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best heart doctors An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins .A 12-lead electrocardiogram was obtained and showed a regular, narrow-complex tachycardia, with narrow P waves deforming the terminal QRS complex (Panel A, arrowheads). The P wave is negative in the inferior leads (forming a pseudo-S wave) and positive in lead V1 (forming a pseudo-r′ wave). On the application of pressure to the carotid sinus, the tachycardia and the bulging of the internal jugular veins were resolved .and sinus rhythm was restored. The characteristics of the arrhythmia were suggestive of atrioventricular nodal reentrant tachycardia, a functional reentrant arrhythmia localized to the AV junction. In its typical form, anterograde conduction occurs over the slow pathway to the ventricle, while near-simultaneous atrial activation occurs over the fast pathway of the AV node. These events lead to the parallel electrical activation of the atria and ventricles. Canon A waves result from the simultaneous contraction of the atria and ventricles against closed atrioventricular valves, causing a reflux of blood into the neck veins.
SAMIKSHA HEART AND DIABETIC CARE IN YELAHANKA Echocardiographic findings in certain cardiac abnormalities It is important to be aware that modern colour flow mapping is so sensitive that small amounts of regurgitation are often detected from quite normal valves. Deciding whether these jets are significant can be difficult and requires experience. Mitral stenosis Thickening and doming of the mitral valve leaflets is visible on M mode and 2D scanning , It may be possible to measure the valve area by planimetry . Secondary changes such as left atrial size and the presence of rheumatic disease of other valves can be seen. Doppler interrogation of the jet of blood entering the left ventricle through the mitral valve will enable estimation of the valve area by a formula called the pressure half-time equation This will usually give accurate and consistent estimates of the valve area and is especially useful for serial measurements over months or years. It will also be possible to detect associated mitral regurgitation with Doppler. Mitral regurgitation and mitral valve prolapse Here the mitral valve may appear normal and abnormal co-aptation of the leaflets is not usually visible . The left atrium will appear enlarged if significant chronic MR is present, and if this is severe left ventricular dilatation will be present. If the MR is due to mitral valve
heart doctors in Kattigenahalli, Bangalore • Impulse conduction Sinoatrial block Some instances of apparent sinus bradycardia are due to sinoatrial (SA) block; this can be ascertained only by observing variations in conduction ratios or characteristic periodicity, The sinoatrial node beats (yes, beats) continuously, 7 but some impulses are blocked from entering the atria. The pauses are often termed ‘sinoatrial block’ or ‘sinus arrest’; it is probably permissible to call them ‘sinus pauses’ for convenience. The upper strip shows typical Wenckebach (see below) grouping, with slight acceleration in the last two groups prior to pauses that themselves are shorter than two sinus cycles. The most likely interpretation is 3:2 and 4:3 SA exit block in this patient with known sick sinus syndrome . The lower strip, taken later, shows only sinus arrhythmia (waxing and waning of the sinus rate with respiration—a normal occurrence). Interatrial block The term LAA, of which abnormal interatrial conduction (block) is a major cause, has replaced the more elegant term P mitrale because mitral valve disease is only one cause of the condition. The P wave is prolonged to or beyond 0.10 seconds and is often notched ); the significant notching should have an inter-peak distance of at least 1 mm (0.04 seconds). It is thought to represent a lesion in Bachman’s bundle, the interatrial tract. Atrioventricular blocks Atrioventricular (AV) blocks delay (first-degree) or prevent some (second-degree) or all (third-degree) of the supraventricular impulses from reaching the ventricles. The blocks may be congenital or acquired, transient or permanent. The most clinically useful classification is based on their anatomical cause and their ECG manifestations. This classification also helps in
heart doctors in Kattigenahalli, Bangalore • Impulse conduction Sinoatrial block Some instances of apparent sinus bradycardia are due to sinoatrial (SA) block; this can be ascertained only by observing variations in conduction ratios or characteristic periodicity, The sinoatrial node beats (yes, beats) continuously, 7 but some impulses are blocked from entering the atria. The pauses are often termed ‘sinoatrial block’ or ‘sinus arrest’; it is probably permissible to call them ‘sinus pauses’ for convenience. The upper strip shows typical Wenckebach (see below) grouping, with slight acceleration in the last two groups prior to pauses that themselves are shorter than two sinus cycles. The most likely interpretation is 3:2 and 4:3 SA exit block in this patient with known sick sinus syndrome . The lower strip, taken later, shows only sinus arrhythmia (waxing and waning of the sinus rate with respiration—a normal occurrence). Interatrial block The term LAA, of which abnormal interatrial conduction (block) is a major cause, has replaced the more elegant term P mitrale because mitral valve disease is only one cause of the condition. The P wave is prolonged to or beyond 0.10 seconds and is often notched ); the significant notching should have an inter-peak distance of at least 1 mm (0.04 seconds). It is thought to represent a lesion in Bachman’s bundle, the interatrial tract. Atrioventricular blocks Atrioventricular (AV) blocks delay (first-degree) or prevent some (second-degree) or all (third-degree) of the supraventricular impulses from reaching the ventricles. The blocks may be congenital or acquired, transient or permanent. The most clinically useful classification is based on their anatomical cause and their ECG manifestations. This classification also helps in
the best cardiac centers in yelahanka Heart Valves Heart valves open when the heart pumps to allow blood to flow forward, and close quickly between heartbeats to make sure blood does not flow backward. Any problem with this normal flow will make it difficult for the heart to effectively pump the blood where it needs to go. The tricuspid valve sits between the right upper chamber (right atrium) and the right lower chamber (right ventricle). The tricuspid valve directs blood flow from the right upper chamber to the right lower chamber. The pulmonary valve directs blood flow from the right lower chamber (right ventricle) into the pulmonary artery, which splits into two arteries so that the blood from the body can get to both lungs. The mitral valve sits between the left upper chamber (left atrium) and left lower chamber. The mitral valve directs blood flow from the left upper chamber into the left lower chamber. The aortic valve directs blood from the left lower chamber (left ventricle) into the aorta. The aorta is the major blood vessel that leads from the left lower chamber to the rest of the body.
