4/24/2011

EKG: Holter recording from a 8 month old baby with cardiomyopathy

Panel 1 - Baseline for comparison.
Panel 2 - What is the reason for change in QRS morphology?
Panel 3 - Based on this panel, do you want to change your opinion for Panel 2?
Panel 4 - How would you differentiate among the following options? (i) Sinus arrhythmia - sinus bradycardia with escape junctional rhythm, (ii) Accelerated junctional rhythm, (iii) Accelerated idioventricular rhythm and (iv) A 5-beat run of ventricular tachycardia.
What is the clinical significance of this finding in an apparently, asymptomatic infant with cardiomyopathy? What if the mother complaints that the baby has been "fussy" recently?



4/20/2011

LV Non-compaction

Pignatelli RH, et al.
Circulation 2003;108:2672-8

LVNC - Diagnostic criteria (Adapted from Heart 2001;86:666-71).
All 3 criteria must be present.
1) Multiple deep echocardiographic trabeculations
2)Trabeculations should communicate with ventricular cavity, shown by color Doppler and recesses demonstrated in apical & middle portions of the ventricle
3) Non-compacted to compacted portions ratio >1.4







Angiography images are from Cardiology in the Young 2007;17:56-63

















Also, see other posting on this subject.

4/19/2011

Pulmonary Artery Hypertension - Arborization by Pulmonary Angiography

Postmortem angiogram of normal and abnormal pulmonary artery arborization:
From Anderson RH & Becker AE. The Heart. Structure in Health and Disease. Gower Medical Publishing. London & New York 1992.

Upper panel - Normal arborization pattern
Lower panel - Winter Tree pattern of Advanced pulmonary hypertension

PFO - Screening tests prior to closure

Screening for hypercoagulable states after a stroke: (Used in the trial)

Protein C & Protein S
Anti-thrombin III
Factor V Leiden (APC res)
Lupus Anticoagulant
Anti-cardiolipin Ab
Anti-phosphatidyl serine Ab
Prothrombin gene mutation
Homcysteine
Cholestrol, HDL, LDL, TG

TOAST criteria:
Large vessel
Cardio-embolic

4/10/2011

ICU: Temporary pacemaker, DDD mode, Wenckebach


DDD pacing is on for 3rd degree AV block (Postop).
There is Wenckebach phenomenon noted.
What parameter is to be checked/adjusted if we want 1:1 conduction?

4/08/2011

ICU, EKG, EP: AV block, DDD Pacing, Checking underlying rhythm

Postop. AV block. DDD pacing. Ventricular wire was disconnected to check underlying AV conduction. What is the underlying rhythm? What is status of AV conduction? Is there a gentler, gradual way to do this - in light of no ventricular escape when V-wire is disconnected?

4/07/2011

ICU: Pattern Recognition

Click on the image to enlarge.

4/04/2011

EP & ICU: Concept of PMT & PVARP

10 mo. old s/p Rastelli for DORV, d-TGA, PS. 3rd deg. AV block. Fig 1: Patients monitor. Fig 2 &3: Temp. pacemaker settings. Pacemaker is set at 100 bpm. On the monitor, it is A-sensing & V-pacing at 133 bpm. Is the pacemaker working properly?




When I attempted to increase upper rate from 140 bpm to 145 bpm, this "warning" came up. What does that mean?

If I really wanted to go up in the upper rate, what are my options to get around the "warning"?

Related questions: What is PVARP? What is PMT? How do you determine the optimal PVARP? (What is retrograde VA conduction time?)

4/02/2011

ICU: Temporary pacemaker

10 mo old with DORV, d-TGA and Pulmonary stenosis. s/p Rastelli. Postop. day 2. Underlying rhythm was 3-degree AV block. Temp. pacemaker is set at DDD mode. What is the pacemaker doing? Is it working properly or not?

Cardiac Output - Change with age


From Congenital Disease of the Heart. AM Rudolph 2nd ed. 2001. Futura Pub. Co. Armonk, NY. p44.

Cath: Oxygen Consumption - Normal values


Oxygen Consumption in Children, measured during cardiac catheterization

Pediatric Cardiology 1996;17:207-13


825 measurements in 504 subjects (256 subjects were < 3 yrs old).

Using semi-open hood system with paramagnetic oxygen analyzer.

The paper gives regression formulas based on HR and BSA - for < 3 yrs and > 3yrs - boys and girls.






















(Closed circles - Boys; Open circles - Girls)






























Also see a later posting

General Cardiology: Kawasaki Coronary Intervention

14 yr old, s/p Kawasaki at 3 yrs of age. Asymptomatic.




Normal Left coronary


After Rotablator Therapy:



EKG - Quiz