above Platypnea-orthodeoxia is characterized by dyspnoea and systemic oxygen desaturation on assuming the sitting or standing position. It was originally described by Burchell et al in 1949 [Burchell HB et al. Reflex orthostatic dyspnea associated with pulmonary hypertension. Am J Physiol. 1949; 159: 563–564]. The basic requirement for the condition is an interatrial communication in the form of a patent foramen ovale, atrial septal defect or an a...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Chiari network
Chiari network is a vestigial structure and is seen as strand like structures within the right atrial cavity on echocardiography. It is an embryonic remnant of the right valve of the sinus venosus. Chiari network is often associated with a patent foramen ovale (PFO). Hence it may be noted in cases of paradoxical embolism and stroke. (Source: Cardiophile MD)
Source: Cardiophile MD - July 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Chiari network paradoxical embolism patent foramen ovale PFO right valve of the sinus venosus stroke Source Type: blogs

Cardiology MCQ 275: Associations of PFO
Which of the following is an association of patent foramen ovale (PFO)? a. Chiari network b. Eustachian valve c. Atrial septal aneurysm d. All of the above ["Click here for the answer with explanation", "Correct Answer:"] d. All of the above Common associations of a PFO are the Eustachian valve, Chiari network and an atrial septal aneurysm. Read more… (Source: Cardiophile MD)
Source: Cardiophile MD - July 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Associations of PFO Atrial septal aneurysm Chiari network Eustachian valve Source Type: blogs

Cardiology MCQ 274: Detection of right to left shunt across PFO
Which of the following tests can be used to detect right to left shunting across a patent foramen ovale (PFO)? a. Saline contrast echocardiography b. Trans cranial Doppler c. Ear oximetry d. All of the above e. None of the above ["Click here for the answer with explanation", "Correct Answer:"] d. All of the above Saline contrast echocardiography using agitated saline is used to detect right to left shunting across a PFO. Trans cranial Doppler can be used to detect micro bubbles in the middle cerebral artery after injection of agitated saline into a peripheral vein. Ear oximetry can detect fluctuation...
Source: Cardiophile MD - July 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance agitated saline into a peripheral vein Detection of right to left shunt across PFO Ear oximetry patent foramen ovale right to left shunt across the PFO saline contrast echocardiography Trans cran Source Type: blogs

PFO detection by saline contrast echocardiography
Patent foramen ovale (PFO) can cause paradoxical embolism and stroke. Hence in every case of stroke, it is necessary to look for a PFO. PFO typically shunts right to left at the end of a Valsalva maneuver. Hence injection of an agitated saline bolus at the end of a Valsalva maneuver and detection of the microbubbles in the left atrium within three cardiac cycles from the right atrial appearance would suggest presence of a PFO. Delayed appearance would indicate a pulmonary arteriovenous fistula. Sometimes injection from the lower limb is needed to detect a PFO because of the preferential streaming of the inferior vena caval...
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology agitated saline bolus Eustachian valve microbubbles patent foramen ovale PFO PFO detection preferential streaming of the inferior vena caval blood pulmonary arteriovenous fistula right to left shunt saline contrast e Source Type: blogs

Associations of patent foramen ovale (PFO)
Patent foramen ovale (PFO) is a small defect in the inter atrial septum in the region of the fossa ovalis, between the layers contributed by the septum primum and septum secundum. Due to the specific direction of the valvular opening, blood can shunt from the right atrium to left atrium, especially during a Valsalva maneuver. Common associations of a PFO are the Eustachian valve, Chiari network and an atrial septal aneurysm. Eustachian valve is at the opening of the inferior vena cava into the right atrium and tends to direct the inferior vena caval blood across the patent foramen ovale. It is a remnant of the embryonic r...
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Chiari network Eustachian valve foramen ovale fossa ovalis patent foramen ovale PFO remnant of the embryonic right valve of the sinus venosus septum primum septum secundum Valsalva maneuver Source Type: blogs

Atrial septal aneurysm
is a floppy portion in the region of the fossa ovalis usually with a diameter of one and a half centimeter or more and having movement amplitude of one centimeter. It is often associated with a patent foramen ovale (PFO). It is one of the predisposing factors for paradoxical embolism and stroke. Atrial septal aneurysms can occur in up to two percent of the population. (Source: Cardiophile MD)
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Atrial septal aneurysm fossa ovalis paradoxical embolism patent foramen ovale PFO stroke Source Type: blogs

