What is Mitochondrial Cardiomyopathy?
Mitochondria have two genomes – mitochondrial and nuclear. Mitochondrial disease could be due to mutations of nuclear or mitochondrial DNA. Mitochondrial DNA is inherited maternally while nuclear DNA has Mendelian inheritance, which could be dominant or recessive [1]. It may be noted in about one in 5000 live births. Cardiac involvement in mitochondrial disease seldom occurs in isolation and is often part of multiorgan dysfunction [2]. Mitochondria being part of the cellular respiratory chain, tissues with high energy requirements like heart, muscle, kidneys and endocrine system are often involved in mitochondrial d...
Source: Cardiophile MD - May 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can Radial Artery be Used as Conduit for CABG After Transradial Coronary Angiography?
Radial artery is being increasingly used as a conduit for coronary artery bypass grafting in multi-vessel coronary artery disease as it provides superior long term patency rates compared to saphenous vein grafts [1]. Radial artery is also increasingly being used as access point for coronary angiography and percutaneous coronary interventions. Concerns have been raised regarding the use of radial artery as conduit after transradial procedures as there is likelihood of vascular trauma during the procedures.
Some authors even mention that prior transradial catheterization is a contraindication for the use of radial artery fo...
Source: Cardiophile MD - May 8, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Cardiac Surgery Coronary Interventions General Cardiology Source Type: blogs
Bainbridge Reflex
Bainbridge Reflex was described over a century back, in 1918 as the influence of venous filling on the heart rate [1]. It was noted as an increase in heart rate in response to a rise in central venous pressure. Mechanoreceptors for the Bainbridge reflex are located at the junction of the right atrium and the caval veins and at the junction of pulmonary veins and the left atrium [2]. It is also known as Bainbridge effect and sometimes called the atrial reflex. Efferent arm of the reflex could involve both parasympathetic withdrawal and sympathetic enhancement.
Axial stretch has been shown to increase spontaneous pacemaker ...
Source: Cardiophile MD - April 23, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Localisation of Ventricular Tachycardia by Surface ECG
Surface ECG can be used to identify the site of origin of ventricular tachycardia. QRS morphologic patterns and vectors are helpful in discerning the activation pattern of the myocardium. Chest wall deformity as well as metabolic and drug effects can cause limitations in analysis sometimes [1]. Identification of site of origin of VT is useful while planning catheter ablation. It is also useful in correlating with the clinical situation as in post myocardial infarction scar related VT. Another instance is for correlation with findings on imaging modalities like echocardiography and cardiac magnetic resonance imaging [2].
F...
Source: Cardiophile MD - April 23, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Myocardial Ischemia-Reperfusion Injury
Myocardial Ischemia-Reperfusion Injury is a paradoxical exacerbation of cellular dysfunction and cell death occurring after restoration of blood supply in previously ischemic tissues. Reperfusion of the myocardium after coronary occlusion in acute myocardial infarction can cause reperfusion arrhythmias like accelerated idioventricular rhythm. Myocardial ischemia-reperfusion injury can also occur after cardiac surgery and circulatory arrest [1]. Though reperfusion is essential for salvage of the myocardium it can sometimes cause paradoxical damage. Reperfusion injury can also affect distant organs occasionally leadin...
Source: Cardiophile MD - April 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Non-Left Main Bifurcation Lesion PCI Strategies
Bifurcation lesions may be noted in almost one third of cases for percutaneous coronary intervention. Outcomes for bifurcation lesions are worse compared to non-bifurcation lesions. The two important strategies for addressing a coronary bifurcation lesion are planned one stent strategy or provisional stenting and elective two stent strategy. In provisional stenting, side branch is stented only if unavoidable.
A multicenter registry of 2044 patients compared the two strategies in non-left main bifurcation lesions. There were 1551 bifurcation lesions of left anterior descending coronary artery and 493 non-LAD bifurcation le...
Source: Cardiophile MD - April 16, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Naming of components of QRS complex
Initial negative deflection of the QRS complex is named a q or Q wave depending on the amplitude. Usually waves less than 5 mm in amplitude are designated by small letters and those larger than 5 mm with capital letters. But this may not be strictly followed by all who use these terminologies. Initial positive deflection will be called an R wave regardless of whether there is a q or Q preceding it. A negative deflection occurring after and r or R wave will be called as S wave, regardless of whether there is a preceding q or Q wave. When there is only a single negative deflection, it is called as a qs or QS complex dependi...
