What is a continuous murmur?
Continuous murmur is not a murmur which is continuously heard throughout systole and diastole, though some like the murmur patent ductus arteriosus is like that. By definition, a continuous murmur begins in systole and continues without interruption, through the second heart sound into diastole. It can cover either part of diastole or the whole of diastole. A murmur which disappears completely before the next first heart sound is still considered continuous if the systolic part continues without interruption during the second heart sound. Highest intensity of continuous murmur is usually heard in rupture of sinus of Valsa...
Source: Cardiophile MD - November 2, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is myocardial contrast echocardiography?
Myocardial contrast echocardiography (MCE) is used for the assessment of myocardial microcirculation and endocardial demarcation. MCE uses gas-filled microbubbles that are inert and remain wholly within the vascular space. These microbubbles have an intravascular rheology similar to that of red blood cells [1]. A continuous intravenous infusion of microbubbles is given to achieve a steady state. These microbubbles are destroyed by high energy ultrasound. The rate of microbubble replenishment within the ultrasound beam is measured and represents the mean red blood cell velocity [2].
Normally, the ultrasound beam fills with...
Source: Cardiophile MD - November 1, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is arterial switch operation for TGA? Cardiology Basics
Arterial switch operation is the ideal corrective surgery for transposition of great arteries (TGA). It was described by Jatene and colleagues in 1976. Normally aorta originates from the left ventricle and pulmonary artery originates from the right ventricle. This is reversed in TGA, so that pulmonary artery arises from the left ventricle and aorta originates from the right ventricle. Arterial switch operation normalizes this relationship, by moving the aorta and pulmonary artery back to their expected positions.
When the blood vessels are switched, the coronary arteries are also repositioned to arise from the new aorta w...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Triggers for IABP
Intra-Aortic Balloon Pump inflates the balloon in diastole and deflates at the onset of systole.
This image of the IABP screen shows diastolic augmentation in the pressure tracing. Period during which the balloon remains inflated is shown as a horizontal bar below the ECG tracing at the top. Live visual indication of balloon inflation will also be there in the balloon inflation indicator at the bottom of the screen when the IABP is operational.
Any of the several types of triggers can be used for timing for inflation in diastole.
ECG trigger: Balloon will be inflated in the middle of the T wave and deflated at the peak o...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is pacemaker syndrome? Cardiology Basics
Pacemaker syndrome is a group of symptoms which can occur in a person implanted with a single chamber ventricular pacemaker. In the normal heart, atria contract first to give a booster filling for the ventricles, followed by the contraction of the ventricles. This is known as atrioventricular (AV) synchrony. When a single chamber pacemaker paces the right ventricle, this AV synchrony is lost and may cause symptoms of pacemaker syndrome.
Persons with pacemaker syndrome may have exertional breathlessness, hypotension and syncope. Easy fatigability, sensation of fullness and pulsations in the head and neck are also features ...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are BNP and NT-proBNP tests? Cardiology Basics
BNP and NT-proBNP tests are used for detection of heart failure. When the heart fails, there is stretching of the ventricles which leads to release of BNP from the myocardium. Pro BNP is the precursor of BNP, which is cleaved by enzymes to NT-proBNP and BNP. BNP stands for brain natriuretic peptide or B-type natriuretic peptide. BNP is biologically active while NT-proBNP is not. NT stands for amino terminal of the protein.
NT-proBNP has a longer plasma half life than BNP. Hence levels of NT-proBNP are more stable. Thus, it can reflect the stretching of the left ventricle, over the previous 12 hours. This is the reas...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is atrial flutter? Cardiology Basics
Atrial flutter is a fast and organized arrhythmia originating from the atria. In this way it is different from the commoner atrial fibrillation which is quite fast but irregular rhythm originating from the atria. It shares the risk of thrombus formation in the atria and needs anticoagulants, like atrial fibrillation. Atrial flutter commonly arises from the right atrium. It can also arise from the left atrium sometimes.
Though the atrial rate is typically around 300/minute, the whole of it does not get conducted to the ventricles. The AV node reduces the number of impulses conducted to the ventricles. When there is only 2:...
Source: Cardiophile MD - October 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are atrial switch operations? Cardiology Basics
Atrial switch operations were the initial operations developed for the treatment of transposition of great arteries. In transposition of great arteries, the aorta arises from the right ventricle and pulmonary artery from the left ventricle. Normally aorta originates from the left ventricle and pulmonary artery arises from the right ventricle.
Schematic diagram of transposition of great arteries
In transposition of great arteries, systemic venous return is pumped back into the body without being sent to the lungs for oxygenation. Blood returning from the lungs is pumped back into the lungs.