Valsalva maneuvers in daily life
include: 1. Coughing 2. Sneezing 3. Squatting 4. Defecation 5. Micturition These Valsalva maneuvers in daily life can produce transient right to left shunt across a patent foramen ovale (PFO) with potential to cause paradoxical embolism. (Source: Cardiophile MD)
Source: Cardiophile MD - July 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology paradoxical embolism patent foramen ovale PFO Valsalva maneuver Source Type: blogs

Does Closing PFOs Prevent Stroke?
Thousands of patients who have had cryptogenic stroke, and are subsequently found to also have a patent foramen ovale (PFO), have undergone PFO closure procedures.  While minimally invasive, a PFO closure is not an entirely benign procedure, and can lead to some nasty complications.  It is a procedure that should be performed only if there is a strong likelihood that it will lead to a better outcome....Read Full Post (Source: About.com Heart Disease)
Source: About.com Heart Disease - February 25, 2014 Category: Cardiology Source Type: blogs

Migraine and Patent Foramen Ovale (PFO)
During the last several years, lots of cardiologists have treated lots of migraine sufferers who also have a patent foramen ovale (PFO) with PFO closure devices. But now the data is in.  And it should be quite clear to any objective observer (a category which may or may not include said cardiologists) that this practice is no longer justifiable....Read Full Post (Source: About.com Heart Disease)
Source: About.com Heart Disease - February 24, 2014 Category: Cardiology Source Type: blogs

Patent Foramen Ovale
Patent foramen ovale (PFO) is a diagnosis that is becoming more and more common - up to 25% of adults have it. PFO is said to increase the risk of stroke, and has been implicated as a cause for migraine headaches. As a result, patients are being asked to undergo an invasive procedure to close their PFOs. But is this common echocardiographic finding really as significant as all that?...Read Full Post (Source: About.com Heart Disease)
Source: About.com Heart Disease - February 21, 2014 Category: Cardiology Source Type: blogs

Probe patent foramen ovale
A probe patent foramen ovale is present in —% of adults: a) 5-10% b) 12-18% c) 20-25% d) None of the above Correct answer: c) 20-25% A probe patent foramen ovale means a probe can be passed from the right atrium to left atrium across the foramen ovale without actually resorting to septal puncture with a needle when you wish to enter left atrium during cardiac catheter interventions like balloon mitral valvotomy. (Source: Cardiophile MD)
Source: Cardiophile MD - November 2, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance balloon mitral valvotomy Source Type: blogs

Teaching medical students to provide high value care
Edward arrived at the hospital following a stroke; a standard work-up failed to reveal an obvious cause. His physician explained that a previously diagnosed patent foramen ovale (PFO), a hole in between the chambers of his heart, may have led to his stroke. He presented three possible treatment options to Edward: (1) medical management with drugs; (2) open surgery to correct the defect; or (3) interventional catheterization to correct the defect. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - August 17, 2013 Category: Family Physicians Tags: Education Heart Medical school Source Type: blogs

Patent foramen ovale in patients with obstructive sleep apnea
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - April 16, 2013 Category: Internists and Doctors of Medicine Tags: cardiovascular pulmonary Source Type: blogs

Surprising facts about PFOs from the land mark study by Hagen
It was in 1984   this paper came from mayo clinic proceedings . Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17-20. When interventional   cardiology was not even in infancy . Now it remains the only data base of nearly 100o hearts  studied  after autopsy . After reading the article  I got  few surprises The mean  incidence  is 27.3 % of general population ( That is  27 crore people with PFO  in India ) In first three decades it goes up to ...
Source: Dr.S.Venkatesan MD - January 31, 2013 Category: Cardiology Authors: drsvenkatesan Tags: cardiology -congenital heart disease autopsy study on pft hagen 1984 mayo clinic proceedings patent foramaen ovale pfo stretched pfo Source Type: blogs

When to consider cardioembolic stroke?
Following features may help in thinking of a cardioembolic etiology for stroke: Sudden onset to maximal neurological deficit Decreased level of consciousness at onset Wernicke’s aphasia or global aphasia without hemiparesis A Valsalva manoeuvre at the time of onset of stroke (can facilitate right to left shunt across a patent foramen ovale and consequently paradoxical emboli originating in the right side of the circulation and terminating the left side of the circulation) Co-occurrence of cerebral and systemic emboli [Arboix A et al. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol...
Source: Cardiophile MD - January 30, 2013 Category: Cardiology Authors: Prof. (Dr.) Johnson Francis MD, DM, FACC, FRCP Edin Tags: General Source Type: blogs