Idiopathic dilated cardiomyopathy
Idiopathic dilated cardiomyopathy is a form of dilated cardiomyopathy with unknown etiology characterised by progressive left ventricular dilatation and systolic dysfunction. Pathologically, there is increase in the size and weight of the heart. There is ventricular dilatation with near normal wall thickness. The myocardial systolic dysfunction is out of portion to the fibrosis.
The incidence of idiopathic dilated cardiomyopathy varies from 3-10 cases per 100,000 population. Death from progressive pump failure occurs at the rate of about 25% in first year, 35-40% in two years and upto 40-80% over five years. Stabiliz...
Source: Cardiophile MD - December 15, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
ECG Changes in Intracranial Hemorrhage
ECG changes are fairly common in intracranial hemorrhage. Giant T inversions with QT interval prolongation may be seen in intracranial hemorrhage even without associated myocardial damage [1]. ECG changes described in subarachnoid hemorrhage include QT interval prolongation, T wave abnormalities and ST segment deviations. Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2].
In a study involving patients with supratentorial hemorr...
Source: Cardiophile MD - November 17, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is SCAPE in Cardiovascular Medicine?
SCAPE is an acronym for sympathetic crash acute pulmonary edema, which can typcially occur in Pickering syndrome with renal artery stenosis [1]. Another term for transient acute pulmonary edema which occurs in renal artery stenosis is flash pulmonary edema. SCAPE is the extreme end of the spectrum of acute pulmonary edema and needs urgent management in the emergency room [2]. Excessive release of catecholamines may increase the permeability of pulmonary capillaries and facilitate flash pulmonary edema [3]. Endothelial dysfunction secondary to excessive activity of renin-angiotenisn-aldosterone axis, impaired synthesis of ...
Source: Cardiophile MD - November 12, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Brugada Syndrome: Diagnosis and Risk Stratification
Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session.
Initial description of Brugada syndrome in 1992 was that of syncopal episodes and/or sudden death in persons with structurally normal heart and a characteristic ECG pattern of right bundle branch block with ST segment elevation in leads V1 to V3. Sometimes individuals with a diagnostic ECG may be totally asymptomatic and may be having a family history of sudden death. Genetic nature of the disorder and mutation in sodium channel gene was described in 1998...
Source: Cardiophile MD - October 27, 2023 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
Rate vs Rhythm Control in Atrial Fibrillation
Rate vs rhythm control as a management strategy in atrial fibrillation has been a long standing topic for debate. Though at one look rhythm control would appear to be the ideal strategy, long term adverse effects of the currently available medications for rhythm control is the often cited down side. AFFIRM [1] and RACE [2] trials were the main reason for the debate as they failed to show any benefit for the rhythm control strategy. AF-CHF trial in those with AF and congestive heart failure also failed to show any advantage for the rhythm control strategy [3]. But there have been important criticisms as well [4]. In AFFIRM...
Source: Cardiophile MD - October 26, 2023 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
Risk of Spontaneous vs Induced Brugada Pattern
It is well known that sodium channel blockers can unmask the ECG pattern in Brugada syndrome. A recent systematic review and meta-analysis evaluated the utility of drug challenge in testing for Brugada syndrome. They found that spontaneous type 1 ECG characterized by coved, down sloping ST elevation with T inversion in right precordial leads had 2.4% annual incidence of serious arrhythmic events. In contrast, those with ECG pattern induced by sodium channel blockers had only 0.65% annual incidence of serious arrhythmic events.
Reference
Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Putthapiban P, Prasitl...
Source: Cardiophile MD - October 19, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How Does Fever Precipitate Arrhythmia in Brugada Syndrome?
In Brugada syndrome dysfunctional voltage gated sodium channels NaV1.5 have delayed activation and earlier inactivation. This leads to shortening of action potential duration. There is additional shortening of action potential duration at higher temperatures. This is the proposed mechanism of precipitation of arrhythmias in Brugada syndrome during febrile episodes. That is why prompt treatment of fever is an important preventive strategy to be deployed in those with Brugada syndrome.
Reference
Krahn AD, Behr ER, Hamilton R, Probst V, Laksman Z, Han HC. Brugada Syndrome. JACC Clin Electrophysiol. 2022 Mar;8(3):386-405. do...
Source: Cardiophile MD - October 17, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Current Role of Digoxin in Heart Failure as Per Guidelines and DIGIT-HF trial of Digitoxin
Use of digoxin in heart failure has come down markedly over the past decades due to concerns of toxicity and availability of more effective medications. Concern for toxicity is because of the narrow therapeutic window of digoxin along with interactions with other cardiovascular drugs and in those with renal dysfunction, which can enhance toxicity. Though an initial loading dose was given earlier, it is no longer used. As per the 2021 ESC guidelines, digoxin may be considered in heart failure with reduced ejection fraction, in sinus rhythm for reducing risk of hospitalizations, though there is no mortality benefit. It may ...
