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cardiology is a world ارتباط مستقیم با ادمین علمی : @cardiogroup ارتباط مستقیم با مسئول روابط عمومی : @chairman1
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A man in his 70s with recent cystogastrostomy for necrotizing pancreatitis with pseudocyst was admitted for Methicillinsusceptible Staphylococcus aureus septicemia and septic shock. On admission, he had focal neurological deficits with radiographic evidence of multifocal subarachnoid hemorrhages, as well as abdominal imaging results that were suggestive of multiple septic emboli.
Skin examination revealed tender, purplish nodules predominately on the fingertips that were compatible with Osler nodes, as well as painless hemorrhagic macules on the palms and soles that were consistent with Janeway lesions. Transesophageal echocardiogram results confirmed the diagnosis of infectious endocarditis (IE) involving the mitral and the aortic valves.
Ref : Jama Network
@cardiology_channel
Prof. Stephan Achenbach shares an angiogram of the right coronary artery, revealing the feeding vessels of a left atrial cardiac myxoma
Thanks to the lady kiristian Tuttle ( BSN , RN ) ( Nursing school studio guides ) from united states
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Antithrombotic Therapy for VTE Disease: Compendium and Review of CHEST Guidelines 2012-2021
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Safety and efficacy of colchicine for the prevention of post-operative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials
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Effectiveness and safety of DOACs vs. warfarin in frail patients with AF
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Efficacy and Safety of DOACs vs. Warfarin Across the Spectrum of BMI and Body Weight: A Patient Level Meta-Analysis of Four RCTs of 58464 Patients With AF
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The ‘10 commandments’ for the 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes
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Cardiac sonography (apical 4ch view)
Severe Mitral regurgitation (MR jet)
AML prolapse
Thank you Dr. Amir soltanifar( cardiologist)
Simplifying mitral valve anatomy and it’s function evaluation(part 5)
Let’s begin discuss the next issue : Papillary muscles.
First look at figure A,as you know the heart is lied obliquely in mediastinum ,not vertically as is shown in schematic pictures !,you see two papillary muscles (PM )arising from the area between the apical and middle thirds of the left ventricular wall:
the antero-lateral papillary muscle is often composed of one body, and the postero-medial papillary muscle usually with two bodies.
Remember simply:although the anterior papillary muscle has only one body but it is supplied from two branches of left coronary artery(LAD and LCX),in contrast although the postero-medial papillary muscle has two body but it is supplied only from circumflex or right coronary artery (depending on dominance) and because of its single system of blood supply, this papillary muscle is particularly prone to injury from myocardial infarction. The attachment of the papillary muscles to the lateral wall of the left ventricle makes the ventricular wall also an integral part of the mitral valve complex. Chronic or acute left ventricular dilatation can lead to papillary muscle displacement with increased leaflet tethering due to tension on chordae tendinae, as well as annular dilatation.
Each papillary muscle provides chordae to both leaflets(the Chords emanate from the PM tips to the corresponding anterior, posterior, and commissural leaflet,figure B)
Early during systole longitudinal contraction of the LV base moves the entire PM (base and tip) closer to the annulus and later during systole, isolated PM contraction shortens the length of the papillary muscles, and increases the distance between the PM tip and the annulus. During the first half of systole papillary muscles move closer together and move concurrently toward the mitral annulus due to unopposed longitudinal contraction of the LV base. Because the mitral leaflets moves upwards toward the atrium at the same time this papillary muscle coordinated and symmetric motion, maintains equal distances between the papillary muscle tips and leaflets, avoiding distortion of mitral leaflets. Furthermore, at the same time annular contraction and folding occurs allowing early systolic coaptation by the early saddle-shape accentuation. At the mid and late systolic period the PM bodies contract, and PM tip are pulled downwardly, away from the annulus and closing leaflets, keeping both leaflets under directed tension and posterior restrain to prevent systolic anterior motion of the leaflets, and to avoid left ventricular outflow tract obstruction by the sail-like anterior leaflet(figure C).
