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
Pulmonary angiography
Pulmonary angiography can be done by introducing a guidewire initially followed by a modified pigtail catheter like Grollman catheter, under fluoroscopic guidance.
Grollman catheter has a gentle rightward curve and an additional right angled leftward curve proximal to the side holes. The tip of the Grollman catheter has a pigtail shape.
Schematic diagram of modified pigtail Grollman catheter
Non-ionic contrast can be injected into the right and left pulmonary arteries to get corresponding angiograms. The guidewire and catheter are introduced through the femoral vein and directed to the pulmonary artery through the inferio...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Role of beta blockers in hypertrophic obstructive cardiomyopathy (HOCM)
Beta blockers are the mainstay of medical treatment in hypertrophic cardiomyopathy with or without obstruction. They reduce the dynamic left ventricular outflow obstruction, angina, exertional dyspnea and the risk of ventricular arrhythmias [1]. Reduction in left ventricular outflow obstruction is mostly due to the negative inotropic effect of beta blockers [2].
Reduction in heart rate by beta blockers increases diastolic filling time. Sympatholytic effect of beta blockade can also reduce ventricular stiffness. Non-vasodilating beta blockers titrated to maximum tolerated dose is considered for those with symptomatic left ...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Chatterjee phenomenon?
Chatterjee phenomenon is post pacing T wave inversion. In the original article by Kanu Chatterjee and associates [1] they found significant ST depression and T wave inversion persisting after discontinuation of pacing. They noted that the mere presence of the lead in the ventricle or atrial pacing did not produce these changes. They also excluded a recent Stokes Adam attack as the cause of the ST-T changes in their cases. Only depolarization of the ventricles from an abnormal site was deemed to be the cause of these changes.
Cardiac memory has been postulated as a mechanism of these changes by other authors as well [...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the important biomarkers for myocardial fibrosis?
Soluble ST2 receptor and Galectin-3 are important biomarkers of myocardial fibrosis.
Reference
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017 Aug 8;136(6):e137-e161. (Source: Cardiophile MD)
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Fontaine classification for peripheral arterial disease
In Fontaine classification [1,2], Stage I is asymptomatic with incomplete vascular obstruction. Stage II is with mild claudication which is divided into A with claudication distance more than 200 m and B with claudication distance less than 200 m. Stage III is with rest pain and stage IV with necrosis or gangrene in the limb.
Rutherford classification classified peripheral arterial disease into acute and chronic limb ischemia [3]. Each is further subdivided into grades and categories based on symptoms, clinical findings, Doppler, ankle brachial index (ABI) and pulse volume recordings.
References
Fontaine R, Kim M, Kieny ...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the most common cause of acquired heart disease in children in developed countries?
Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. In developing countries it will be rheumatic heart disease.
Timely treatment of Kawasaki disease with intravenous immunoglobulin can reduce the incidence of coronary aneurysms from 25% to around 4%. Children with coronary aneurysms due to Kawasaki disease needs lifelong cardiology follow up. The prognosis depends on the initial and current level of coronary involvement. Some children may develop coronary obstruction and thrombosis leading to myocardial infarction. Revascularization procedures may be needed in some of th...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Non-vitamin K antagonist oral anticoagulants (NOACs) and valvular heart disease with AF
Subgroup analysis of certain clinical trials support the use of rivaroxaban, apixaban, dabigatran and edoxaban in patients with aortic stenosis, aortic regurgitation or mitral regurgitation having atrial fibrillation. NOACs can also be used in aortic bioprosthesis with atrial fibrillation if the valve has been implanted more than 3 months back.
NOACs are better avoided in those with moderate or severe mitral stenosis and atrial fibrillation in view of high thromboembolic risk. NOACs should not be used in those with mechanical prosthetic valve with or without atrial fibrillation. Those patients still require vitamin K anta...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are the statin adverse effects with confirmed causality?
Statin adverse effects with confirmed causality, though rare are:
a) Myalgia/myopathy
b) Temporary elevation of alanine aminotransferase
c) New onset diabetes mellitus
Reference
Banach M et al; International Lipid Expert Panel (ILEP). The Role of Nutraceuticals in Statin Intolerant Patients. J Am Coll Cardiol. 2018 Jul 3;72(1):96-118. doi: 10.1016/j.jacc.2018.04.040. PMID: 29957236. (Source: Cardiophile MD)
Source: Cardiophile MD - November 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
In what conditions are descending aortic flow reversal seen on Doppler echo?
Descending aortic flow reversal can be noted in aortic regurgitation, rupture of sinus of Valsalva into right ventricle and patent ductus arteriosus. It may be noted that transient descending thoracic aortic flow reversal may be detectable by Doppler echo without any of these conditions.
When the aortic wall is stiff as in hypertensives with atherosclerosis, transient flow reversal is thought to be one mechanism for cerebral embolism from aortic plaques beyond the origin of cerebral vessels.
In severe aortic regurgitation it is a pan diastolic flow reversal with end diastolic velocity more than 20 cm/s. It is taken as an ...
Source: Cardiophile MD - November 16, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
