Monday 27 April 2015
Sunday 26 April 2015
WPW syndrome associated with left sided posterior-lateral bundle of Kent
 |
| Kent bundle is located in the left posterior lateral aspect of left ventricle because delta wave and QRS are positive in V1 &V2 and there is left axis deviation |
Friday 24 April 2015
You can't outrun a bad diet
"It's time to wind back the harms caused by the junk food industry's public relations machinery. Let's bust the myth of physical inactivity and obesity," they write. "You can't outrun a bad diet."
http://www.cbsnews.com/news/the-key-to-weight-loss-you-cant-outrun-a-bad-diet/
http://www.cbsnews.com/news/the-key-to-weight-loss-you-cant-outrun-a-bad-diet/
Thursday 23 April 2015
Tuesday 21 April 2015
Sunday 19 April 2015
Beauty, the body, and identity
Beauty, the body, and identity
The body is our closest ally and
our greatest enemy. We inhabit it
and cannot escape it. We wake with
it and we die with it. The body will
kill us, even when our minds resist.
The body is a source of our shame
as well as an expression of our pride.
Our body is our primordial identity.
But still we ask: who are we, what
are we? Although it would be foolish
to think that ancient Greek art
can provide simple answers to our
questions, it certainly can provoke
thoughts and responses that will
illuminate these questions in
extraordinary ways.
Beauty, the body, and identity - The Lancet
-Richard Horton
Email:richard.horton@lancet.com
Wednesday 15 April 2015
Tuesday 14 April 2015
Is your heart age older than you? My heart age is 34, what’s yours?
http://www.heartage.me/your-heart-age/you
Did you know that your heart age can be older than your actual age? More than 6 million people have already taken our test around the world. Join them today to find out your heart age and how to improve it.
Did you know that your heart age can be older than your actual age? More than 6 million people have already taken our test around the world. Join them today to find out your heart age and how to improve it.
Primary mitral regurgitation
1.Define :Primary MR is characterized by pathology of the valvular apparatus, to include the leaflets, chordae, papillary muscles, or annulus. Secondary regurgitation typically results from left ventricular (LV) dysfunction, which alters LV wall motion and geometry, tethering the leaflets and causing malcoaptation. The amount of regurgitant volume that may cause adverse outcomes differs between primary and secondary MR; amounts that would be considered only “moderate” in a case of primary MR may be “severe” when the etiology is secondary.
2.Severe primary mitral regurgitation :The rule of 567=5:Regurgitation fraction is 50% or more;6 :Regurgitation volume is 60 ml or more and 7:Vena contracta is 0.7 or more .
3.Acute severe may be faintly audible or not at all audible because of very high left atrial pressure.There during PBMV auscultate for residual MS but not for appearance of severe MR (Pressure tracing,ECHO and symptom would tell).
Severe MR[Rule of 4,5,6,7]
Vena contracta of the mitral regurgitation jet ≥0.7 cm
Regurgitant volume ≥60 ml
Regurgitant fraction ≥50%
Effective regurgitant orifice area of ≥0.4 cm2
LV dilation
2.Severe primary mitral regurgitation :The rule of 567=5:Regurgitation fraction is 50% or more;6 :Regurgitation volume is 60 ml or more and 7:Vena contracta is 0.7 or more .
3.Acute severe may be faintly audible or not at all audible because of very high left atrial pressure.There during PBMV auscultate for residual MS but not for appearance of severe MR (Pressure tracing,ECHO and symptom would tell).
Severe MR[Rule of 4,5,6,7]
Vena contracta of the mitral regurgitation jet ≥0.7 cm
Regurgitant volume ≥60 ml
Regurgitant fraction ≥50%
Effective regurgitant orifice area of ≥0.4 cm2
LV dilation
Alcohol is not for good
The occurrence of cardiovascular disease (CVD) events remains the number one cause of death worldwide. Therefore, the definition of potentially modifiable targets to reduce the incidence of CVD remains a key public health priority. While excessive alcohol consumption is a major contributor to the occurrence of non-cardiovascular morbidity and mortality, a large body of evidence suggests that individuals consuming low to moderate amounts of alcohol have a lower risk of suffering from some, but not all CVD outcomes. For example, previous studies found a linear inverse relationship between alcohol consumption and the occurrence of ischaemic heart disease or myocardial infarction, and a U-shaped association of alcohol consumption with the occurrence of sudden cardiac death. In contrast, low to moderate amounts of alcohol intake have not been found to be protective for the incidence of atrial fibrillation or stroke.
Monday 13 April 2015
Saturday 11 April 2015
Friday 10 April 2015
Thursday 9 April 2015
Wednesday 8 April 2015
Classification of endoleaks after endovascular aneurysm repair.
(Ib) perigraft flow occurring distally, and (Ic) perigraft flow around
an iliac artery occlusion device.
