Potential Risk of Serious Bleeding in Patients With AF Using Diltiazem With Apixaban or Rivaroxaban
A potentially serious drug interaction between diltiazem and apixaban or rivaroxaban has been reported in US Medicare patients taking these drugs together for atrial fibrillation. The study has been published as online ahead of print in the Journal of American Medical Asociation [1]. The study compared serious bleeding risk for new users of apixaban or rivaroxaban with atrial fibrillation treated with diltiazem or metoprolol. It was a retrospective cohort study which included US Medicare benefiaries aged 65 years or more with atrial fibrillation and follow up period was one year. Primary outcome was a composite of bleedi...
Source: Cardiophile MD - April 19, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Who Needs a CT Coronary Angiogram?
CT coronary angiograms are increasing in popularity as a non-invasive screening test for detecting blocks in coronary arteries.
Coronary arteries are blood vessels supplying oxygenated blood to the heart.
Angiograms are images of blood vessels, usually obtained by injecting medications for contrast from body structures.
CT angiograms are reconstructions from multi slice CT scans following injection of contrast material into a forearm veins.
Veins are blood vessels returning deoxygenated blood to the heart.
CT coronary angiogram can be done as an outpatient test, in the X-ray department.
As of now CT angiograms cannot repla...
Source: Cardiophile MD - April 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the Cyanotic Congenital Heart Diseases with Increased Pulmonary Blood Flow?
D-Transposition of great arteries
Double outlet right ventricle without pulmonary pulmonary stenosis
Taussig-Bing anomaly
Total anomalous pulmonary venous return
Truncus arteriosus
Single ventricle (double inlet ventricle, univentricular heart) (Source: Cardiophile MD)
Source: Cardiophile MD - April 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the Cyanotic Congenital Heart Diseases With Decreased Pulmonary Blood Flow?
Tetralogy of Fallot
TOF with pulmonary atresia
Pulmonary atresia with intact interventricular septum
Tricuspid atresia
Double outlet right ventricle
Transposition of great arteries with ventricular septal defect and pulmonary stenosis
Ebstein’s anomaly of tricuspid valve
In DORV and tricuspid atresia, there are also variants with increased pulmonary blood flow, in the absence of associated pulmonary stenosis. (Source: Cardiophile MD)
Source: Cardiophile MD - April 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the acyanotic congenital heart diseases with left to right shunt lesions?
Atrial septal defect – Ostium Primum, Ostium Secundum, Sinus Venosus
Partial anomalous pulmonary venous return
Atrioventricular septal defect
Ventricular septal defect – inlet, outlet, perimembranous, muscular
Patent ductus arteriosus
Aortopulmonary window
Coronary artery fistula draining to right heart
Ruptured sinus of Valsalva aneurysm to right heart (Source: Cardiophile MD)
Source: Cardiophile MD - April 17, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Commotio cordis
Sometimes a player drops down dead after being accidentally hit by a ball or another player. This situation which can occur in any contact sports is known as commotio cordis. The sudden hit on the chest causes the heart to stop in ventricular fibrillation. Ventricular fibrillation is a very fast irregular electrical activity of the lower chambers which prevents proper contraction of the heart.
The intensity of the blow is not sufficient to cause any damage to the chest wall. No structural damage is noted in the heart as well. If there is a contusion (bruising) of the heart, it will be called contusio cordis. Contusio cordi...
Source: Cardiophile MD - April 17, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Ventricular Tachycardia Management
Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. If the rate is very fast, hemodynamic deterioration can occur rapidly. On the ECG, ventricular tachycardia can be defined as three or more ventricular ectopic beats occurring in a sequence at a rate more than 100 per minute.
Ventricular tachycardia which gets spontaneously terminated within 30 seconds is called non sustained ventricular tachycardia (NSVT) . Sustained ventricular tachycardia is one which does not get spontaneously terminated within 30 seconds or needs cardioversion before that due to hemodynamic compromise.
Based on the morphology...
Source: Cardiophile MD - April 17, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Difference Between Invasive and Non-Invasive Ventilation
Ventilator is a device used to support breathing. It is used when there is difficulty in breathing or when spontaneous breathing has stopped. Ventilator is an important life supporting device useful in many life threatening conditions.
Invasive ventilator is usually used in the intensive care setting or the operating room. An endotracheal tube is introduced under topical anaesthesia with sedation or general anaesthesia. The endotracheal tube is connected to a mechanical ventilator using appropriate connection tubing. In those who do not tolerate the presence of an endotracheal tube deep sedation and neuromuscular blockade ...
