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 [..]

ECG

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 [..]

ECG

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 [..]

Angiography and Interventions, General

Five Ps of critical limb ischemia

 Pain Pallor Paraesthesia Paralysis Pulselessness

General

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 [..]

General

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 [..]

General

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 [..]

General

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 [..]

General

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 [..]

General

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 [..]

Angiography and Interventions, General