Echocardiographic signs in acute cardiovascular conditions
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This document provides signs and findings on echocardiography for diagnosing four acute cardiovascular conditions: systolic heart failure, heart failure with preserved ejection fraction, pulmonary embolism, and tamponade. For each condition, it lists key echocardiographic findings including measurements of cardiac chambers and valves, velocities, and motion abnormalities that are indicative of the condition.
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I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
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2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
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Diastolic dysfunction
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Non-invasive haemodynamic monitoring by Echocardiography
A lecture highlighting the role of Echocardiography as a major hemodynamic monitoring tool in the Intensive Care settings and the assessment of loading conditions.
Regurgitant Valvular Heart Diseases.pptx
Regurgitant Valvular heart diseases clinical presentation, diagnosis, workup and management MR, TR, AR, PR
Aortic valve stenosis
This document discusses aortic stenosis (AS) across different age groups and etiologies. It covers symptoms, physical exam findings, diagnostic criteria based on valve area and gradients, and indications for intervention. AS presents asymptomatically in early stages but can progress to cause angina, syncope and dyspnea from increased left ventricular pressure and reduced coronary flow. Physical exam may reveal delayed upstroke of the pulse and apical impulse. Diagnosis is made using echocardiography to measure valve area and gradients. Guidelines recommend intervention for severe AS or worsening symptoms.
AORTIC VALVE DS.pptx
This document discusses the etiology, pathophysiology, clinical features, investigations, and treatment of aortic regurgitation and aortic stenosis. It provides details on:
1. The various causes of aortic regurgitation including congenital bicuspid valve, connective tissue disorders like Marfan's syndrome, rheumatic heart disease, and infective endocarditis.
2. The typical asymptomatic phase of chronic aortic regurgitation and signs of left ventricular dysfunction like reduced ejection fraction and heart failure symptoms.
3. The characteristic physical exam findings of aortic regurgitation including widened pulse pressure, diastolic murmur, and signs related to abrupt distension and collapse of arteries
Echocardiography
This document provides information on various cardiac diagnostic tests and procedures, including their indications and findings. Echocardiography can be used to evaluate valvular heart disease, tumors, and left ventricular function. Doppler echocardiography is used to quantify valvular diseases and intracardiac shunts. Exercise stress testing is used to diagnose coronary artery disease and evaluate cardiac function and arrhythmias. Abnormal findings on stress tests indicate higher cardiac risk. Holter monitoring documents rhythm disturbances over 24 hours. Myocardial perfusion scans identify ischemia, and abnormal scans indicate higher risk. Cardiac catheterization and coronary angiography visualize coronary arteries and are used to evaluate chest pain and dysfunction. Electrocardiograms can diagnose conditions
Common chest x rays and common ecgs
This document provides an overview of common chest x-rays and electrocardiograms (ECGs). It discusses how to read ECGs, including assessing heart rate, rhythm, intervals, axis, and signs of chamber enlargement or blocks. Common arrhythmias like SVT, VT, atrial flutter are described. Chest x-ray findings for conditions like consolidation, atelectasis, pleural effusion, pneumothorax, pulmonary edema, emphysema, lung tumors and pneumonia are also reviewed. The document aims to equip readers with the basics of interpreting these common diagnostic imaging tests.
Tricuspid pulmonary valves
This document provides an overview of tricuspid and pulmonary valve diseases. It discusses the anatomy of the right atrium, right ventricle, and tricuspid valve. It then covers tricuspid stenosis, including causes, chest X-ray findings, echocardiography findings, and severity assessment. Tricuspid regurgitation is also discussed, including causes, chest X-ray findings, and echocardiography findings. MRI and CT imaging of tricuspid valve disease is briefly mentioned. The document concludes by stating that Ebstein anomaly is a myopathy.
Aortic acceleration as a noninvasive index of left ventricular contractility ...
Aortic acceleration as a noninvasive index of left ventricular contractility ...Scintica Instrumentation
Key topics covered during this webinar include:
Evaluating cardiac contractility using mean or peak aortic acceleration
Investigating cardiac relaxation using mitral peak early velocity to peak atrial velocity ratio
Interpreting myocardial perfusion capacity through coronary flow reserve at baseline and with disease or other conditions
How Doppler Flow Velocity measurements can be used in translational research from mice to mammals
In a recent ground-breaking publication in Scientific Reports by Nature Research, Perez et al. highlight the use of noninvasive blood flow velocity measurements to quantify cardiac contractility as a surrogate to +dP/dt max. The article titled “Aortic acceleration as a noninvasive index of left ventricular contractility in the mouse” describes an alternate methodology to what is highly considered the gold standard for evaluating cardiac contractility and relaxation in preclinical research. The acute and terminal nature of acquiring +dP/dt using invasive blood pressure catheters is less than ideal, so finding a noninvasive surrogate is of great interest to the scientific research community.