Source: Cardiophile MD - April 16, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Difference Between a Biphasic and Monophasic Defibrillators
The direct current shock given can have a monophasic or biphasic waveform. In monophasic shock, the shock is given in only one direction from one electrode to the other. In a biphasic shock, initial direction of shock is reversed by changing the polarity of the electrodes in the latter part of the shock. Usually the initial voltage applied is higher than the reversed polarity shock. Biphasic waveforms were initially developed for use in implantable cardioverter defibrillators (ICD) and later adapted to external defibrillators. Biphasic truncated exponential waveform and rectilinear biphasic waveform are two types of biphas...
Source: Cardiophile MD - April 16, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Need High Awareness of Symptoms of Heart Attack
High degree of awareness of heart attack symptoms in the community will go a long way in seeking early treatment. For life threatening diseases like heart attack, early recognition of symptoms and prompt reporting to the emergency department is highly desirable.
But a study from United States showed that 47% were not able to recognize some heart attack symptoms while 6% were not able to recognize any heart attack symptoms.
The main heart attack symptoms assessed by the study were:
Chest pain or discomfort
Shortness of breath
Pain or discomfort in arms or shoulders
Feeling weak, lightheaded, or faint
Jaw, neck, or back pai...
Source: Cardiophile MD - April 16, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Assessment of LV Diastolic Function by Echo in SR and AF
Echocardiographic assessment of left ventricular diastolic function with special reference on diastolic function assessment in atrial fibrillation.
Though there are several parameters for evaluation of left ventricular diastolic function by echocardiography, the most commonly used are the pulsed Doppler mitral E/A ratio and tissue Doppler mitral E/e’ ratio.
Some of the other useful parameters are mitral E velocity deceleration time, changes in mitral inflow with Valsalva maneuver, mitral L velocity, isovolumic relaxation time, left atrial maximum volume index, pulmonary vein systolic/diastolic velocity ratio, color M-mod...
Source: Cardiophile MD - April 15, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
ECG in LMCA Stenosis
ECG in a person with persistent anginal pain for the past several hours showing significant ST segment depression anterolateral leads along with sinus tachycardia. ST segment elevation is noted in aVR. Such a pattern is consistent with significant left main coronary artery stenosis.
Clinical evaluation and X-Ray chest showed features of pulmonary edema. Angiography done after initial stabilization showed severe stenosis of distal left main coronary artery. In addition, there were multiple lesions in all three vessels, making a standard indication for an urgent coronary artery bypass grafting.
A similar ECG pattern can also...
Source: Cardiophile MD - April 13, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Intravascular Ultrasound (IVUS) for Coronary Intervention
Coronary Intravascular Ultrasound (IVUS) equipment consists of an IVUS catheter, pullback device and the imaging console. If lesion lengths have to be assessed, motorized pullback is required. For assessing lesion morphology a manual pullback can also be done. While manual pullback allows concentration on specific lesions, it may miss some lesions in between if the pullback is not steady. Catheter has to be disengaged while evaluating coronary ostial lesions.
Heparin and intracoronary nitroglycerine are given before the guide wire is inserted after the coronary cannulation with a guide catheter. The IVUS catheter is then i...
Source: Cardiophile MD - April 11, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Differentiating Between Cardiac and Non-Cardiac Chest Pain
It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chest pain so that important ailment is not missed. There can be a lot of overlap between symptoms due to heart disease and disease of other nearby organs.
Still some general observations are possible regarding chest pain originating from the heart. The typical pain of cardiac origin is a central chest pain which occurs on walking or other forms of exercise, known as effort angina. This pain is caused by insuffic...
Source: Cardiophile MD - April 10, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Echocardiographic evaluation in aortic regurgitation
Echocardiographic evaluation of aortic regurgitation, demonstrated through multiple images. Echocardiogram in parasternal long axis view shows dilated left ventricle, left atrium, aorta and a small portion of the right ventricle, which is usually the outflow region. Mitral valve leaflets seen in open position between the left ventricle and left atrium are thickened.
The large aortic regurgitation jet can be seen as a mosaic jet in the left ventricular outflow tract anterior to the anterior mitral leaflet. A portion of the thickened aortic valve can be seen between the aorta and left ventricle.
The AR jet is almost filling ...
Source: Cardiophile MD - April 10, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