THE BEST HEART CENTERS NEAR ME Heart conditions that can lead to sudden cardiac arrest A life-threatening arrhythmia usually develops in a person with a pre-existing heart condition, such as: Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart. This can make it harder for your heart to conduct electrical impulses smoothly. Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of scar tissue. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm. Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. In both cases, your heart's muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias. Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia. Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition that was present at birth (congenital heart disease). Even adults who've had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest. Electrical problems in the heart. In some people, the problem is in the heart's electrical system itself instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as Brugada's syndrome and long QT syndrome.
Indications for Hemodynamic Monitoring in Patients with STEMI Management of complicated acute myocardial infarction Hypovolemia versus cardiogenic shock Ventricular septal rupture versus acute mitral regurgitation Severe left ventricular failure Right ventricular failure Refractory ventricular tachycadia Differentiating severe pulmonary disease from left ventricular failure Assessment of cardiac tamponade Assessment of therapy in selected individuals Afterload reduction in patients with severe left ventricular failure Inotropic agent therapy Beta-blocker therapy Temporary pacing (ventricular versus atrioventricular) Intraaortic balloon counterpulsation Mechanical ventilation
HEART SPECIALISTS IN YELAHANKA NEW TOWN BANGALORE Mitral stenosis Rheumatic mitral stenosis is rare in developed countries but is an important cause of maternal and fetal morbidity and mortality in many parts of the world. Mitral stenosis is often poorly tolerated because of the shortened diastolic filling period that occurs during pregnancy. A mitral valve area of less than 1.5 cm2) means a considerable risk to the mother of pulmonary oedema as pregnancy proceeds. Even previously asymptomatic patients are at risk. Close follow-up and regular echocardiograms are indicated. Treatment to slow the heart and increase the length of diastole (beta-blockers) should be commenced if symptoms (dyspnoea) appear or the Doppler echo measurement of pulmonary artery pressure exceeds 50 mmHg Diuretics may improve symptoms but for severe stenosis balloon valvotomy can be performed during pregnancy.30 There are risks to the mother and fetus associated with the procedure, which should be performed only at an experienced centre and only for severe stenosis. Aortic stenosis Delivery is usually well tolerated by women with aortic stenosis unless they are very symptomatic. If heart failure has developed, balloon valvotomy of the valve is safer than surgical replacement. The procedure provides temporary relief of symptoms. Mechanical prosthetic valves and pregnancy
Cardiology doctors Mathikere – BELCardiologist in Doddaballapur Road, Bangalore • SVT The resting ECG is usually normal and this certainly does not exclude the diagnosis. When the ECG is normal between attacks, the accessory pathway responsible for the problem is said to be ‘concealed’ . Sometimes the ECG will show a short PR interval This can be a normal variant, but for patients with intermittent rapid and regular palpitations it suggests the presence of an intra-nodal accessory pathway. This is called Lown–Ganong–Levine syndrome.4 Fibres close to, or within, the atrioventricular node bypass the normal slow conduction between the atria and ventricles and allow impulses to overtake the normal conduction. The atrial impulse reaches the ventricles early and the PR interval is short. During an episode of SVT one pathway conducts impulses anterogradely—that is, from the atria to the ventricles—and the other conducts impulses retrogradely. This enables a circuit of electrical activity to cause atrial and then ventricular contraction independently of the sinus node and very fast t all patients with WPW on the surface ECG develop symptoms of SVT. During an episode of tachycardia the QRS morphology returns to normal since anterograde (forward) conduction is usually (> 90% cases) via the normal pathway The opposite is true when AF and (much rarer) atrial flutter occur; such patients are at quite high risk of sudden death. VT Again, the resting ECG is usually normal between attacks but brief runs of VT may be present, or there may be evidence of ischaemia (e.g. an old infarct), which suggests an ischaemic substrate for VT.
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