Single Frame Echo Quiz
Transcript of the video: Interpreting an echo quiz just from a single frame has a lot of limitations. But, still for an academic exercise, we will try. Unlike the ECG, where a single image may be more informative, echo usually requires moving images. And moreover, even ECG requires a knowledge of the clinical background before interpretation, to avoid errors. Similarly, for echocardiogram, what we would do usually is, first we do a clinical history evaluation, then physical examination, and after that only we proceed with echocardiography in our routine work. But for an academic curiosity, we will just try to interpret an...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
X-Ray Chest PA View in Severe PAH
Transcript of the video: Here is an X-ray chest PA view. The striking finding is the huge enlargement of the right pulmonary artery, almost aneurysmal dilatation of right pulmonary artery. Main pulmonary artery is also grossly dilated. And you can see left pulmonary artery shadow and rest of it is not seen here. It will be behind the main pulmonary artery shadow, because left pulmonary artery descends behind the main pulmonary artery and it will be a retrocardiac shadow. It is not visible here. This is the aortic knuckle. And you are seeing some end on views probably. This could be an end on view. This also could be, but y...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the meaning of 10% gradient on treadmill?
Transcript of the video: A question that is often asked is, what is the meaning of 10% gradient in a treadmill test? Usually, in the first stage of Bruce protocol, of treadmill test, there is a 10% gradient in stage 1. That means, if the treadmill length is 150 centimeters, the front end is elevated, about 15 cm from the ground, so that this produces a slope. So 15 cm elevation for a 150 cm treadmill will give a 10% gradient. This is what happens in stage 1 of standard Bruce protocol. In modified Bruce protocol, there is no gradient in stage 1, so that the treadmill will be horizontal. In stage 2, 5% gradient is given and ...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Electrophysiology Catheters and EP Tracing in Ventricular Pacing
Transcript of the video: Just before discussing about an electrophysiology tracing in ventricular pacing, we will have a look at how the electrodes are placed. This is the left anterior oblique view and right anterior oblique view on fluoroscopy. Multiple catheters can be seen here. Those marked by yellow arrows are not catheters, they are the surface electrodes on the chest, pasted over the chest using usual dot snappers. And, intracardiac electrodes this one is coming from above. It is introduced through the jugular vein, into the coronary sinus. It is a decapolar catheter, meaning 10 poles are there. The poles are numbe...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
ECG Quiz, Focusing Mainly on Rhythm
Here is the transcript of the video: Now we will have an ECG, focusing mainly on the rhythm analysis. That is what we are going to see. Clinical history is currently not available, let us see, what we can make out from the ECG.
If you have a look at this ECG, sometimes, in this region, you may pass off it as just a low normal heart rate with nothing else. But careful analysis in this region will easily tell you that, this is one P wave with a fairly normal PR interval. But you have another P wave here, which is not conducted. So, for two P waves, you have one QRS. You might be tempted to think that this is 2:1 AV block. Th...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Why is an Implantable Defibrillator NOT Useful Soon After Myocardial Infarction?
Here is the transcript of the video: Implantable defibrillator is an important life saving device. It can automatically detect life threatening ventricular arrhythmias and treat them, either with a shock or, sometimes by overdrive pacing. Then, why is it mentioned that, implanting a defibrillator soon after an acute myocardial infarction, in those with left ventricular dysfunction and prone for ventricular arrhythmias and sudden cardiac death, is not useful?
This a representative image, showing the implanted defibrillator, and two shock coils, one in the superior vena cava and another in the right ventricle. These are high...
Source: Cardiophile MD - March 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Micro and Nanoplastics and Cardiovascular Events – Recent Study
Use of plastics in daily life is currently on the increase and it is a well known pollutant in our water bodies like rivers, ponds, lakes and ocean. Plastics can be degraded into microplastics which are smaller than 5 mm and nanoplastics which are smaller than 1000 nanometer [1]. Microplastics and nanoparticles can trigger toxicologic effects in the body [2]. Both microplastics and nanoplastics can enter our body through ingestion, inhalation and even by topical exposure on the skin. According to a webpage from United States National Oceanic and Atmospheric Administration (NOAA), microbeads which are a type of microplastic...
Source: Cardiophile MD - March 8, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Echocardiogram in Rheumatic Mitral and Aortic Regurgitation
Transcript of the video: This is an apical five chamber view and this is an apical four chamber view. You can see four chambers – RV, LV, RA, LA, and the transducer location is here. And this is five chamber because, in addition you are seeing the aorta also. Right atrium has not been labelled. In this view, you can see that mitral leaflets are thickened.