So, survival is impossible unles...
Source: Cardiophile MD - October 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is Ebstein ’s anomaly? Cardiology Basics
What is Ebstein’s anomaly? Cardiology Basics
Ebstein’s anomaly is a congenital anomaly of the tricuspid valve, which may manifest soon after birth or more commonly later in life. In Ebstein’s anomaly, two of the three leaflets of tricuspid valve are displaced further into the right ventricle. Usually anterior leaflet is not displaced while the septal and posterior tricuspid leaflets are displaced. So, a part of the right ventricle becomes part of the right atrium functionally and is called atrialized right ventricle. Undisplaced anterior leaflet is elongated.
The tricuspid valve in Ebstein’s anomaly can have severe...
Source: Cardiophile MD - October 26, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are ventricular ectopic beats (VPC)? Cardiology Basics
Ventricular ectopic beats are premature heart beats originating from the ventricles. Normal heart beats originate from the sinus node, situated in the upper part of right atrium. Sinus node is the natural pacemaker of the heart which gives out regular impulses to induce sequential contractions of atria and ventricles.
Ventricular ectopic beats (VEB) are also known by other names like ventricular premature beat (VPB), ventricular premature complex (VPC) and premature ventricular complex (PVC). Ventricular ectopic is the commonest form of cardiac arrhythmia.
In a ventricular ectopic beat, the sequence of activation is diffe...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is PT-INR monitoring? Cardiology Basics
INR is short for International Normalized Ratio of Prothrombin Time. It is also called PT-INR. The INR monitoring is used to monitor the dosage of vitamin K antagonists like warfarin. Vitamin K antagonists are used for stroke prevention in atrial fibrillation as well as for deep vein thrombosis and pulmonary embolism. Non vitamin K oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban and apixaban do not need INR monitoring. Warfarin is routinely used when there is a mechanical prosthetic valve, to prevent valve thrombosis and thromboembolism. As of now, DOACs are not i...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is pericardial effusion – Cardiology Basics
What is pericardial effusion – Cardiology Basics
Pericardial effusion is collection of fluid between the visceral and parietal layers of the pericardium. If the amount of pericardial fluid is large or there is a rapid increase in the amount of pericardial fluid, compression of the heart prevents its proper filling. This reduces cardiac output and causes hypotension and is known as cardiac tamponade.
Cardiac tamponade needs urgent pericardial aspiration or surgical drainage if the fluid is very thick. Very thick fluid can be there in purulent bacterial pericarditis. Sometimes it can be a hemopericardium due to bleedin...
Source: Cardiophile MD - October 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is a bidirectional Glenn procedure (BDG)? Cardiology Basics
Bidirectional Glenn procedure is done for children with some types of cyanotic congenital heart diseases. The classical Glenn procedure is an end to end anastomosis of the superior vena cava to the right pulmonary artery so that the superior vena caval venous blood does not reach the left pulmonary artery. Bidirectional Glenn (BDG) procedure is an end to side anastomosis of superior vena cava to the right pulmonary artery. Main pulmonary artery is then divided and sutured. BDG helps flow into both pulmonary arteries. BDG is usually followed later by a Fontan repair.
BDG is performed in patients with anatomical or fu...
Source: Cardiophile MD - October 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Can dark chocolates keep heart disease away? Cardiology Basics
A study published in ‘Circulation’ – the flagship journal of American Heart Association, suggested that eating dark chocolate can decrease your risk for myocardial infarction.
Myocardial infarction is usually due to a coronary obstruction, though there are other varieties as well, according to the Universal Definition of Myocardial Infarction. High oxidative stress and limited availability of antioxidants can cause endothelial damage in the arteries, leading to increased chances for a thrombosis.
Dark chocolates (which contain 70% cocoa) have lots of flavonoids – potent antioxidants which helps to overcome the oxi...
Source: Cardiophile MD - October 24, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is an implantable cardioverter defibrillator (ICD)? Cardiology Basics
Implantable cardioverter defibrillator or ICD is a cardiac implantable electronic device or CIED. The device is implanted subcutaneously under local anaesthesia, usually below the left clavicle. The electrodes from the device are introduced into the right sided cardiac chambers through a subclavian vein puncture. The ICD senses and analyzes heart rhythm continuously. It can detect life threatening ventricular arrhythmias and treat them electrically.
If a ventricular tachycardia is detected, the ICD tries to overdrive it by fast pacing. If it does not suppress the ventricular tachycardia, the ICD delivers a shock through i...
Source: Cardiophile MD - October 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
