What is Eisenmenger syndrome? Cardiology Basics
Eisenmenger syndrome is a late complication of congenital heart diseases with large left to right shunts. Fortunately, it is rare now-a-days because most conditions which can cause Eisenmenger syndrome later, are detected by neonatal screening and treated early so that this complication does not develop later. Eisenmenger syndrome is a condition in which long standing high pulmonary blood flow leads to irreversible pulmonary hypertension with reversal of shunt. Right to left shunt causes reduced systemic oxygen saturation with cyanosis.
This is an echocardiogram showing a left to right shunt from the left ventricle to the...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the difference between pulsed wave and continuous wave doppler?
In pulsed wave Doppler, same piezoelectric crystal is used to transmit and receive the echo from the sample volume. Hence the signals are sent out in pulses and the intervals between the pulses are used to receive the echoes. In continuous wave Doppler, one piezoelectric crystal transmits continuously and another one receives continuously. As the transmission and reception are continuous, it is not possible to find out the depth from which the return signals are received. At the same time continuous wave Doppler can analyze higher velocities while pulsed wave Doppler can analyze only lower velocities.
In case of pulsed Do...
Source: Cardiophile MD - October 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is colour Doppler echocardiography? Cardiology Basics
Usual colour Doppler echocardiogram is superimposition of colour Doppler images on a two dimensional echocardiogram. Colour M-Mode is superimposition of colour Doppler images on an M-Mode echocardiogram. The principle of Doppler is that the frequency of sound wave coming from an object which is moving towards the ultrasound probe increases while that from an object moving away from the probe decreases. It is similar to the difference in the sound of a train whistle, which is different when the train is moving towards you than when it is moving away from you. In Doppler echocardiography, the target is moving red blood cell...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a perimembranous VSD? Cardiology Basics
Perimembranous VSD is the commonest type of ventricular septal defect. When there is a ventricular septal defect, blood shunts from the left ventricle to the right ventricle as the pressure in the left ventricle is higher. This leads to increased pulmonary blood flow. VSD usually occurs as a congenital defect, though it can rarely occur in the adult after a myocardial infarction due to rupture of the ventricular septum. If the VSD is large, high pulmonary blood flow increases the amount of blood returning to the left atrium and left ventricle through the pulmonary veins. This volume overloading of the left ventricle can l...
Source: Cardiophile MD - October 14, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How to interpret an echo report? Cardiology Basics
Echocardiogram, often called just echo in short is ultrasound imaging of the heart. Though the actual types of details mentioned in echo report may vary between institutions and even persons reporting it, in general there are several common aspects. Reports of children with congenital heart disease will have a different pattern. This discussion is mainly on an echo report from a general cardiology setup.
In addition to details of identification and date of procedure, indication for the study and the quality of images are usually mentioned in the beginning of the report. Quality of images may be poor in those with emphysem...
Source: Cardiophile MD - October 12, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Gerbode ventricular septal defects type I, II and III
Though congenital left ventricle to right atrium connections have been described as early as 1838 at autopsy [1, cited in 2], the description by Frank Gerbode and colleagues was in 1958, in their surgical series [3]. They described three varieties of communications:
Fusion of the septal leaflet of the tricuspid valve to the edges of the ventricular septal defect associated with a perforation of the leaflet. Shunt occurs from left ventricle directly into right atrium.
A defect or cleft of tricuspid valve close to its point of attachment directly overlying the VSD.
A combination of these two lesions.
They also described t...
Source: Cardiophile MD - September 8, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
New onset IRBBB
A PubMed search for new onset incomplete right bundle branch block returned 7 citations of which only two were on incomplete right bundle branch block. Another search on new onset IRBBB returned 40 citations but they were on RBBB rather than IRBBB.
The first result on IRBBB was in a study on hybrid transthoracic periventricular device closure of ventricular septal defects [1]. Three of their 59 patients developed incomplete right bundle branch block. One of them resolved during follow up. One had mild residual VSD shunt.
The second was on electrophysiological study before and after paramembranous ventricular septal ...
