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 atria...
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 fluctuations in oxygen saturat...
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.
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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 40 % .
PFOs size increase with age due 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
