ePLAR: Echocardiographic Pulmonary to Left Atrial Ratio
ePLAR is a simple echocardiographic estimation useful in differentiating pre-capillary from post capillary pulmonary hypertension [1].
ePLAR = TR Vmax/(Mitral E/e’)
ePLAR: Echocardiographic pulmonary to left atrial ratio
TR Vmax: Maximum velocity of tricuspid regurgitation jet by Doppler echocardiography in m/s
E: E wave in the mitral flow Doppler
e’: Septal mitral annular tissue Doppler velocity
ePLAR values are lower in post-capillary pulmonary hypertension. E/e’ reflects left ventricular filling pressure which is left atrial pressure. TR Vmax reflects the pulmonary artery systolic pressure. That is h...
Source: Cardiophile MD - February 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Giant T inversion and NSVT
Giant T inversion with NSVT
Holter tracing showing giant T wave inversion and non sustained ventricular tachycardia, both at the beginning of the tracing and at the end. Ventricular ectopic beats are also seen in between. Variation in QRS amplitude of the NSVT beats are evident. It is likely that this will soon progress to torsades des pointes in the setting of gross QT interval prolongation. QT interval is seen as 640 ms in a cycle with cycle length of 600 ms. So, the QTc will be 640 ms. The first ventricular ectopic is followed by a good compensatory pause while the second one is almost an interpolated ventricular ecto...
Source: Cardiophile MD - February 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
Mobile right heart thrombus : Capture by Flowtriever device is possible
What shall we do when encountering a mobile right heart thrombi waiting to get dislodged at any time?
A series of question comes as the answer to this query
Feeling helpless? What will be the consequence?Massive pulmonary embolism? Can we thrombolyse and dissolve it ?
Logistics of emergency open-heart surgery are too many. What about capturing the thrombus? A dream thought, now seemingly possible.Inari Flowtriever though made originally for pulmonary embolism can come in handy in any foreign body removal. I think It is approved by FDA. Here is a case report from Dr Gautam reddy.
Echo...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: New hardware pulmonary embolism Inari flow triever mobile ra rv clot Source Type: blogs
Chest pain, ST Elevation, and tachycardia in a 40-something woman
A prehospital cath lab activation for STEMI came through with the information that the 40-something woman had chest pain and a pulse of140.We were immediately skeptical that the patient had a STEMI because of the high heart rate. She would have to be in cardiogenic shock with a massive STEMI for that. Certainly possible, but when the heart rate is so high, be skeptical.The patient arrived with this ECG:Here the heart rate is obviously no longer 140What do you think?ECG: it certainly appears to be an anterior STEMI, but it is important to realize that right ventricular ischemia from either inferior and RV STEMI ...
Source: Dr. Smith's ECG Blog - January 30, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology
Sinus venosus ASD (also referred to as SVC ASD) is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between SVC/P...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs
Fight Aging! Newsletter, January 4th 2021
The objective of this study is to quantify the overall and cancer type-specific risks of subsequent primary cancers (SPCs) among adult-onset cancer survivors by first primary cancer (FPC) types and sex. Among 1,537,101 survivors (mean age, 60.4 years; 48.8% women), 156,442 SPC cases and 88,818 SPC deaths occurred during 11,197,890 person-years of follow-up (mean, 7.3 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 18 of the 30 FPC types, and risk of dying from any SPCs was statistically significantly higher for 27 of 30 FPC types as compared with risks in the general po...
Source: Fight Aging! - January 3, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Modified Blalock – Taussig shunt
The original Blalock – Taussig (BT) shunt was designed by Helen B Taussig (physician) and Alfred Blalock (surgeon) at the John Hopkins Hospital. This was based on the observation by Helen B Taussig that infants with severe pulmonary stenosis or pulmonary atresia had worsening of cyanosis after spontaneous closure of ductus arteriosus. The BT shunt was an anastomosis between subclavian artery and pulmonary artery, to enhance pulmonary blood flow those infants with severe cyanotic congenital heart disease with low pulmonary blood flow.
Different techniques have been used to modify a BT shunt when it is not technically fea...
Source: Cardiophile MD - December 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Blalock – Taussig shunt BT shunt classic Blalock – Taussig shunt Modified Blalock – Taussig shunt modified BT shunt Source Type: blogs
" Pay me now, or pay me later "
This patient presented with acute pulmonary edema without chest pain.A bit of history prior to showing the ECG:The patient had been hospitalized at a different hospital for pneumonia and NonSTEMI for a week. The troponin I had peaked at 40 ng/mL, and echo showed multiple wall motion abnormalities and EF of 35%. The patient suffered third degree heart block with bradycardia and required permanent pacemaker placement. A troponin that high is usually associated with Occlusion.I reviewed the ECGs from that hospital and they donot show OMI. But many ECGs in patients with OMI do not reveal the OMI, even when I ...
Source: Dr. Smith's ECG Blog - December 10, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Don't Just Rely on X-Rays
A woman in her 50s reported
four days of left-sided pleuritic chest pain in her lower ribs. No other symptoms:
no fever, trauma, shortness of breath, cough, or wheezing. It's COVID times, so
who knows? A chest x-ray and labs were ordered. The x-ray appeared clear.