Utilizing a Doppler Flow Velocity System (DFVS) from Indus Instruments, Dr. Reddy and his group show that peak acceleration in the ascending aorta can be used in place of invasive LVP catheters. This novel technique enables serial measurements in the same animal, which reduces animal-to-animal variability, allows for the use of fewer subjects, and decreases data collection time.
Please join us during our upcoming webinar on March 4th, 2021 at 11am EST to hear Dr. Reddy present his findings with a LIVE Q&A session at the end.
References:
Perez, J.E.T., Ortiz-Urbina, J., Heredia, C.P. et al. Aortic acceleration as a noninvasive index of left ventricular contractility in the mouse. Sci Rep 11, 536 (2021)Cardiovascular monitoring final ppt.pptx
This document provides an overview of cardiac monitoring techniques including pulmonary artery catheters, transesophageal echocardiography, and coagulation monitoring. It discusses the indications, contraindications, and complications of pulmonary artery catheters. It also describes the waveforms seen in different cardiac chambers and how they can help assess cardiac function. Transesophageal echocardiography views and the structures they allow viewing are outlined. Coagulation monitoring with heparin and the activated clotting time during cardiac surgery is summarized, along with complications like heparin resistance and heparin-induced thrombocytopenia.
Pare
This document summarizes cyanotic congenital heart disease. It describes:
1) The classification of congenital heart diseases into left to right shunts, right to left shunts, and obstructive lesions.
2) The causes of cyanosis including right to left shunting defects like tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, and total anomalous pulmonary venous return.
3) The clinical presentation, evaluation, and management of cyanotic spells in tetralogy of Fallot patients and the surgical repairs for various cyanotic congenital heart defects.
Echocardiographic assesment of systolic and diastolic dysfunction
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
Carotid doppler study pk
This presentation includes nice carotid doppler and nice explantion for radiology resident. This presentation includes nice doppler images . Thanks
Use of echocardiography in icu
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
Similar to Echocardiographic signs in acute cardiovascular conditions (20)
ECHOCARDIOGRAPHIC EVALUATION of LEFT VENTRICULAR DIASTOLIC FUNCTION toufiqur ...
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1Hemodynamics of constrictive pericarditis dr deepak raju
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Non-invasive haemodynamic monitoring by Echocardiography
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Aortic acceleration as a noninvasive index of left ventricular contractility ...
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Echocardiographic assesment of systolic and diastolic dysfunction
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COMPLETE ATRIOVENTRICULAR HEART BLOCK.pptx
first degree second degree and third degree atrioventricular block
Willens's syndrome.pptx
A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
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Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...https://aiimsbhubaneswar.nic.in/
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
- The sites of origin for supraventricular tachycardia (SVT) and ventricular arrhythmias.
- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...https://aiimsbhubaneswar.nic.in/
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
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Echocardiographic signs in acute cardiovascular conditions
- 1. Signs in acute cardiovascular conditions Echocardiography
- 2. Thumbnails Systolic heart failure Heart failure with preserved left ventricular ejection Pulmonary embolism Tamponade
- 3. Explanation • E: early mitral inflow velocity • e′: early diastolic mitral annular velocity • A: duration of the pulmonary flow reversal • Ar: duration of the A-wave • DT: deceleration time
- 4. Systolic heart failure 1. LVEF<45–50% 2. LVEDD >55 mm and/or > 32 mm/m² 3. LVESD >45 mm and/or 25 mm/m² 4. LVEDV > 97 ml/m² 5. LVESV > 43 ml/m² 6. Abnormal wall motion(Global or RWMA) 7. Functional MR and/or TR 8. Peak tricuspid velocity >3 m/s 9. Aortic time velocity integral <15 cm 10. Diastolic dysfunction 11. E/A ≥ 2 + DT < 150 ms indicates increased LV filling pressures
- 5. Heart failure with preserved left ventricular ejection 1. LVEF ≥ 50% 2. LVEDV< 97 ml/m² 3. LVESV< 43 ml/m² 4. E/e′ ≥13 5. Ar – A ≥ 30 ms 6. LA volume ≥ 34 ml/m² 7. Peak tricuspid velocity > 3 m/s 8. Ultrasound lung cometsc + signs and symptoms of heart failure
- 6. Pulmonary embolism 1. Thrombus in right chambers 2. Abnormal septal motion 3. Dilatation RA, RV 4. End diastolic RV/LV diameter > 0.6 or area > 1.0 5. Global RV hypokinesia 6. McConnell sign 7. Mild to severe TR 8. PAH:40–50 mmHg (>60 mmHg in the case of pre-existing pulmonary hypertension)
- 7. Tamponade 1. Small in acute & large in chronic pericardial effusion 2. Swinging heart(frog in the well) 3. RA collapse (rarely LA) 4. Diastolic collapse of the anterior RV-free wall (rarely LV) 5. IVC dilatation (no collapse with inspiration) 6. TV flow increases and MV flow decreases during inspiration (reverse in expiration):Very good couple 7. Systolic and diastolic flows are reduced in systemic veins in expiration and reverse flow with atrial contraction is increased
- 8. Cute little