Echocardiograms in a few congenital heart diseases
In this series, we have echocardiograms of a few congenital heart diseases. The first one shows left ventricle to right atrium shunt associated with a perimembranous ventricular septal defect. Various possibilities are discussed. The second one shows an ostium primum atrial septal defect with tricuspid regurgitation. Associated tricuspid regurgitation is also seen. Third one shows a few views of tetralogy of Fallot (TOF). There is a patent ductus arteriosus associated with TOF in this case. The intact patch at the site of intracardiac repair of the subaortic ventricular septal defect in TOF is seen in the last few frames...
Source: Cardiophile MD - November 8, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD LV-RA shunt ostium primum ASD perimembranous VSD TOF Source Type: blogs
Tetralogy of Fallot – Pre and Post Repair Echocardiogram
Tetralogy of Fallot – Pre and Post Repair Echocardiogram
Tetralogy of Fallot is the commonest cyanotic congenital heart disease in the adult. Large subaortic ventricular septal defect with overriding aorta, infundibular pulmonary stenosis and right ventricular hypertrophy are the components of tetralogy of Fallot. A patent ductus arteriosus is seen in this case as a natural protective mechanism to improve the pulmonary blood flow.
The echocardiogram after repair shows the intact patch over the erstwhile subaortic ventricular septal defect. There is no residual ventricular septal defect. (Source: Cardiophile MD)
Source: Cardiophile MD - November 6, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography aortic override continuous flow across the ductus patch across the ventricular septal defect patent ductus arteriosus right to left shunt Tetralogy of Fallot Source Type: blogs
ECG and CXR in ventricular septal defect
ECG in ventricular septal defect
ECG is normal in a small ventricular septal defect. Large VSD with large left to right shunt will have left ventricular volume overload with small q, tall R and upright T waves in lateral leads. Large VSD progresses to biventricular overload when there is hyperdynamic pulmonary hypertension. The ECG pattern of biventricular hypertrophy is called Katz – Wachtel phenomenon with tall biphasic (R=S) QRS complexes with amplitude over 50 mm in mid precordial leads. This pattern is usually seen in children. Since the QRS amplitude is high it often overshoots the margin of the ECG graph as seen ...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Katz – Wachtel phenomenon peripheral pruning Source Type: blogs
Ventricular septal defect
Ventricular septal defects (VSD) can be divided into perimembranous, muscular, inlet and outlet VSDs, depending on the location. Of these perimembranous VSDs are the commonest. VSDs can decrease in size and undergo spontaneous closure. Spontaneous closure is most likely with small muscular and perimembranous VSD, while inlet and outlet VSDs are least likely to close.
Perimembranous ventricular septal defect
Perimembranous VSD with perimembranous aneurysm
Echocardiogram in ventricular septal defect: Parasternal long axis view shows the subaortic perimembranous ventricular septal aneurysm (marked by arrows). The color mosai...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC atrioventricular septal defect doubly committed VSD Eisenmenger complex Eisenmenger reaction Gerbode VSD Inlet ventricular septal defect maladie de Roger Muscular ventricular septal defect Outlet ventricular septal defect perimembr Source Type: blogs
Congenital heart disease overview
Congenital heart disease can be broadly classified into cyanotic and acyanotic. Acyanotic congenital heart disease can be further subdivided into left to right shunts, obstructive lesions and a miscellaneous group. Cyanotic congenital heart disease can be classified into those with decreased pulmonary blood flow and those with reduced pulmonary blood flow.
Left to right shunts include atrial septal defect, ventricular septal defect, patent ductus arteriosus and aortopulmonary window. One person can have more than one of these shunts. Large left right shunts can induce the development of pulmonary hypertension and lead to ...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Chamber enlargements on ECG
Atrial enlargement
The normal P wave has a maximum amplitude of 2.5 mm (0.25 mV) and a maximum width of 2.5 mm (100 ms). In right atrial enlargement, the amplitude increases while in left atrial enlargement, it is the width (duration) which increases. Both increases in biatrial enlargement. P wave abnormalities are best assessed in leads II and V1. Normal P wave is upright in lead II. In V1, a tiny initial spike is followed by a shallow negative wave.
P mitrale: P mitrale is a notched and broad P wave with taller second peak indicating left atrial enlargement. It may be noted that initial part of P wave is contributed b...