Type II(Branch):Branch arteries back-bleed because of collateral flow. These
endoleaks include (IIa) back-bleeding inferior mesenteric artery
and (IIb) back-bleeding lumbar artery.
Type III :Flow persists between the segments of a modular graft and
include (IIIa) leaks between iliac limbs or an iliac limb and main
body component and (IIIb) leaks between main body components.
Type IV(Porosity) :Flow is present through endograft material (graft porosity).
Type V(Endotension) :(V), Persistent or recurrent pressurization of the
aortic aneurysm exists in the absence of demonstrable endoleak.
References
Eliason JL, Upchurch GR Jr. Endovascular abdominal aortic aneurysm
repair. Circulation. 2008;117:1738–1744.
Tuesday 7 April 2015
Left pulmonary artery hypoplasia is associated with Tetralogy of Fallot's
 |
| Large patent doctus arteriosus supporting blood supply to left lung |
 |
| A large collateral from descending thoracic aorta supporting left lung blood supply |
 |
| Diminutive pulmonary artery due to hypoplasia with narrowed left pulmonary artery |
Sunday 5 April 2015
Aortic arch anatomy variations in human
The aortic arch can be characterized into three types based on the vertical distance from the origin of the innominate artery to the top of the arch
Type A-. A type 1 arch has a distance that is less than one times the diameter of the left common carotid artery (CCA). A type 2 arch originates from one to two CCA diameters from the top of the arch, and a type 3 arch originates more than 2 CA diameters from the top of the arch
Type B and C -Left common carotid artery from innominate artery
Type D-True bovine arch
Type E-Arteria lusoria
Saturday 4 April 2015
Cardiac resynchronization therapy
Before CRT -
1. AHA criteria for CRT indication -OK
2. Coronary Angiogram to rule out ischemic left ventricular dysfunction [CAG/SPECT/CMRI]
4. Coronary sinus angiogram in AP/RAO/LAO view to find suitable coronary vein tributary to place the left ventricular lead and antecubetal vein angiogram to rule anomalous venous system on the day
1.2
On the day of CRT
1. Keep coronary angiogram on screen of AP view
2. TPI in place through transfemoral
3. Scrub
4. Left infraclavicular local anaesthesia
5. Insert 3 short guide wire into IVC
6. Introduce 10Fr coronary sinus sheath
7. Repeat coronary sinus venogram to find suitable LV tributary if already documented view is not well profiled
LV lead insertion
7. Release one lead for introduce 10Fr sheath for left ventricular lead
8. Take JR -4Fr through 10Fr sheath and enter 10Fr sheath into coronary sinus
9. Advance 4Fr JR into the suitable left coronary sinus tributary [upper most and left most]
10. Remove terumo and JR keeping 10Fr in CS
11. Take reverse barman or 20ml syringe, do a coronary sinus venogram to find a suitable tributary
11. Load PTCA wire into LV lead and shape the tip of PTCA wire by giving double bend
12. Introduce LV lead into a pilable sheath then introduce same into 10Fr
13. Advance PTCA wire into suitable tributary
14. Move the LV lead into the above
15. Check threshold and if ok
16. Remove the pilable 10Fr and release its hub through sleeve of LV lead and lead screwing end
17. Secure LV lead into pocket using proline 2-0
18. Then introduce RV tin lead
19. Introduce RA appendage lead
20. Test each one for threshold, cough and deep inspiration and diaphragm contraction
21, Connect lead CRT device -top to RAA, MIDDLE-rv and bottom-lv, never forget to check lead connection proper also by their assigned number