Source: Cardiophile MD - October 16, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Gardner Treadmill Protocol
Gardner Treadmill Protocol, also known as Gardner-Skinner Protocol was described in 1991 [1]. It is used mainly in the evaluation of peripheral arterial disease. The seminal article evaluated the effect of handrail support on claudication distance. Handrail support reduces energy cost of treadmill walking, and can affect claudication distance and hemodynamic responses in persons with peripheral vascular disease. Reliability of tests may also be reduced unless same pressure is applied to the handrails over repeated tests.
Gardner treadmill protocol is a symptom limited one with progressive graded workload having constant s...
Source: Cardiophile MD - October 6, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Climbing More Than Five Flights of Stairs Daily Reduces Risk of Heart Disease!
World Heart Day greetings to all. Climbing more than five flights of stairs every day can reduce the risk of atherosclerotic cardiovascular disease by over 20% according to a study using data from the UK Biobank, published in the journal Atherosclerosis [1]. But beware, those who stop climbing has a higher risk than those who never did it! The study had over four hundred and fifty thousands adult participants. Information about climbing stairs, sociodemographic factors and lifestyle factors were collected at baseline and by a resurvey after 5 years. Median follow up period was 12.5 years. Similar results were noted for bo...
Source: Cardiophile MD - September 29, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Dip and plateau pattern of ventricular pressure tracing in constrictive pericarditis
Thickened and stiff pericardium in chronic constrictive pericarditis has poor compliance reducing the distension of cardiac chambers to a limited fixed total volume. Transmission of intrathoracic pressure to the pericardial cavity is also prevented by thickening of the pericardium [1]. Manifestation of compression occurs when the total cardiac volume reaches the pericardial volume in diastole. The severe restriction causes elevation of pulmonary and systemic venous pressure which becomes equal to diastolic pressures in all cardiac chambers. Relative change is more on the right sided chambers. Inspiratory fall in intratho...
Source: Cardiophile MD - August 31, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How can PDA mask a coarctation of aorta?
Coarctation of aorta may be missed when there is a large patent ductus arteriosus. This is because the ampulla of the ductus arteriosus is typically across the narrowed segment of aorta in coarctation of aorta. The wide ampulla in a way ameliorates the obstruction, making clinical detection of coarctation difficult. A good pulse can be felt in the lower limbs in such situations. There could be sudden deterioration with shock and mult-organ failure when such an associated patent ductus arteriosus is closed in an infant with an undetected coarctation of aorta. Detection of coarctation could also be difficult by transthoraci...
Source: Cardiophile MD - August 25, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Evaluation of Prosthetic Aortic Valve Obstruction
This discussion will focus beyond the basic clinical evaluation, ECG, chest X-ray and hematological workup. Hematological workup is important in aortic valve obstruction because of likelihood of associated hemolytic anemia and acquired von Willebrand Syndrome. Former is due to destruction of red blood cells across the narrowed aortic valve, and latter due to loss of the largest multimers of von Willebrand factor. High shear stress across the narrowed aortic valve exposes a region of the von Willebrand factor which is susceptible to a specific von Willebrand protease. This can lead on to gastrointestinal angiodysplasia (He...
Source: Cardiophile MD - August 9, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Poor Long Term Outcome With Subsequent Pregnancies After Peripartum Cardiomyopathy
This study was from a single centre where mortality in women with peripartum cardiomyopathy was higher than in other studies from the United Studies. Most of the patients were African American and of low socioeconomic status. Earlier studies have clearly demonstrated a different phenotypic presentation and outcome in African American women with peripartum cardiomyopathy compared to non-African American women. African American women had been shown to be diagnosed later, present lower LVEF, larger LV volume and more severe heart failure symptoms. The rate of recovery was lower and time for recovery markedly longer in that pa...
Source: Cardiophile MD - June 28, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
High-Frequency Low-Tidal-Volume Ventilation During Atrial Fibrillation Ablation Improves Long Term Outcome
Catheter ablation for pulmonary vein isolation is an important modality of treatment for paroxysmal atrial fibrillation. It is also useful for persistent atrial fibrillation, though a little less. Importance of maintaining a stable contact force of the catheter during radiofrequency ablation cannot overstressed as it contributes to lesion size and achieving transmural lesion. Both these are important in reducing re-connection of pulmonary veins, an important cause for recurrent atrial fibrillation after catheter ablation. General anaesthesia during procedure reduces the rate of pulmonary vein reconnection and hence recurr...
Source: Cardiophile MD - June 24, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
