What is Morrow procedure?
Ventricular septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM) is otherwise known as Morrow procedure.
In Morrow procedure, a rectangular trough is created in the basal left ventricular septum from below the aortic valve to a point beyond the point of contact of the anterior mitral leaflet to the septum (point of SAM septal contact). It is the procedure of choice for symptomatic drug refractory HOCM, provided it is done in centers with adequate experience with the procedure.
Reference
1. Morrow AG, Reitz BA, Epstein SE, Henry WL, Conkle DM, Itscoitz SB, Redwood DR. Operative treatment in hypertrophic subao...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can digoxin be given in hypertrophic cardiomyopathy?
Low dose digoxin can be used to control ventricular rate in those with left ventricular ejection fraction less than 50%, having NYHA class II-IV symptoms and permanent atrial fibrillation (Class IIb, level of evidence C, 2014 European Society of Cardiology Guidelines)
Being an inotropic agent digoxin can enhance the left ventricular outflow tract obstruction. Even in those without LVOT obstruction, digoxin is not recommended, except in the specific subset mentioned above, that too only as a Class IIb recommendation.
Reference
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, L...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Sudden cessation of cerebral blood flow causes syncope in how many seconds?
Sudden cessation of cerebral blood flow causes syncope in 6-8 seconds.
A fall of systolic blood pressure to 50–60 mmHg at the level of the heart, which corresponds to 30–45 mmHg at the level of the brain in the upright position can also cause syncope with complete loss of consciousness.
Syncope is defined as transient loss of consciousness due to cerebral hypoperfusion, which has a rapid onset, short duration and complete recovery.
Reference
1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG; ES...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the commonest sustained arrhythmia in HCM?
Commonest sustained arrhythmia in hypertrophic cardiomyopathy is atrial fibrillation. Atrial fibrillation (AF) can occur in about 1/5th of cases of hypertrophic cardiomyopathy (HCM). Factors predisposing to AF in HCM are left atrial pressure and size due to left ventricular diastolic dysfunction, left ventricular outflow tract obstruction and mitral regurgitation. About one fourth of them may develop embolic episodes and stroke. It has been suggested that those with left atrial diameter of 45 mm or more should undergo 48 hour Holter once or twice a year to look for AF. Anticoagulation is recommended in those with AF ...
Source: Cardiophile MD - November 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
High risk features in the history of a syncopal event
Some features in history of syncope indicating a high risk of cardiac origin are:
Associated with new onset of chest discomfort or breathlessness
Syncope during exertion or while supine
Sudden onset palpitation soon followed by syncope
Syncope which occurs after prolonged standing or in crowded or hot places indicates reflex syncope as the most likely possibility. Other associated features for a low risk syncope are being triggered by cough, defecation or micturition, during a meal or post prandial, after sudden unexpected unpleasant sight, sound, smell or pain and while getting up from supine or sitting position.
Refer...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Important risk factors for aortic dissection
Most common risk factor for aortic dissection in the International Registry of Acute Aortic Dissection (IRAD) was hypertension. Hypertension was noted in 76.6% in the IRAD, while Marfan syndrome was noted only in 4.4% and diabetes mellitus in 7.8%. Twenty year data from IRAD has been published. It is a study involving over 7300 cases from over 51 sites in 12 countries. Two thirds were type A dissection and one third type B. Two thirds were men and the mean age was 63 years. In general type A cases underwent surgery and type B cases underwent endovascular repair. There has been a decrease in overall in hospital mortality i...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is paroxysmal nocturnal dyspnea?
In paroxysmal nocturnal dyspnea, patient wakes up with breathlessness and sits up or even stands. It is relieved over a few minutes. Paroxysmal nocturnal dyspnea is different from orthopnea which occurs soon after assuming the supine position and is relieved by sitting up. Orthopnea has no relation to sleep. Onset of paroxysmal nocturnal dyspnea is delayed after onset of sleep as it takes some time for the peripheral edema fluid to get absorbed and translocate to the lungs. PND usually occurs 2 – 4 hours after onset of sleep. Sympathetic withdrawal during sleep is also a proposed mechanism. Paroxysmal nocturnal dyspnea ...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Which is the most commonly monitored ECG lead?
Lead II is used for continuous monitoring because it gives a good P wave and a reasonable QRS complex for fair delineation of rhythm abnormalities.
If ST segment monitoring in acute coronary syndrome is the aim of monitoring, V5 may be a better lead as ST shifts are often well seen in chest leads. In inferior leads the amplitude of ST shifts are generally lower.
