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Author Archives: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin
Cardiology question / answer session 2
What are the possible types of Wide QRS tachycardia at a rate of 300 per min? 1. Atrial fibrillation with WPW syndrome – rate is fast due to [..]
Mahaim fibre tachycardia
No delta wave in sinus rhythm. It is a form of pre-excitation. Mahaim fibres do not conduct retrogradely. So tachycardia is always with wide QRS complexes – anti [..]
Peripheral Intra Arterial Thrombolysis
Cannulate the vessel and pass a guide wire across the thrombus before thrombolysis. Heparin is given intravenously as soon as the guide wire passes the thrombus. Heparin bolus [..]
Stentless bioprosthetic valve
Stentless bioprosthetic valve produces better exercise hemodynamics and greater regression of left ventricular hypertrophy when used in the aortic position They have a better orifice size for a given [..]
Prosthetic valve degeneration
“Creep” seen in Hancock bioprosthesis is due to bending of the struts. It is not obvious on echocardiographic imaging, but increases the transvalvar gradient as measured by Doppler echocardiography. Mechanical [..]
Management of prosthetic valve thrombosis
If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus [..]
Prosthetic valve associated hemolysis
Prosthetic valve associated hemolysis is more with paravalvar leak, endocarditis and structural failure in bioprosthetic valve. Control of hypertension with beta blockers can reduce hemolysis – shear stress reduced [..]
Indications for surgery in prosthetic valve endocarditis
a) Persistent bacteremia after 7-10 days b) Heart failure c) Early prosthetic valve endocarditis d) Fungal endocarditis e) Paravalvar leak f) Annular or aortic abscess g) True or [..]
Role of Intravascular Ultrasound (IVUS) in coronary stenting
Incomplete stent apposition can be detected by intravascular ultrasound (IVUS). In case the balloon has fractured the plaque, but stent has not expanded fully, contrast will fill the space [..]