Heart pearls! http://www.heartpearls.com For all cardiology enthusiasts! Bonjour! Click on the title above to go to site index so that you can browse the articles! Fri, 18 May 2012 07:15:29 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 ECG of LBBB http://www.heartpearls.com/2012/05/ecg-of-lbbb.html http://www.heartpearls.com/2012/05/ecg-of-lbbb.html#comments Fri, 18 May 2012 07:15:29 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/ecg-of-lbbb.html

 

 

 

 

 

LBBB with LA enlargement

]]> http://www.heartpearls.com/2012/05/ecg-of-lbbb.html/feed 0 ECG in an asymptomatic patient http://www.heartpearls.com/2012/05/ecg-in-an-asymptomatic-patient.html http://www.heartpearls.com/2012/05/ecg-in-an-asymptomatic-patient.html#comments Thu, 10 May 2012 11:48:38 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/ecg-in-an-asymptomatic-patient.html

 

This ECG shows second degree AV block with QRS rate of 60 bpm.

]]> http://www.heartpearls.com/2012/05/ecg-in-an-asymptomatic-patient.html/feed 0 ECG in a patient with exertional angina and exertional dyspnoea http://www.heartpearls.com/2012/05/ecg-in-a-patient-with-exertional-angina-and-exertional-dyspnoea.html http://www.heartpearls.com/2012/05/ecg-in-a-patient-with-exertional-angina-and-exertional-dyspnoea.html#comments Sat, 05 May 2012 06:03:34 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/ecg-in-a-patient-with-exertional-angina-and-exertional-dyspnoea.html

 

 

 

 

The ECG shows LA enlargement as evidenced by P mitrale in lead II and increased P wave duration and LV hypertrophy by voltage criteria. Deep precordial T inversions are seen.

Echo showed hypertrophic cardiomyopathy.

]]> http://www.heartpearls.com/2012/05/ecg-in-a-patient-with-exertional-angina-and-exertional-dyspnoea.html/feed 0 ECG rhythm diagnosis http://www.heartpearls.com/2012/05/ecg-rhythm-diagnosis.html http://www.heartpearls.com/2012/05/ecg-rhythm-diagnosis.html#comments Thu, 03 May 2012 12:05:09 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/ecg-rhythm-diagnosis.html

 

First degree heart block, slight sinus bradycardia.

]]> http://www.heartpearls.com/2012/05/ecg-rhythm-diagnosis.html/feed 0 ECG rhythm strip lead II http://www.heartpearls.com/2012/05/ecg-rhythm-strip-lead-ii.html http://www.heartpearls.com/2012/05/ecg-rhythm-strip-lead-ii.html#comments Thu, 03 May 2012 04:55:57 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/ecg-rhythm-strip-lead-ii.html

 

Atrial fibrillation with controlled ventricular rate.

]]> http://www.heartpearls.com/2012/05/ecg-rhythm-strip-lead-ii.html/feed 0 Gemfibrozil http://www.heartpearls.com/2012/05/gemfibrozil.html http://www.heartpearls.com/2012/05/gemfibrozil.html#comments Tue, 01 May 2012 10:45:38 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/gemfibrozil.html Gemfibrozil is a drug used to treat hypertriglyceridemia. Dose is 600 mg bid. It has to be taken half an hour before meals. It should not be used in renal failure. It is safe in hepatic dysfunction. Most common side effect is dyspepsia. It can cause atrial fibrillation in 1% cases. It may cause myopathy, especially in patients receiving statins. It should not be used with simvastatin or cerivastatin. Co-administration with repaglinide may cause severe hypoglycemia. It may increase warfarin effect. Common trade name is Lopid.

]]> http://www.heartpearls.com/2012/05/gemfibrozil.html/feed 0 Chest X-ray in severe pulmonary artery hypertension http://www.heartpearls.com/2012/05/chest-x-ray-in-severe-pulmonary-artery-hypertension.html http://www.heartpearls.com/2012/05/chest-x-ray-in-severe-pulmonary-artery-hypertension.html#comments Tue, 01 May 2012 10:23:24 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/chest-x-ray-in-severe-pulmonary-artery-hypertension.html

 

Chest X-ray in a patient with severe pulmonary artery hypertension. Dilated main pulmonary artery and right atrial enlargement are clearly seen. There is ventricular enlargement, though overlying breast shadow makes assessment of its type difficult. Peripheral pruning is also not clearly seen.