It is always a good practice to look at the baseline ECG to choose which lead to monitor in each person. If lead II is almost equiphasic in the given person, monitoring lead II may give a lot of false ‘asystole’ alarms and cause ‘alarm fatigue’ for the sta...
Source: Cardiophile MD - November 22, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Ebstein ’s anomaly?
What is Ebstein’s anomaly?
Ebstein’s anomaly is characterised by the distal displacement of the septal and posterior leaflets of the tricuspid valve. The anterior leaflet is not displaced and hence is quite large and sail like. Closure of the large anterior tricuspid leaflet produces the ‘sail sound’ characteristic of Ebstein’s anomaly. The distal displacement of the tricuspid valve causes atrialization of a portion of the right ventricle. (Source: Cardiophile MD)
Source: Cardiophile MD - November 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the features of Williams syndrome?
Williams syndrome is characterised by supravalvar aortic stenosis, elfin facies and hypercalcemia. Learning disability is often associated. Peripheral pulmonary stenosis is also an association.
In supravalvar aortic stenosis, the right upper limb blood pressure can be more than that in left upper limb causing anisopsphygmia, because the jet is directed towards the brachiocephalic artery. This is due to Coanda effect. (Source: Cardiophile MD)
Source: Cardiophile MD - November 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Aerobic training
Aerobic exercises are those which stresses the oxygen transport system while resistance exercises stress the musculoskeletal system. Target heart rate for aerobic training is 70 percent of the maximum predicted heart rate. Maximum predicted heart rate is 220-age of the individual.
While doing a treadmill exercise test often we aim at above 90% of the maximum predicted heart rate. But when a treadmill test is done for risk stratification soon after myocardial infarction (pre-discharge; seldom done in this era of early invasive management), only a target heart rate of 70% of maximum predicted heart rate is aimed.
During aer...
Source: Cardiophile MD - November 21, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Digoxin amiodarone interaction
Important drugs which can increase the levels of digoxin are quinidine, verapamil, amiodarone and dronedarone [1]. The dose of digoxin should be halved with concomitant use of verapamil, amiodarone or dronedarone. Drugs with high levels of protein binding displace digoxin from protein binding sites and increase the effective blood levels of digoxin. Monitoring of plasma digoxin levels and frequent evaluation for signs and symptoms of digoxin toxicity are recommended while using these drugs in combination with digoxin, when that combination is deemed essential.
Another reason for caution while combining digoxin and amiodar...
Source: Cardiophile MD - November 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Airway hemorrhage in Eisenmenger syndrome
In Eisenmenger syndrome airway hemorrhages have to be thought of specially when moving from lower to a higher altitude as during air travel or while ascending a mountain. Hemoptysis has been reported as a cause of death in Eisenmenger syndrome in 11-29% [1].
Defects in hemostatic mechanism due to abnormal platelet function, thrombocytopenia, deficiencies of clotting factor as well as depletion of von Willebrand factor may also contribute to airway hemorrhages in Eisenmenger syndrome [2].
References
Jensen AS, Iversen K, Vejlstrup NG, Sondergaard L. Pulmonary artery thrombosis and hemoptysis in Eisenmenger syndrome. ...
Source: Cardiophile MD - November 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Modified Rankin Score (mRS)?
In the original Rankin score proposed in 1957, there were 5 grades of stroke severity ranging from “no significant disability” to “severe disability’ [1]. Modified Rankin Score (mRS) has been used to quantify disability after recovery from a cardiac arrest [2]. The score ranges from for 0 with no symptoms to 6 which would mean mortality. In between there is 1 with no significant disability and 2 with slight disability. Moderate disability requiring some help is 3 and 4 is moderately severe disability in which the person is not able to walk or attend to bodily needs without help. Modified Rankin Score 5 indicat...
Source: Cardiophile MD - November 20, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Lake Louise criteria is for the diagnosis of myocarditis on CMR
Lake Louise criteria are based on those for detection of myocardial edema, hyperemia and capillary leakage, necrosis and fibrosis. Myocardial early gadolinium enhancement suggests hyperemia and capillary leakage. Edema is indicated by an area of high intensity signal in T2 weighted images. It can be global in some cases. In the absence of late gadolinium enhancement which would indicate necrosis or fibrosis, edema is suggestive of potentially reversible myocardial injury. Global myocardial edema may be difficult to identify visually and needs software support which compares myocardial T2 weighted images with that of skele...
Source: Cardiophile MD - November 19, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
