How to check for pulsus paradoxus?
Pulsus paradoxus is an exaggeration of the normal inspiratory fall in blood pressure. The paradox in pulsus paradoxus is that the pulse is not well felt when the heart sounds are still audible. The extent of fall in inspiratory pressure can be documented using a sphygmomanometer.
Pulsus paradoxus
Pulsus paradoxus is the typical finding in cardiac tamponade, though it can occur more commonly in obstructive airways disease. In obstructive airways disease, it is due to the wide swing in intrathoracic pressure. Other less likely causes are constrictive pericarditis and restrictive cardiomyopathy. It has also been reported in ...
Source: Cardiophile MD - December 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Annulus paradoxus and annulus reversus on tissue Doppler in constrictive pericarditis
Annulus paradoxus
The term “annulus paradoxus” was proposed by Ha JW et al to indicate the inverse correlation of E/E’ to pulmonary capillary wedge pressure (PCWP) on tissue Doppler evaluation in constrictive pericarditis. Usually a positive correlation is found in patients with primary myocardial disease between E/E’ and PCWP [1]. In their study of 10 patients, E’ was not elevated despite high left ventricular filling pressures. Hence E/E’ was low, with a mean 9 and it was <15 in 9 of their 10 patients.
Another study of 130 surgically confirmed patients with constrictive pericardit...
Source: Cardiophile MD - March 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Phenocopies of hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the left ventricle, not related to load. It is a genetically transmitted condition. There are several mimickers of hypertrophic cardiomyopathy which can be called phenocopies of hypertrophic cardiomyopathy. Conventional form of HCM has been called sarcomeric HCM as it is due to mutations in genes encoding sarcomeric proteins [1].
Here is a small list of phenocopies of hypertrophic cardiomyopathy which is not truly exhaustive:
Fabry disease
Danon disease
PRKAG2 Cardiomyopathy
Pompe disease
Cardiac amyloidosis
Athlete’s heart
Hypertensive heart disease
...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Mimickers of HCM Mimickers of hypertrophic cardiomyopathy Mimics of HCM Mimics of hypertrophic cardiomyopathy Source Type: blogs
Cardiology MCQ Test 4
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Source: Cardiophile MD - October 21, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Diagnosis – the adjectives are just as important as the nouns
This article from the Clinical Journal of the American Society of Nephrology speaks loudly to this problem – The CKD Classification System in the Precision Medicine Era
Chronic diseases of the kidney range from rare inherited disorders, such as Fabry disease, to more common acquired entities, such as diabetic kidney disease. Despite the myriad clinical phenotypes and histopathologic subtypes, even within, for example, diabetic kidney disease, this diverse collective is viewed similarly when estimates of glomerular filtration align. Contrast this approach with that of multiple myeloma, a diagnosis that prompts routine...
Source: DB's Medical Rants - December 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Marker of myocardial stretch – Cardiology MCQ
Which of the following is a marker of myocardial stretch:
a) BNP
b) Troponin
c) Myoglobin
d) Galectin 3
Correct answer: a) BNP
BNP and NT-pro-BNP are markers of myocardial stretch which can be markedly increased in heart failure. They can also be used to differentiate between constrictive pericarditis and restrictive cardiomyopathy as there is no myocardial stretch in constrictive pericarditis.
Troponin is a marker of myocardial necrosis and so is myoglobin, though the former is highly specific while the latter is non-specific.
Galectin 3 is a new biomarker protein, a member of the lectin family. It is associated with ac...
Source: Cardiophile MD - July 26, 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 New Test Series 3
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Source: Cardiophile MD - July 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 24
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Source: Cardiophile MD - March 26, 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 11
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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 9
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Source: Cardiophile MD - January 27, 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 2
This study reported 32 arrhythmic episodes in 24 patients. There was spontaneous recovery with abstinence from alcohol.
Reference
1. Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ. Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders. Am Heart J. 1978 May;95(5):555-62.Question 14Diagnosis based on the echocardiogram:
AEbstein’s anomaly of tricuspid valveBNone of the aboveCEndomyocardial fibrosisDIdiopathic dilatation of right atriumQuestion 14 Explanation: Endomyocardial Fibrosis (EMF) is a type of restrictive cardiomyopathy. It is characterised by fibros...
Source: Cardiophile MD - January 16, 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
Echo Quiz – Cardiology MCQ
Diagnosis based on the echocardiogram:
a) Ebstein’s anomaly of tricuspid valve
b) Idiopathic dilatation of right atrium
c) Endomyocardial fibrosis
d) None of the above
Correct answer: c) Endomyocardial fibrosis
Endomyocardial Fibrosis (EMF) is a type of restrictive cardiomyopathy. It is characterised by fibrosis and obliteration of the ventricular cavity, predominantly involving the right ventricle. Read more on EMF…
Such gross right atrial enlargement may also be noted in Ebstein’s anomaly of tricuspid valve, but the fibrosis at right ventricular apex is not seen. In Ebstein’s anomaly, there is dis...
Source: Cardiophile MD - November 15, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Echocardiography Source Type: blogs
What is the effect of Inspiration on JVP and blood pressure ?
Image modified from http://www.anatomygallery.info
That’s normal . . . what happens during pathological states ?
There are important diseases that restricts entry of blood into right heart chambers. They can occur either in an acute (Tamponade) or in chronic fashion like constrictive pericarditis and restrictive cardiomyopathy.These entities show distinctive impact on JVP and systemic pulse.
The two pathognomonic signs are Kussmaul sign and pulsus paradoxus that go hand in hand in most situations.Inappropriate elevation of JVP with inspiration is termed as Kussmaul sign , while exaggerated fal...
Source: Dr.S.Venkatesan MD - May 10, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Clinical cardiology Jugular venous pulse pericardial disease bernhiem effect effect of inspiration on jvp kusmals sign kusmaul sign kussmal's sign Kussmaul sign pulsus paradoxus Reverse bernheim effect ventricular interdependence Source Type: blogs
Endomyocardial Fibrosis (EMF)
is a type of restrictive cardiomyopathy. It is characterised by fibrosis and obliteration of the ventricular cavity, predominantly involving the right ventricle. Isolated involvement of left ventricular inflow region may cause left ventricular inflow and mimic mitral stenosis. But that variety is extremely rare. The common variety involves the right ventricular inflow and body, often obliterating the right ventricular apex. Right ventricular outflow is usually spared. This is the only region of the right ventricle which contracts well in EMF and is clinically evident as right ventricular outflow tract pulsations in the th...
Source: Cardiophile MD - May 9, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology 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
