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Archive for October, 2013

Unusual tips in PTMC : How to cross a critically narrowed mitral orifice ?

Posted in Cardiology - Animations, Cardiology -Non coronary Interventions -PTMC, cath lab tips and tricks, PTMC -Tips and tricks, tagged , , , , , , , , , on October 12, 2013| Leave a Comment »

Click over the Image  for animation

ptca balloon for PTMC inoue 002

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Why we take LV end-systolic diameter(LVESD) in mitral regurgitation assesement ?

Posted in Cardiology -unresolved questions, Infrequently asked questions in cardiology (iFAQs), Mitral regurgitation, rheumatic heart disease, valvular heart disease, tagged , , , , , on October 11, 2013| Leave a Comment »

Regurgitant  lesions of cardiac valves  are often tricky for the heart . Myocardium shows “love- hate” relationship with these  leaky valves.  Some of them are  “sort of”  stress relievers for  LV . A mild MR will make the LV comfortable in terms of wall stress. When the wall stress is reduced the contractility increases and LV EF may raise a little.Hence EF is never going to help us to assess true LV function in MR .

LV end diastolic dimension(LVEDD) is  a preload dependent  parameter .A patient with 6.5cm LV EDD  may still  have good contractility  and he may reach even a  40mm LV ESD, implying an intact LV function.

LV function should be best  assessed  in systole .(After all ,  systole is the prime function of heart) .Further , it should be assessed when the LV is  free from  influence of the all  loading  conditions of heart .  (Note : The initial part of systole  depends on after load. As the systole progresses the influence  of after-load lessens .In the pressure volume loop* , the point at which loading conditions are least operative is end systole.)

* Please realise , heart is a dynamic organ there is no true load independent point in cardiac cycle  as pressure and volume are eternally coupled.

What happens in AR ?

The same rule applies for Aortic regurgitation, but the parameters worsen little later than that of MR. For same degree of regurgitant fraction MR will require early surgery than AR.The reason for better  tolerablity of  AR  is due to largely  intact LA function and compliance till very late stages of AR.(In AR- it’s single chamber volume overload , while in MR  it’s two chambers !)

Final message

LVEDD is not used in assessing MR  as it is a pre-load dependent parameter that will not reflect true myocardial  function /dysfunction. LV ESD is fairly accurate  measure of LV systolic function minus all loading factors .

Watch out  for next topic

Vasodilator therapy in MR and AR : How is it different ?

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Future directions in cardiology : A land mark review by Valentine Fuster

Posted in cardiology journals, Cardiology research topics, Cardiology Risk assesment, Great Men in cardiology, Great websites in cardiology, history of cardiology, Land mark articles in cardiology, Top ten in cardiology, tagged , , , , , , , on October 4, 2013| Leave a Comment »

Medical research   often ventures into a directionless and meaningless  exercise with or without intention .The reason is simple , unlike  other fields,  scientists enjoy  the ultimate freedom of expression.

How to find genuine treasures from this chaos ?

We need people like Valentine Fuster ,

valentine fuster global cardiology what is the future

Here is link to the article in   circulation 2011  which I consider a must read for all cardiologists !

global cardiovascular health valentine fuster circulation 2011

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What do you mean by adequate LV function . . .Doctor ? !

Posted in Cardiology -unresolved questions, echocardiography, LV function, tagged , , on October 1, 2013| Leave a Comment »

Many modern  day cardiologists  consider  doing echo ,  a mean job and leave it to  technicians and fellows . Final report  often ends up with a cursory glance. The culture of reporting an  important aspect of LV  function is reaching a new low. It is common  to find the following terminologies  in  the  echo reports in many  parts of the country*     (Guess it is not used elsewhere ! )

  • LV function good
  • LV function adequate
  • Good bi-ventricular  function
  • LV function fair

what is adequate LV function

Among these , the term adequate LV function has caught  the  imagination  of young cardiologists ! Especially , this description  often appear in pre- operative  screening echo for non cardiac surgeries .

Recently ,one of my patient asked me what do we mean by adequate  LV function . I told  him it means nothing . . . it’s all  fancy words  !  but , generally  it is used to imply  normal LV function . . . I  clarified .

Think over for few minutes   . . . what do we  want to convey  by calling LV function  as adequate ?

Does it mean normal ?  or  Just less than normal  ?

If adequate LV function  is accepted ,  what is inadequate ?

Adequate for whom ?  For the patient ?  or  for the physician ?

Adequate  for daily activity  ?  or  Adequate to  with-stand  the proposed  surgery ?

Final message

Even  learned cardiologists indulge in this  term  frequently . This is  rather a fancy and unprofessional  way reporting LV function . They pass this  style to their residents  as well para medics .Adjectives  in medical science are not banished . . . but should be   judiciously used . In my opinion  the term adequate LV function should be removed from all echo labs .   Youngsters please  watch out.

Related links in this site .

LV ejection fraction fallacies

What is LV dysfunction ?

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