Comments for Cardiophile MD

Comment on Rheumatic heart disease – mitral stenosis by Johnson Francis

Johnson Francis — Sat, 07 Jan 2012 01:26:27 +0000

Usual features of atrial septal defect like rSR’ pattern in V1 with additional features of true left atrial enlargement should prompt one to think of associated mitral stenosis. A word of caution is needed here as a pseudo left atrial enlargement pattern in V1 is quite common with atrial septal defect. A pseudo left atrial enlargement pattern has a sharp atrial intrinsicoid deflection. In V1 the normal P wave has a small, sharp positive deflection followed by a small more rounded negative deflection. The downward slope of the P wave from the peak of the positive wave to the negative wave is known as the atrial intrinsicoid deflection. This deflection is steep in pseudo left atrial enlargement while it is gradual and rounded in true left atrial enlargement. A prominent rounded negative deflection of P wave in V1 indicating true left atrial enlargement would suggest additional mitral stenosis in case of atrial septal defect. The P mitrale pattern in lead II if present is also useful. Isolated atrial septal defect can have only right atrial overload which is manifested as a single peak sharp P wave in lead II. Biatrial overload pattern (both tall sharp upstroke and a rounded negative wave in V1 as well as a wide and tall P wave in lead II) also should suggest mitral stenosis in addition to atrial septal defect. Biatrial enlargement can occur with pure mitral stenosis with severe pulmonary hypertension. But rSR’ pattern in V1 would be unlikely in such a case and we would expect pure features of right ventricular hypertrophy (prominent R wave in V1).

Comment on Rheumatic heart disease – mitral stenosis by Arjun Lakshman

Arjun Lakshman — Fri, 06 Jan 2012 18:21:45 +0000

what are the features in ecg that help in diagnosis of Lutembacher syndrome?

Comment on Rheumatic heart disease – mitral stenosis by Johnson Francis

Johnson Francis — Thu, 01 Dec 2011 10:46:30 +0000

Paul Wood’s hypothesis is that the frequency of valve involvement rheumatic fever depends on the hemodynamic load to the valve. Mitral valve faces the maximum hemodynamic load – the left ventricular systolic pressure in the closed position. Hence it has the maximum damage. Aortic valve faces the aortic diastolic pressure in the closed position and hence is the next commonly involved. Pulmonary valve faces the least load when it is closed – the pulmonary artery diastolic pressure, which is very low. Hence pulmonary valve involvement due to rheumatic process is least common. Pulmonary regurgitation can occur due to severe pulmonary hypertension in severe mitral stenosis. That is not direct involvement by the rheumatic process.

Comment on Rheumatic heart disease – mitral stenosis by Pragnesh shah

Pragnesh shah — Thu, 01 Dec 2011 08:59:15 +0000

why mitral valve involvement is more common in rheumatic heart disease?

Comment on About by Johnson Francis

Johnson Francis — Thu, 08 Sep 2011 07:21:01 +0000

Two new MCQs posted today in response to your request!

Comment on About by ramesh

ramesh — Wed, 07 Sep 2011 17:00:18 +0000

great site for learning
quiz shall be displayed again

Comment on Protein losing enteropathy in post Fontan patients by Johnson Francis

Johnson Francis — Wed, 20 Jul 2011 17:01:09 +0000

Thank you for the information. The article has been located at: Link

Comment on Cardiology MCQ – ECG finding in acute pericarditis by Christopher

Christopher — Wed, 20 Jul 2011 16:47:36 +0000

Other findings suggestive of pericarditis are diffuse ST elevation (excluding aVR), PR elevation in aVR, and ST depression in aVR.

Comment on Protein losing enteropathy in post Fontan patients by David Simpson

David Simpson — Wed, 20 Jul 2011 14:29:10 +0000

Thanks for raising this serious complication. A good recent article on this problem is "Protein-Losing Enteropathy after Fontan Operation" Jack Rychik, MD Congenit Heart Dis. 2007;2:288–300. Which detail further treatment options including the use of Sildenfiil to lower pulmonary vascular resistance. Parents of children affected by PLE may be interested in filling in an online questionnaire aimed at furthering research in this area, Link

Comment on What is myocardial stunning? by Christopher

Christopher — Mon, 02 May 2011 13:17:08 +0000

Is the mechanism by which this occurs known?