Feeds:
Posts
Comments

Archive for the ‘Cardiology – Pioneers’ Category

Three types of cardiac apical Impulse : An Illustration

Posted in Cardiology - Pioneers, Clinical cardiology, tagged , , , on September 1, 2016| Leave a Comment »

lv apex radiological clinical anatomicallv apex radiological clinical anatomical 002

 

Read a related article

How do you define apical impulse ?

How do you define apical impulse ?

Read Full Post »

Cartoons in cardiology : Options for end stage heart failure :

Posted in cardiac drugs, cardiac failure, Cardiology - Pioneers, Cardiology -Hemodynamics, Cardiology -Mechnisms of disease, tagged , , , , , , , , on December 19, 2014| Leave a Comment »

This cartoon succinctly  depict all the options we have in our fight against end stage heart failure .We know , a failing heart is often compared to a sick , aged and tired horse.

cardiac failure cartoon tired horse whicpping lionel opie book

Image courtesy Heart Physiology: From Cell to Circulation :Lionel H. Opie Lippincott Williams & Wilkins, 2004

 

1.Don’t whip the horse (Except in emergency)

  • Avoid all Inotropics ( Doubutamine and Milrinone were shown to improve quality of life marginally but  with dramatic reduction in quantity of life ! However , the same thing does not apply for Digoxin as it is the  the only Inotropic with a soothing para-sympathetic comfort  !
  • Please be reminded, CRT wires could act as  “multiple whip equivalents” right inside the heart , especially in advanced class 3 or just recovered class 4 patients. Beware!

2.Unload the horse

Vasodilators

  • ACEI/ARBS

3.Slow the horse

  • Never exert too much (Not more than 70% of capacity)
  • Beta blockers
  • Ivabradine (Slow the sinus node and expect a reduction in MVO2 )

4.Change the horse

  • Heart transplant may be the best solution

5.Switch to an Artificial Horse(Tractor )

  • ie  LV assist device

6.Finally try to heal the horse (Still largely in research labs!)

  • Genetic engineering
  • Tissue repairing
  • Stem cells
  • Holistic and spiritual healing etc (Has really  worked in few )

Read Full Post »