22. Most of the procedure like PPI 23. Keep lead loops behind the PG by that you would not cut them on next visit
24. Keep the connecting side to left and top and the trade mark on PG should look anterior
25. Fix PG to both upper and lower part inside.
26. Complete like PPI
After CRT
-Immediate Chest X-Ray to rule out pneumothorax
-Watch for pocket hemotoma at earliest
-
1. AHA criteria for CRT indication -OK
2. Coronary Angiogram to rule out ischemic left ventricular dysfunction [CAG/SPECT/CMRI]
4. Coronary sinus angiogram in AP/RAO/LAO view to find suitable coronary vein tributary to place the left ventricular lead and antecubetal vein angiogram to rule anomalous venous system on the day
1.2
On the day of CRT
1. Keep coronary angiogram on screen of AP view
2. TPI in place through transfemoral
3. Scrub
4. Left infraclavicular local anaesthesia
5. Insert 3 short guide wire into IVC
6. Introduce 10Fr coronary sinus sheath
7. Repeat coronary sinus venogram to find suitable LV tributary if already documented view is not well profiled
LV lead insertion
7. Release one lead for introduce 10Fr sheath for left ventricular lead
8. Take JR -4Fr through 10Fr sheath and enter 10Fr sheath into coronary sinus
9. Advance 4Fr JR into the suitable left coronary sinus tributary [upper most and left most]
10. Remove terumo and JR keeping 10Fr in CS
11. Take reverse barman or 20ml syringe, do a coronary sinus venogram to find a suitable tributary
11. Load PTCA wire into LV lead and shape the tip of PTCA wire by giving double bend
12. Introduce LV lead into a pilable sheath then introduce same into 10Fr
13. Advance PTCA wire into suitable tributary
14. Move the LV lead into the above
15. Check threshold and if ok
16. Remove the pilable 10Fr and release its hub through sleeve of LV lead and lead screwing end
17. Secure LV lead into pocket using proline 2-0
18. Then introduce RV tin lead
19. Introduce RA appendage lead
20. Test each one for threshold, cough and deep inspiration and diaphragm contraction
21, Connect lead CRT device -top to RAA, MIDDLE-rv and bottom-lv, never forget to check lead connection proper also by their assigned number
22. Most of the procedure like PPI 23. Keep lead loops behind the PG by that you would not cut them on next visit
24. Keep the connecting side to left and top and the trade mark on PG should look anterior
25. Fix PG to both upper and lower part inside.
26. Complete like PPI
After CRT
-Immediate Chest X-Ray to rule out pneumothorax
-Watch for pocket hemotoma at earliest
-
Friday 3 April 2015
Wednesday 1 April 2015
Five follow up result for TAVI is comparable to surgery in high risk group
SAN DIEGO — In this video, Steven R. Bailey, MD, chief of cardiology at the University of Texas Health Sciences Center and Cardiology Today's Intervention Editorial Board member, discusses results from three late-breaking trials evaluating percutaneous valve technology presented at the American College of Cardiology Scientific Sessions.
He said that the 5-year results from PARTNER 1, 2-year data from CoreValve High Risk and 30-day from the PARTNER II S3 trials consistently indicate the benefits of transcatheter aortic valve replacement systems.
In PARTNER 1, researchers evaluated inoperable and operable patients, and found that TAVR recipients "feel better, live longer and live better" with a lower cost of care, Bailey said. He added that the 5-year data suggest continued valve performance without degeneration — and, in fact, that hemodynamics in the valve area were improved compared with surgery. The similar outcomes observed between surgery and TAVR recipients allow for confidence that TAVR is a viable alternative treatment, even among high-risk patients, Bailey said.
The CoreValve High Risk study compared the self-expanding transcatheter valve (CoreValve, Medtronic) with surgery, and the researchers observed better outcomes with the CoreValve at both 1 year and 2 years. Bailey said these results were "incredibly exciting," and stressed that these improved outcomes were present across all patient subtypes, regardless of age, sex, diabetes status or surgical risk.
The PARTNER II S3 trial evaluated 30-day outcomes from TAVR with the Sapien 3 system (Edwards Lifesciences) compared with earlier-generation devices. Bailey said there was a significant improvement in mortality and significant decrease in leak around the valve, which correlates with long-term outcomes. He added that these results suggest "significant progress" with the new TAVR technologies, which will continue to improve over time and offer further benefit for patients.
http://www.healio.com/cardiology/intervention/news/online/%7B9cb06d31-1b8a-45e9-a97d-c89f3527cc36%7D/video-results-from-three-trials-suggest-significant-progress-for-tavr-technology
He said that the 5-year results from PARTNER 1, 2-year data from CoreValve High Risk and 30-day from the PARTNER II S3 trials consistently indicate the benefits of transcatheter aortic valve replacement systems.
In PARTNER 1, researchers evaluated inoperable and operable patients, and found that TAVR recipients "feel better, live longer and live better" with a lower cost of care, Bailey said. He added that the 5-year data suggest continued valve performance without degeneration — and, in fact, that hemodynamics in the valve area were improved compared with surgery. The similar outcomes observed between surgery and TAVR recipients allow for confidence that TAVR is a viable alternative treatment, even among high-risk patients, Bailey said.
The CoreValve High Risk study compared the self-expanding transcatheter valve (CoreValve, Medtronic) with surgery, and the researchers observed better outcomes with the CoreValve at both 1 year and 2 years. Bailey said these results were "incredibly exciting," and stressed that these improved outcomes were present across all patient subtypes, regardless of age, sex, diabetes status or surgical risk.
The PARTNER II S3 trial evaluated 30-day outcomes from TAVR with the Sapien 3 system (Edwards Lifesciences) compared with earlier-generation devices. Bailey said there was a significant improvement in mortality and significant decrease in leak around the valve, which correlates with long-term outcomes. He added that these results suggest "significant progress" with the new TAVR technologies, which will continue to improve over time and offer further benefit for patients.
http://www.healio.com/cardiology/intervention/news/online/%7B9cb06d31-1b8a-45e9-a97d-c89f3527cc36%7D/video-results-from-three-trials-suggest-significant-progress-for-tavr-technology
Use of IABP was not found to improve mortality among patients with acute myocardial infarction in the RCTs
Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction:A Meta-analysis
http://archinte.jamanetwork.com/article.aspx?articleID=2210888
Importance Intra-aortic balloon pump (IABP) therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Guidelines, which previously strongly recommended it, have recently undergone substantial change.