Source: Cardiophile MD - February 22, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Coronary Angioplasty
Initial part of the video clip shows left coronary angiogram with total occlusion of left anterior descending coronary artery. Annotations are given in still frames in between. Next view shows inflation of balloon in LAD. Check angiogram after initial balloon dilatation is shown next. Post stenting angiograms in multiple views follow, to look for any residual luminal stenosis or potential complications of angioplasty.
Coronary Angioplasty (Source: Cardiophile MD)
Source: Cardiophile MD - February 4, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Normal Colour Doppler Echocardiogram in Multiple Views
Starting from the two dimensional parasternal long axis view, followed by colour flow mapping, M-Mode at chordal level, parasternal short axis view at aorta-left atrium level and mitral valve level, apical four chamber view and suprasternal view in sequence. Annotation is given in still pictures inserted in between the video clips. (Source: Cardiophile MD)
Source: Cardiophile MD - February 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography Source Type: blogs
Regional wall motion abnormalities in LAD territory on echocardiography.
Echocardiography is one of the simplest investigations to assess the myocardial regional wall motion abnormalities in coronary artery disease. Regional wall motion abnormalities can also be assessed by nuclear imaging and cine CT (computed tomography) scan / MRI (magnetic resonance imaging). The wall motion is scored from 1 to 4 depending on whether it is normal wall motion, hypokinesia, akinesia or dyskinesia. Hypokinesia means reduced contraction, akinesia means absence of contraction and dyskinesia means bulging out in systole. In order to standardize the reporting of wall motion abnormalities, American Society of Echo...
Source: Cardiophile MD - February 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Echocardiography General Cardiology Source Type: blogs
Epsilon Wave
Epsilon wave, the classical ECG finding in arrhythmogenic right ventricular dysplasia is seen at the end of the QRS complex. Epsilon wave is typically seen in right precordial leads though it has been noted in left precordial leads in those with left ventricular involvement. ARVD is better termed arrhythmogenic cardiomyopathy because of the possibility of left ventricular involvement. Epsilon wave represents the delayed activation of surviving islands of myocardium within the fibrofatty tissue in ARVD [1]. Some have called it as a ‘post excitation’ wave, as a corollary to the delta wave in pre excitation.
It ...
Source: Cardiophile MD - January 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Compliant vs noncompliant balloon catheters
Compliant balloon will increase in diameter as the pressure in the indeflator increases, as the name implies. They are made of polyurethane or silicone and can be inflated up to several times the nominal size. Compliant balloon is used when there is a need for the expanded balloon to fully conform to the vessel lumen or occlude it.
On the other hand, noncompliant balloons are high pressure balloons made of polyester or nylon. They can exert high pressure to expand up to a specific diameter, but not significantly beyond that. They can be used to crack calcified lesions and expand stents.
Then there is the concept of semi-c...
Source: Cardiophile MD - January 10, 2023 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Intraoperative Imaging for Porcelain Aorta
Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Intraoperative epiaortic echocardiography along with manual palpation during surgery has been described as the most sensitive technique for detecting ascending aortic atheroma and calcification [1].
A prospective study evaluated this in hundred consecutive patients undergoing coronary bypass or valve surgery [2]. Ascending aorta was assessed by manual palpation by the operating surgeon, intraoperative transesophageal echocardiography and epiaortic ultrasound using linear and phased-array imaging. No difference was noted...
Source: Cardiophile MD - December 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Thrombus, tumor or vegetation?
This question is often faced by the echocardiographer while evaluating a mass detected on the heart valves or cardiac chambers. Usual method is to take it in the clinical context. There could also be non-infective vegetations of marantic endocarditis which are almost impossible to differentiate from infective vegetations. Marantic vegetations can be suspected in the presence of small and multiple vegetations changing from one examination to another, without associated abscess or valve destruction [1]. It may be noted that echocardiography is neither 100% specific nor 100% sensitive for the diagnosis of infective endocardi...
Source: Cardiophile MD - December 15, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Deep vein thrombosis of upper limbs vs lower limbs
The chance of pulmonary embolism is 6% for upper extremities, while it ranges from 15 – 30% with lower limbs. Recurrence at one year is 2-5% for upper extremities while it is 10% for lower extremities. The incidence of post thrombotic syndrome is much higher for lower extremities than upper extremities. (Source: Cardiophile MD)
Source: Cardiophile MD - December 10, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
