Heart Transplantation with Donor Hearts Harvested After Circulatory Death
Conventionally, heart transplantation is done using donor hearts obtained after brain death of the donor. That means the heart was still beating at the time of harvesting. Now a study published in the New England Journal of Medicine has reported on the utility of reanimated hearts obtained after circulatory death [1]. This if found to be useful in the long term, is certainly going to increase the pool of donor hearts available for the patients in the long waiting list for heart transplantation. It was a multi-center, randomized, non-inferiority trial with assignment in 3:1 ratio. Candidates in the circulatory death grou...
Source: Cardiophile MD - June 10, 2023 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery Source Type: blogs

What is Fontan Paradox?
The term Fontan Paradox was coined by Marc de Leval in 2005 as paradox seen in Fontan circulation with caval hypertension, mainly in the splanchnic region and relative pulmonary arterial hypotension [1,2]. According to him, in a normal biventricular circulation, the mean caval pressures are less than 10 mm Hg and the mean pulmonary arterial pressure is at least 15 mm Hg to keep the pulmonary vasculature patent. He further suggested that a mechanical device capable of producing a step down in pressure energy of 5 mm Hg in the inferior vena cava and producing a step up of 5 mm Hg in the pulmonary arteries could potentially ...
Source: Cardiophile MD - June 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

COAPT Trial of Transcatheter Mitral Valve Repair in Patients with Heart Failure
Patients with heart failure and left ventricular dilatation may have secondary or functional mitral regurgitation. This is due to alteration of the left ventricular geometry producing changes in the functioning of papillary muscles and chordae tendineae and poor coaptation of the mitral leaflets. Secondary mitral regurgitation causes volume overloading of the left ventricle and is associated with reduced survival, increased hospitalization rates and decreased quality of life [1, 2]. Secondary mitral regurgitation can be reduced by guideline directed medical therapy and cardiac resynchronization therapy. This will also pro...
Source: Cardiophile MD - June 5, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Structural Heart Disease Interventions Source Type: blogs

Myocardial Insulin Resistance
Myocardial insulin resistance is said to occur in about 60% of patients with type 2 diabestes mellitus and is associated with higher cardiovascular risk compared to those with insulin sensitive myocardium [1]. It is  known that systemic insulin resistance is an independent risk factor for heart failure and cardiovascular death [2]. Myocardial insulin resistance occuring along with systemic insulin resistance is characterized by ineffecient energy metabolism and contributes to post ischemic heart failure. Myocardial insulin resistance can also be caused by myocardial hypertrophy, independent of systemic insulin resist...
Source: Cardiophile MD - June 3, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Can Febuxostat Protect From Contrast Induced AKI?
Contrast induced acute kidney injury is an important concern in patients undergoing percutaneous coronary interventions due the larger volume of contrast needed in comparison to diagnostic studies. It is more likely in patients undergoing primary angioplasty for acute myocardial infarction because of greater hemodynamic instability and lack of chance for protective measures like pre-procedure hydration. A randomized controlled trial evaluated 120 patients with stage 3 chronic kidney disease who underwent PCI for acute coronary syndrome [1]. 60 patients received Febuxostat in addition to intravenous hydration and N-acetylc...
Source: Cardiophile MD - June 2, 2023 Category: Cardiology Authors: Johnson Francis Tags: Coronary Interventions General Cardiology Source Type: blogs

Causes of heart attack and cardiac arrest in teenagers
A heart attack occurs when blood flow to a part of the heart muscle stops. Heart attacks in teenagers can be caused by rare genetic diseases, such as familial homozygous hypercholesterolemia, which increases blood cholesterol levels, and some rare diseases that affect the blood vessels of the heart, such as Kawasaki disease. Cardiac arrest means the heart stops working completely. A heart attack can lead to cardiac arrest. Inherited diseases like Congenital long QT syndrome and Brugada syndrome that cause cardiac arrhythmias and can also cause cardiac arrest in adolescents. (Source: Cardiophile MD)
Source: Cardiophile MD - June 1, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Clinical Examination of Cardiovascular System For Medical Students
Discussion on blood pressure is not included here as a separate topic is dedicated to it. Though the most commonly examined pulse is the radial, to check some of the characteristics, a more proximal pulse like the brachial or carotid needs to be examined. Following parameters of the pulse are routinely documented: 1. The rate: Normal rate in adult is 60-100 per minute. It is higher in children. Younger the child, higher the pulse rate. Rhythm: Regular and irregular rhythms are possible. Mild variation with respiration is called respiratory sinus arrhythmia, with higher rate in inspiration. Respiratory sinus arrhythmia may...
Source: Cardiophile MD - May 30, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

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