Source: Cardiophile MD - September 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC incomplete right bundle branch block pattern Left ventricular pressure overload left ventricular volume overload LVH strain pattern P mitrale P pulmonale P tricuspidale Right ventricular pressure overload right ventricular volume ove Source Type: blogs
Cardiac murmurs
Cardiac murmurs are initially classified into systolic, diastolic and continuous. They can be timed in relation to the carotid pulse. A systolic murmur starts with or after the first heart sound and ends at or before the second heart sound. Clinically, systole can be timed with the onset of carotid pulse. Diastolic murmurs start with or after the second heart sound. By definition, a continuous murmur starts in systole, persists through the second heart sound, into the diastole. When the pressure gradient is high between the two chambers across which the murmur is generated is high, the murmur is high pitched.
Levine’s g...
Source: Cardiophile MD - September 24, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Austin Flint murmur continuous murmur crescendo-decrescendo murmur delayed diastolic murmur diamond shaped murmur Early diastolic murmur Ejection systolic murmur Gibson’s area Gibson’s murmur Graham steel murmur holosystolic Source Type: blogs
Auscultatory areas
Precordium is generally divided into four auscultatory areas, but other areas may be checked in specific situations. The common auscultatory areas correspond to the locations at which the corresponding valvular events are better heard.
Aortic area: Also called primary aortic area as there is a secondary aortic area along the left sternal edge. Primary aortic area is the 2nd right intercostal space, close to sternum.
Pulmonary area: 2nd left intercostal space, close to sternum.
Tricuspid area: Lower left sternal edge, medial to apex beat.
Mitral area: At the apex beat, usually within the mid clavicular line in the 5th lef...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Erbs’s area maladie de Roger primary aortic area Roger’s area secondary aortic area Source Type: blogs
Palpation of precordium and adjacent areas
Palpation initially confirms the findings of inspection and further looks for new findings.
Apex beat: Apex beat is defined as the lowest and outer most point of definite cardiac impulse. If apex beat is not felt on left side, immediately check on right side or else we might miss a dextrocardia. There some who even palpate both sides simultaneously for this reason. Apex beat is initially felt with the palm of the hand and then localized with the index finger. Sometimes it may be difficult to palpate in obese individuals and in those with emphysema. Palpation in held expiration and in the left lateral position may help in...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Inspection of precordium
Precordial examination starts with inspection, though inspection and palpation are often combined in regular practice. Some of the features to look for are:
Sternal deformities: Pectus excavatum is concavity of the sternum, and is the commonest congenital malformation of the chest wall which may be associated with congenital heart diseases like ventricular septal defect. Pectus carinatum is sternal prominence, also known as pigeon chest, which can occur in congenital heart disease with large left to right shunts in infancy.
Visible pulsations: Suprasternal pulsations can be seen in aortic aneurysm and aortic regurgitatio...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
Jugular venous pulse (JVP)
Assessment of jugular venous pulse has to be done in the internal jugular vein though a beginner is often tempted to use the external jugular vein. External jugular vein may be kinked and it may not reflect the true right atrial pressure. Jugular venous pressure is measured with reference to the sternal angle. The sternal angle is 5 cm above the mid right atrium in all positions. Normal internal jugular venous pulsations are not visible in the neck in the sitting position. Hence it is typically measured with 45 degrees propped up position. But if the venous pressure is elevated, measurement in sitting position is possible...
Source: Cardiophile MD - September 22, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC abdominojugular reflux cannon waves Friedreich’s sign hepatojugular reflux Superior vena cava syndrome Source Type: blogs
General examination – eyes and facial dysmorphism
General examination – eyes and facial dysmorphism
Clinically examination is guided by the symptoms. Unless the history is not correlated with findings, important diagnostic possibilities may be missed. Clinical examination starts off with a focused general examination followed by a detailed examination of the cardiovascular system. Relevant points in other systems like basal crepitations, hepatosplenomegaly and neurological deficits should be looked for.
Examination strategy should be fitting to the clinical situation. When a patient presents to the emergency room, it should be a short but focused examination to perm...
Source: Cardiophile MD - September 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs
One more cause for acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Please add, one more cause for Acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Oxygen step up in right atrium – MCQ – Answer
Oxygen step up in right atrium – MCQ – Answer
Step up in oxygen saturation on cardiac catheterization in the right atrium is suggestive of – Correct answer: a) Atrial septal defect
In ventricular septal defect oxygen step up is seen at ventricular level. For example, if the oxygen saturation is 64% in the right atrium, it becomes 82% in the right ventricle due to entry of oxygenated blood from the left ventricle across the ventricular septal defect. In patent ductus arteriosus, oxygen step up is noted at the level of the pulmonary artery.
Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