This is anterior mitral leaflet, thickened, and in the closed position of mitral valve, when there should be no flow to the left atrium, you are seeing a jet, a mosaic jet, which has been traced out. Multi-coloured jet due to high velocity and turbulence. That is wh...
Source: Cardiophile MD - March 6, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Higher Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation Noted After Spinal Cord Injury
There are several factors which increase the risk of cardiovascular disease in survivors of spinal cord injury. They have a greater prevalence of obesity, dyslipidemia, metabolic syndrome and diabetes mellitus. Energy expenditure is lesser both due to lack of motor function and lack of opportunities to engage in physical activity. Autonomic dysfunction caused by spinal cord injury is associated with abnormalities in blood pressure, heart rate variability, arrhythmias and blunted cardiovascular response to exercise which can limit the capacity to perform physical activity [1].
A recent large study from Korea compared over 5...
Source: Cardiophile MD - February 27, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Left Ventricular Noncompaction
Left ventricular noncompaction is an incidental echocardiographic finding in some while others may be symptomatic. In left ventricular noncompaction, there is a thin subepicardial compact layer and a thick subendocardial layer which is non-compact and has prominent trabeculations and recesses between the trabeculae. Blood flow into and out of these recesses can provide a spectacular view on colour Doppler echocardiography, almost looking like flames of fire near the apex, in the apical four chamber view. When non-compaction is associated with left ventricular dysfunction it is called left ventricular non-compaction cardiom...
Source: Cardiophile MD - February 26, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Phenotypes in Arrhythmogenic Cardiomyopathy
Arrhythmogenic Cardiomyopathy was better known as Arrhythmogenic Right Ventricular Dysplasia or ARVD and sometimes as Arrhythmogenic Right Ventricular Cardiomyopathy or ARVC earlier. When left ventricular [1] and biventricular involvement became increasingly recognized, the terminology has been revised to Arrhythmogenic Cardiomyopathy. A study published in JACC has compared the phenotypic expression and clinical outcomes in patients with arrhythmogenic cardiomyopathy [2]. Of the 446 patients, 44% had arrhythmogenic right ventricular cardiomyopathy, while 23% had arrhythmogenic left ventricular cardiomyopathy. 33% had bive...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
Fontan Fenestration: To do or not to do?
Leaving a fenestration in the interatrial septum during a Fontan repair is useful in relieving the central venous congestion when pulmonary blood flow is driven by venous pressure in Fontan repair. Data from a multicenter Pediatric Heart Network has been published in JACC: Advances [1]. Subjects were between 2-6 years at Fontan surgery done between 2010 and 2020 with cardiac catheterization done within 1 year prior to the surgery. Fenestration was done in 465 of the 702 patients. Interestingly placement of fenestration was associated with center and Fontan type – whether it was lateral tunnel or extra cardiac. Shorte...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery General Cardiology Source Type: blogs
Fetal aortic valvuloplasty
is considered for fetuses with severe valvar aortic stenosis and echocardiographic features suggesting a risk of progression to hypoplastic left heart syndrome. Though surgical options are available for infants with hypoplastic left heart syndrome, morbidity and mortality are high. So if progression to hypoplastic left heart syndrome can be prevented by fetal aortic valvuloplasty, that would be theoretically a great boon. But centers which offer fetal aortic valvuloplasty are very few and cases suitable for fetal aortic valvuloplasty are quite rare. Hence there is difficulty in attaining good case volumes for optimal proc...
Source: Cardiophile MD - February 22, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Structural Heart Disease Interventions Source Type: blogs
Role of ultrahigh-spatial-resolution photon-counting CT in assessment of coronary artery disease
I had posted about photon counting CT which converts X-rays directly to electronic signals unlike conventional CT which converts X-rays first to light and then to electronic signals. Direct conversion allows low energy photons to be differentiated from electronic noise. When data is acquired directly from photons of different energy levels, better contrast-to-noise ratio can be realized. Photon-counting-detector CT also improves spatial resolution. A study published in Radiology, the flagship journal of the Radiological Society of North America evaluated both in vivo and in vitro coronary stenosis using ultrahigh-sp...
Source: Cardiophile MD - February 22, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Greater Benefit for Women with Leisure Time Physical Activity
It is well known that regular physical activity can reduce cardiovascular and all-cause mortality. Female individuals usually lag behind male individuals in exercise programs. But a study involving over four hundred thousand adults in the United States of America showed that women derive greater gains in all-cause and cardiovascular mortality risk reduction from equivalent levels of leisure-time physical activity [1]. The study had nearly 5 million person-years of follow up. Regular leisure-time physical activity was associated with 24% lower risk of all-cause mortality in females while the corresponding figure for males w...
Source: Cardiophile MD - February 20, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