Source: Cardiophile MD - August 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
Basics of hemodynamic evaluation – 3
Basics of hemodynamic evaluation – 3
While evaluating intracardiac shunt lesions by cardiac catheterization, an easy way is to look at the step up or step down in the oxygen saturation between two chambers. For example, in case of left to right shunts, step up is noted between superior vena cava (SVC) and right atrium in case of atrial septal defect (ASD). Among the atrial septal defects, step up is noted in high right atrium for sinus venosus ASD, mid right atrium for secundum ASD and low right atrium for primum ASD. Step up from right atrium to right ventricle is noted in ventricular septal defect. In case of paten...
Source: Cardiophile MD - December 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Mural endocarditis
Vegetations in infective endocarditis are usually situated on the valves. If they are located on the walls of the cardiac chambers, it is known as mural endocarditis [1]. When mural endocarditis occurs without any cardiac structural abnormalities like ventricular septal defects, it is called primary mural endocarditis [2]. Primary mural endocarditis is extremely rare.
Left atrial mural endocarditis usually occurs due to the jet lesion of mitral regurgitation [1,3]. Left atrial mural endocarditis is usually picked up by trans esophageal echocardiography. Vegetations are mostly located just distal to the mitral orifice betw...
Source: Cardiophile MD - October 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Segmental approach to congenital heart disease
Segmental approach is used routinely in the echocardiographic evaluation of congenital heart disease. It is also useful in other cardiac imaging modalities used for evaluation of congenital heart disease like computed tomography and magnetic resonance imaging. Chest X-ray is useful in evaluating the cardiac position and visceral situs as it gives an overview of cardiac position in the thorax, position of left and right bronchi, aortic arch, liver and stomach air bubble [1].
Here is a chest X-ray in mesocardia with levo transposition of great arteries:
X-ray chest PA showing mesocardia with L-TGA and L-posed aorta seen as ...
Source: Cardiophile MD - July 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Cardiology MCQs
Which of the following is an innocent murmur?
Gibson’s murmur
Roger’s murmur
Still’s murmur
Dock’s murmur
Correct answer: 3. Still’s murmur
Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Congenitally corrected transposition of great arteries
Congenitally corrected transposition of the great arteries (CCTGA or cTGA) is a condition in which there is atrioventricular and ventricular arterial discordance so that the circulation is physiological. Congenitally corrected transposition of great arteries is also known as l-transposition of great arteries (l-TGA) because of the levo transposition of aorta. Levo posed aorta forms a hump along the left upper heart border on chest X-ray.
The right atrium connects to the morphological left ventricle, which in turn connects to the pulmonary artery so that systemic venous blood reaches the pulmonary circulation. The left atr...
Source: Cardiophile MD - June 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Chest X-ray in left to right shunts
Chest X-ray is a simple, cheap and easily available investigation for the evaluation of left to right shunts. But it is often avoided in pediatric age group due to concerns of radiation. Cardiac size and lung vascularity can be readily assessed and followed up serially [1]. Lung vascularity pattern is different in pre-tricuspid and post tricuspid shunts. Pattern changes with the development of pulmonary hypertension as the shunt decreases. Cardiac size also decreases when the shunt decreases. Cardiac chamber enlargements are also different according to the level of shunt.
Chest X-ray in atrial septal defect
Atrial septal ...
Source: Cardiophile MD - May 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Fetal and transitional circulation
Fetal circulation is different from adult circulation. The changes occurring soon after birth constitutes transitional circulation. Respiratory gas exchange in the fetus occurs in the placenta rather than the lungs. Fetal cardiovascular system is designed so that the most saturated blood reaches the heart and the brain. Fetal circulation can be called a shunt dependent circulation because there are intracardiac and extracardiac shunts [1].
Cardiac output in the fetus is called combined ventricular output (CVO). Despite the low oxygen partial pressures in fetal blood, presence of fetal hemoglobin and high combined ventric...
Source: Cardiophile MD - April 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Major aortopulmonary collateral arteries
Major aortopulmonary collateral arteries (MAPCA) occur in cyanotic congenital heart diseases with decreased pulmonary blood flow (tetralogy of Fallot like physiology). They are a natural protective mechanism to improve pulmonary blood flow. MAPCAs are more likely to occur in pulmonary atresia than in simple tetralogy of Fallot.
MAPCAs can also occur in conditions other than the typical pulmonary atresia with ventricular septal defect. In a retrospective review of such cases, 33 had single ventricle anatomy while the rest had two ventricle anatomy. Among those with single ventricle, 15 had unbalanced complete atrioventricu...
Source: Cardiophile MD - April 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