#cardiology
#mitral_valve
Thank you Mr.Doctor seyyed reza miri ( interventionist , top ranked in national exam congenital cardiology
Patient had abdominal und back pain since 2 days and sought family doctor for laxatives prescription 😅
After knowing he has a contained rupture of a juxtarenal Aneurysm measuring almost 11 cm in diameter he asked for time to consider the operation 😬. Luckily his family was able to persuade him and he was successfully operated replacing the infrarenal aorta which showed a big defect on the posterior wall with intraoperative Perfusion of the renal arteries with cold saline. Yet he is now having deterioration of his renal function which have now reached a stable point. Our nephrologist see no reason for dialysis till now.
@cardiology_channel
Thank you to Mr. Dr. Mohammad Abdulfazel, a vascular surgeon from Germany - Frankfurt
@cardiology_channel
(A) Wolff-Parkinson-White (WPW) syndrome (pink arrow: Delta wave). (B) Long QT interval. (pink arrow: QT interval).
ECG features of WPW in sinus rhythm
PR interval < 120ms
Delta wave: slurring slow rise of initial portion of the QRS
QRS prolongation > 110ms
Discordant ST-segment and T-wave changes (i.e. in the opposite direction to the major component of the QRS complex)
Pseudo-infarction pattern in up to 70% of patients — due to negatively deflected delta waves in inferior/anterior leads (“pseudo-Q waves”), or prominent R waves in V1-3 (mimicking posterior infarction)
QT Interval
Time from the start of the Q wave to the end of the T wave
Represents time taken for ventricular depolarisation and repolarisation, effectively the period of ventricular systole from ventricular isovolumetric contraction to isovolumetric relaxation
The QT interval is inversely proportional to heart rate:
The QT interval shortens at faster heart rates
The QT interval lengthens at slower heart rates
An abnormally prolonged QT is associated with an increased risk of ventricular arrhythmias, especially Torsades de Pointes
Congenital short QT syndrome has been found to be associated with an increased risk of paroxysmal atrial and ventricular fibrillation and sudden cardiac death
Normal QTc values
QTc is prolonged if > 440ms in men or > 460ms in women
QTc > 500 is associated with an increased risk of torsades de pointes
QTc is abnormally short if < 350ms
A useful rule of thumb is that a normal QT is less than half the preceding RR interval
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💡Transcatheter Mitral Valve Replacement (TMVR)
The mitral valve controls blood flow between the upper left heart chamber (atrium) and the lower left heart chamber (ventricle)
✅️Transcatheter mitral valve replacement may be appropriate for patients who have mitral valve regurgitation or mitral valve stenosis but aren't good candidates for open-chest mitral valve repair and replacement surgery. Older people and those with underlying health conditions have higher risks of open-chest surgery and may be better candidates for TMVR
🫀TMVR is an option for some people with mitral valve disease who aren’t good candidates for open-heart surgery.
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Challenging Transcatheter Tricuspid valve in valve (TVIV) implantation with Sapien 3 valve in high risk patient with Redo operation & huge cardiomegaly
final RA graphy revealed very enlarged RA
Tehran Heart Center, March 2024
Thanks to Dr. alimohammad Haji
professor of interventional cardiology head of advance endovascular & structural heart intervention course at tehran heart center
@cardiology_channel
What is Transcatheter Mitral Valve Replacement, or TMVR?
With TMVR, the mitral valve in the heart is replaced with a catheter-based valve which is delivered via a small incision between the ribs or a puncture in the groin rather than traditional open-heart surgery. This procedure is required to correct the mitral valve when it is weakened from regurgitation or stenosis. The new valve implants are either of a synthetic or biological nature generated from other living tissue
@cardiology_channel
🫀Overview of Antihypertensive Medications👩⚕️
💊ACE Inhibitors
Suffix: -pril
Ex: lisinopril, enalapril
💡ACE think Acepril (April)
💊ARBs
Suffix: -sartan
Ex: losartan, valsartan
💡ARB think ARTAN
💊Beta Blockers
Suffix: -olol
Ex: metoprolol, atenolol
💡Beta Blockers are funny think oLOL
💊Calcium Channel Blockers
Suffixes: -dipine, -zem
Ex: amlodipine, diltiazem
💡Pine & Zem block calcium channels
💊Digitalis (Cardiac Glycosides)
Suffixes: -oxin, -ox
Ex: digoxin
💡DIG think Digitalis & Digoxin
💊Diuretics
Suffixes: -ide, -thiazide, -actone
Ex: furosemide, hydrochlorothiazide, spironolactone
💡Spironolactone think potassium Sparing
Aspirin-Free Antiplatelet Strategies After PCI
EHJ State of the Art Review
Antithrombotic therapy in patients with ACS: similarities and differences between European expert consensus and the 2023 ESC guidelines
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Antithrombotic Therapy for Patients Undergoing Cardiac Electrophysiological and Interventional Procedures JACC State-of-the-Art Review
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Background
Transcatheter occlusion of the heart valve (THV) related to paravalvular leak (PVL) is associated with a high failure rate with existing devices due to the complex interaction of the THV and the aortic/mitral annulus.