Objective To assess IABP efficacy in acute myocardial infarction.
Data Sources Human studies found in Pubmed, Embase, and Cochrane libraries through December 2014 and in reference lists of selected articles. Search strings were “myocardial infarction” or “acute coronary syndrome” and “intra-aortic balloon pump” or “counterpulsation.”
Study Selection Randomized clinical trials (RCTs) and observational studies comparing use of IABP with no IABP in patients with acute myocardial infarction.
Data Extraction and Synthesis Two reviewers independently extracted the data, and risk of bias in RCTs was assessed using the Cochrane risk of bias tool. We conducted separate meta-analyses of the RCTs and observational studies. Data were quantitatively synthesized using random-effects meta-analysis.
Main Outcomes and Measures Thirty-day mortality.
Results There were 12 eligible RCTs randomizing 2123 patients. In the RCTs, IABP use had no statistically significant effect on mortality (odds ratio [OR], 0.96 [95% CI, 0.74-1.24]), with no significant heterogeneity among trials (I2 = 0%; P = .52). This result was consistent when studies were stratified by the presence (OR, 0.94 [95% CI, 0.69-1.28]; P = .69, I2 = 0%) or absence (OR, 0.98 [95% CI, 0.57-1.69]; P = .95, I2 = 17%) of cardiogenic shock. There were 15 eligible observational studies totaling 15 530 patients. Their results were mutually conflicting (heterogeneity I2 = 97%; P < .001), causing wide uncertainty in the summary estimate for the association with mortality (OR, 0.96 [95% CI, 0.54-1.70]). A simple index of baseline risk marker imbalance in the observational studies appeared to explain much of the heterogeneity in the observational data (R2meta = 46.2%; P < .001).
Conclusions and Relevance :Use of IABP was not found to improve mortality among patients with acute myocardial infarction in the RCTs, regardless of whether patients had cardiogenic shock. The observational studies showed a variety of mutually contradictory associations between IABP therapy and mortality, much of which was explained by the differences between studies in the balance of risk factors between IABP and non-IABP groups.
http://archinte.jamanetwork.com/article.aspx?articleID=2210888
Importance Intra-aortic balloon pump (IABP) therapy is a widely used intervention for acute myocardial infarction with cardiogenic shock. Guidelines, which previously strongly recommended it, have recently undergone substantial change.
Objective To assess IABP efficacy in acute myocardial infarction.
Data Sources Human studies found in Pubmed, Embase, and Cochrane libraries through December 2014 and in reference lists of selected articles. Search strings were “myocardial infarction” or “acute coronary syndrome” and “intra-aortic balloon pump” or “counterpulsation.”
Study Selection Randomized clinical trials (RCTs) and observational studies comparing use of IABP with no IABP in patients with acute myocardial infarction.
Data Extraction and Synthesis Two reviewers independently extracted the data, and risk of bias in RCTs was assessed using the Cochrane risk of bias tool. We conducted separate meta-analyses of the RCTs and observational studies. Data were quantitatively synthesized using random-effects meta-analysis.
Main Outcomes and Measures Thirty-day mortality.
Results There were 12 eligible RCTs randomizing 2123 patients. In the RCTs, IABP use had no statistically significant effect on mortality (odds ratio [OR], 0.96 [95% CI, 0.74-1.24]), with no significant heterogeneity among trials (I2 = 0%; P = .52). This result was consistent when studies were stratified by the presence (OR, 0.94 [95% CI, 0.69-1.28]; P = .69, I2 = 0%) or absence (OR, 0.98 [95% CI, 0.57-1.69]; P = .95, I2 = 17%) of cardiogenic shock. There were 15 eligible observational studies totaling 15 530 patients. Their results were mutually conflicting (heterogeneity I2 = 97%; P < .001), causing wide uncertainty in the summary estimate for the association with mortality (OR, 0.96 [95% CI, 0.54-1.70]). A simple index of baseline risk marker imbalance in the observational studies appeared to explain much of the heterogeneity in the observational data (R2meta = 46.2%; P < .001).
Conclusions and Relevance :Use of IABP was not found to improve mortality among patients with acute myocardial infarction in the RCTs, regardless of whether patients had cardiogenic shock. The observational studies showed a variety of mutually contradictory associations between IABP therapy and mortality, much of which was explained by the differences between studies in the balance of risk factors between IABP and non-IABP groups.
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