Perhaps it was pleurisy. The white blood count was more than 17 mL! Still no fever:
99.2°F.Then the D-dimer came back
elevated. A chest CT angiogram was obviously the next step. Maybe it was a pulmonary
embolism.Surprise! It was pneumonia,
and it wasn't a little one!Chest x-rays are used as a
screening tool for pneumonia. They require le...
Source: Lions and Tigers and Bears - November 30, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Why AF is often well tolerated in Hypertrophic cardiomyopathy ?
Up to 25 % of LV filling is done by atrial contraction. Atrial booster function is important in LV outflow lesions. This can be critical in patients who have diastolic deformities of LV. ( an audible or even palpable S4 confirms the atrial kick in these situations ) This is how we were taught for decades right. Still, it may hold good in many left-sided condtions, but in HCM it definitely seems to be not true.
A succinct review of this topic makes a good read.
Incidence if AF in HCM is about 20% (Mostly paroxysmal 70 % , Persistent /Permanent 30 %)
Mechanism of AF IN HCM
Incre...
Source: Dr.S.Venkatesan MD - November 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation af in hocm affirm study atrial fibrillation in hypertrophic cardiomyopathy current guidelines in hcm hcm hocm mechansim of af in hcm pathophysiologyof hcm Source Type: blogs
Extreme shock and cardiac arrest in COVID patient
This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He was moderately hypoxic. He had the following EKG recorded:Low voltage, suggests effusion.(see Ken ' s discussion of low voltage below)There is a QS-wave in V2.There is minimal, probably normal STE in V2-V6.A bedside cardiac ultrasound was normal, with no effusion. He had troponins ordered, and the first returned at 72 ng/L (Abbott Architect hs cTnI; URL for males = 34 ng/L). An elevated troponin in a COVID patient confers about 4x the risk of mortality than a normal one.He was admitted on oxygen and was&...
Source: Dr. Smith's ECG Blog - November 12, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
This skill can be taught and learned
I was texted this ECG by a former resident, who just just graduated (there are 2 images of thesame ECG, as they are not of high quality):What do you think?It came with the message: " Thanks for the good training, Steve! "I responded: " Sweet! This would have been missed by almost anyone. " It is diagnostic ofLADOMI (but not STEMI!). OMI= Occlusion Myocardial Infarction.This physician said he had been handed the ECG just before starting a shift, while being told it is a woman with chest pain, and he immediately activated the cath lab based on just that information + the ECG.As all emergency physi...
Source: Dr. Smith's ECG Blog - November 8, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
ASD overview and secundum ASD
Atrial septal defect (ASD) is the commonest congenital heart disease in the adult, barring of course bicuspid aortic valve. ASD being a post tricuspid shunt, development of pulmonary hypertension and Eisenmenger syndrome is delayed and survival to adult age group is common. Some even argue that pulmonary hypertension in ASD is primary pulmonary hypertension which the individual was otherwise destined to develop. Anyway pulmonary hypertension is likely to develop in ASD with large left to right shunt of long duration, though the severity of pulmonary hypertension is variable. Supra systemic pulmonary arterial pressures are...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Bimodal pattern of cyanosis in ASD ostium primum ASD ostium secundum ASD Secundum atrial septal defect sinus venosus ASD Spontaneous closure of ASD Source Type: blogs
Aortic and pulmonary vascular abnormalities on CXR
Aortic abnormalities on CXR
Right aortic arch: Side of aortic arch is recognized by the indentation of tracheal air shadow. Normally it is on the left side as it is left aortic arch. In right aortic arch, the indentation is on the right side. Right aortic arch may be seen in tetralogy of Fallot and truncus arteriosus.
Ascending aorta: Ascending aorta is seen well just above the right atrial contour on the right cardiac border when it is dilated. Dilated ascending aorta can occur in:
Post stenotic dilatation in aortic stenosis
Annuloaortic ectasia in Marfan syndrome
Ascending aortic aneurysm
Aortic knuckle: Intimal calci...
Source: Cardiophile MD - September 29, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC 3 sign in coarctation of aorta Antler sign Ascending aorta calcium sign cephalization cottage loaf sign E sign in coarctation of aorta Figure of 8 sign inverted moustache sign knuckle sign Palla’s sign Redistribution Revers Source Type: blogs
Repost: Syncope, Shock, AV block, RBBB, Large RV, " Anterior " ST Elevation in V1-V3
I came across this post from 2015 while answering a question on Twitter, and decided to repost it:http://hqmeded-ecg.blogspot.com/2015/12/syncope-shock-av-block-large-rv.htmlSyncope, Shock, AV block, RBBB, Large RV, " Anterior " ST Elevation in V1-V3An elderly male had a syncopal episode. 911 was called. When medics arrived, the patient was alert and following commands. In the presence of the medics, he lost consciousness and became apneic and underwent 30 seconds of chest compressions, after which he started moaning and was again able to communicate and follow commands. No shock was ever delivered.A 1...
Source: Dr. Smith's ECG Blog - September 23, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