Goals
This study reports on new transcatheter techniques for the treatment of PVL after THV.
materials and methods
The authors describe consecutive patients who underwent PVL closure after transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve replacement (TMVR). A covered self-expanding stent (Viabahn) was deployed in the defect to create a seal between the THV and the annulus. A vascular plug (Amplatzer Vascular Plug 2 [AVP2] or AVP4) was then deployed inside the covered stent to eliminate the PVL.
Results
Eight patients with THV-related PVL were treated using this method (aortic [3 SAPIEN, 1 Evolut], mitral [2 SAPIEN-in-MAC (mitral annular calcification), 2 M3 TMVR). Different combinations of stents and plugs were used (5 mm × 2.5 cm Viabahn + 6 mm AVP4 [n = 2], 8 mm × 2.5 cm Viabahn + 10 mm AVP2 [n = 5], and 10 mm × 5.0 cm Viabahn + 12 mm AVP2 [n = 1]). All had technical success with immediate removal of the target PVL, without in-hospital complications. None had signs of postoperative hemolysis. All patients were discharged alive (median 3.5 days [Q1–Q3: 1.0–4.8 days]). No residual PVL was observed at discharge, except for 1 patient with mild failure due to another untreated PVL site. One patient died before 30 days due to a valve complication in MAC TMVR. In the remaining patients, none had PVL recurrence at 30 days. Symptoms were reduced to NYHA functional class I/II in 6 patients. NYHA functional class symptoms remained in 1 patient with mitral regurgitation awaiting valve replacement.
Conclusion
The technique of sequential deployment of covered stent and vascular plug may effectively treat PVL related to THV.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066433
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A 23 mm Metronic valve was implanted as VIV with a successful intervention to the degenerating valve of the patient to whom we had a 23 mm Edwards Saphien XT valve implanted in our clinic in 2017. It was an important case for us as it was the first valve in valve intervention among the cases we performed in our own clinic
Thank you, Mr. Doctor Ali Riza Akyuz professor of interventional cardiology of Turkey - Ankara
Does Niacin (Vitamin B3) increase Your Risk of Heart 🫀Disease?
🫀According to a study published in February 2024 in Nature Medicince journal, terminal metabolites of excess NIACIN were linked to higher 3 year risk of Heart Attack, Stroke and other adverse cardiac events.
🫀This trial studied two NIACIN metabolites, 2PY and 4PY.
🫀Link to the article below ⬇️:
https://www.nature.com/articles/s41591-023-02793-8
🫀The Authors concluded:
'Collectively, these results indicate that the terminal breakdown products of excess niacin, 2PY and 4PY, are both associated with residual CVD risk. They also suggest an inflammation-dependent mechanism underlying the clinical association between 4PY and Major Adverse Cardiovascular Events'.
🫀Niacin deficiency causes a serious disease called pellagra, which was common at the beginning of the 20th century. Currently Niacin is included in flours and cereals.
@cardiology_channel
آمیلوئیدوز سیستمیک ناشی از پروتئین ترانس تیرتین (ATTR) شایع ترین نوع آمیلوئیدوز است که باعث کاردیومیوپاتی می شود.
آمیلوئیدوز ATTR باعث ایجاد کاردیومیوپاتی در حدود 150000 نفر در ایالات متحده می شود و تافامیدیس تنها درمان تایید شده در حال حاضر است. تافامیدیس پیشرفت آمیلوئیدوز ATTR را کند کرد و بقا را بهبود بخشید و از بستری شدن در بیمارستان در مقایسه با دارونما در افراد مبتلا به کاردیومیوپاتی مرتبط با ATTR جلوگیری کرد.