]]> http://www.heartpearls.com/2012/05/chest-x-ray-in-severe-pulmonary-artery-hypertension.html/feed 0 Chest X-ray in a patient with chest pain. http://www.heartpearls.com/2012/05/chest-x-ray-in-a-patient-with-chest-pain.html http://www.heartpearls.com/2012/05/chest-x-ray-in-a-patient-with-chest-pain.html#comments Tue, 01 May 2012 10:13:04 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/05/chest-x-ray-in-a-patient-with-chest-pain.html

 

60 year old alcoholic male with chest pain.

What is the chest X-ray diagnosis?

 

 

Ans- scroll down

 

 

Bilateral gynecomastia.

]]> http://www.heartpearls.com/2012/05/chest-x-ray-in-a-patient-with-chest-pain.html/feed 0 Who should be screened for secondary hypertension? http://www.heartpearls.com/2012/03/who-should-be-screened-for-secondary-hypertension.html http://www.heartpearls.com/2012/03/who-should-be-screened-for-secondary-hypertension.html#comments Thu, 01 Mar 2012 07:29:19 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/03/who-should-be-screened-for-secondary-hypertension.html
  • Screen for secondary hypertension in the following situations-
    • Young hypertensive- age less than 30 yrs
    • End organ damage- retinal hemorrhage, papilledema, neurological problems, kidney problems
    • Acute BP rise
    • Resistant hypertension- hypertension is not controlled with three antihypertensives of different classes, one of which is a diuretic
  • Renovascular hypertension
    • Most common cause of secondary hypertension
    • Clinical clues
      • Severe hypertension (> 180/120) after 55 yrs
      • Creatinine elevation with antihypertensives
      • Renal size asymmetry more than 1.5 cm
      • Unilateral small kidney < 9 cm
      • Recurrent flash pulmonary edema
      • Renal bruit
  • Kidney disease
    • Suspect if elevated serum creatinine or abnormal urine analysis
  • Primary aldosteronism
    • Main clue is unexplained hypokalemia. Another clue is mild hypernatremia.
    • Serum potassium is normal in more than half
    • If clinical suspicion is high, do ratio of plasma aldosterone to plasma renin (may be falsely elevated in obese)
  • Oral contraceptives
  • Phaeochromocytoma
    • Trial of headache, sweating and palpitations
  • Cushing’s syndrome
    • Moon facies, central obesity, ecchymoses, proximal muscle weakness
  • Sleep apnoea syndrome
  • Coarctation of aorta
  • Hypothyroidism
  • Hyperparathyroidism- elevated serum calcium
    • ]]>     http://www.heartpearls.com/2012/03/who-should-be-screened-for-secondary-hypertension.html/feed 0     Levosimendan http://www.heartpearls.com/2012/02/levosimendan.html http://www.heartpearls.com/2012/02/levosimendan.html#comments Thu, 02 Feb 2012 04:10:50 +0000 Dr Jayachandran Thejus MD http://www.heartpearls.com/2012/02/levosimendan.html
  • Mechanism of action
    • Calcium sensitizer- sensitizes myocardium to calcium
      • Drug binds to troponin C- this stabilizes calcium induced change in tropomyosin- hence actin-myosin crossbridge formation is facilitated and prolonged
      • Contractile apparatus is sensitized to available calcium
      • Since calcium is not increased (unlike other inotropes)-
        • Myocardial oxygen demand is not increased
        • No increase in arrhythmias
      • No binding to troponin C during diastole when calcium level is low (binding to troponin C is dependent on calcium levels)- hence no diastolic dysfunction
    • Vasodilation
      • Decreases preload and afterload
      • Increases coronary perfusion
      • Chance of hypotension
  • Advantages as an inotrope
    • No tachyphylaxis
    • No arrhythmia risk
    • Not antagonized by beta blockers
  • Studies
    • LIDO study
      • Compared levosimendan with dobutamine in heart failure
      • Hemodynamic improvement was more with levosimendan
      • Mortality was lower with levosimendan
    • RUSSLAN study
      • Compared levosimendan with placebo in post MI heart failure
      • Levosimendan decreased mortality and worsening of heart failure
  • Adverse effects
    • Hypotension
    • Headache
  • Available product
    • Injection: 2.5 mg/mL (5 mL, 10 mL)
  • Dosage
    • 6-24 mcg/kg over 10 minutes followed by a continuous infusion of 0.05-0.2 mcg/kg/minute, adjusted according to response.
    • ]]>     http://www.heartpearls.com/2012/02/levosimendan.html/feed 0