Bock J, Benitez M. Blunt Cardiac Injury. Cardiology Clinics. 2012;30(4):545-55.
Armstrong E, MD, Kulkarni A, Hoffmayer K, et al. Am J Cardiol 2012;110: 345–349
Keywords: Pulmonary Arterial Hypertension (PAH) (PubMed Search)
A. Yao. Journal of Cardiology 60 (2012) 344–349
Hijazi K. Coarctation of the aorta: From fetal life to adulthood. Cardiology Journal. 18(5):487-95, 2011
Keywords: Kawasaki Disease, Mucocutaneous lymph node syndrome (PubMed Search)
Scuccimarri R. Kawasaki Disease. Pediatric Clin N Am 59(2012)425-445
Keywords: Rheumatic fever, rheumatic heart disease (PubMed Search)
Marijon E. Mirabel M. Celermajer DS. Jouven X. Rheumatic heart disease. Lancet. 379(9819):953-64, 2012 Mar 10.
Keywords: Torsades de pointes, prolonged QT syndrome (PubMed Search)
Congenital and Acquired Long QT Syndrome.Cardiology in Review. 12(4):222-34, 2004 Jul-Aug.
Bazett's Formula QTc = QT/RR1/2
Keywords: Long QT Syndrome (PubMed Search)
Congenital and Acquired Long QT Syndrome.Cardiology in Review. 12(4):222-34, 2004 Jul-Aug
Keywords: de Winter T wave, proximal LAD occlusion (PubMed Search)
An ECG pattern that signifies occlusion of the proximal left anterior descending coronary artery (LAD) without ST-segment elevation
de Winter R, et al. A New ECG Sign of Proximal LAD Occlusion. NEJM Nov, 2008:359;19
Keywords: E-point septal separation (EPSS), left ventricular function, bedside emergency ultrasound (PubMed Search)
EPSS is an accurate and rapid bedside estimation of left ventricular function
First an image of heart should be obtained in the parasternal long-axis view
The ultrasound cursor should be placed through the anterior leaflet of the mitral valve
Subsequently, M-mode is applied and the distance between the anterior leaflet and the interventricular septum is measured during early diastole
A measurement of 7mm or greater indicates poor EF (see attachment below)
Secko MA, Lazar JM, Salcicciolo LA, Stone MB. Can junior emergency medicine physicians use E-point septal separation to accurately estimate left ventricular function in acutely dyspneic patients. Acad Emerg Med. 2011;18:1223-6
Cardiac amyloidosis can present along a spectrum from asymptomatic to severe CHF w/conduction abnormalities
ECG with low voltage + echocardiogram with thickened myocardium should heighten suspicion
Definitive Dx. is myocardial biopsy identifying the infiltrative lesion (MRI w/gad is also supportive)
AL (light chain) amyloidosis is an acquired disease from improperly functioning plasma cells
¨ Rapidly progressive and life threatening
¨ Tx. w/chemotherapeutic agents (+/- BMT)
Transthyretin-related (TTR) amyloidosis is produced by the liver (2 types)
Familial transthyretin-related amyloidosis (ATTR)
Senile systemic amyloidosis (SSA)
¨ Both are slowly progressive
¨ Tx liver transplant (ATTR) and supportive care (SSA)
Quarta C, Kruger J, Falk R. Cardiac Amyloidosis. Circulation. Sept 2012;126(2)178-182
Keywords: Chagas Disease, AV Block (PubMed Search)
Etiological agent is the parasite Trypanosoma cruzi
Elizari M, Chiale P. Cardiac arrhythmias in Chagas' heart disease. Journal of cardiovascular electrophysiology.1993 vol:4 iss:5 pg:596 -608
Keywords: Autoantibody-associated Congenital Heart Block, neonatal lupus, CHB (PubMed Search)
Autoantibody-associated congenital heart block (CHB), also know as neonatal lupus, is responsible for the majority (~60-90%) of CHB
This is secondary to maternal antibodies that cross the placenta and may disappear postnatal
Neonatal lupus can result in diffuse myocardial disease both with and without conduction disturbances, structural defects, and electrophysiologic anomalies
Overall mortality is up to 30%, with 15% mortality before 3 months of age
More than 65% of surviving newborns require pacemakers
Maternal screening and fetal echocardiography has allowed routine prenatal diagnosis
Capone C, Buyon J, Friedman D, Frishman W. Cardiac Manifestations of Neonatal Lupus: A Review of Autoantibody-associated Congenital Heart Block and its Impact in an Adult Population. Cardiology Review. 2012, Mar-Apr;20(2):72-76
Keywords: Heyde s Syndrome, aortic stenosis, angiodysplasia (PubMed Search)
Aortic valve (AV) stenosis associated with gastrointestinal angiodysplasia
Proteolysis of Von Willebrand (type 2A) as it passes through the stenotic valve is one culprit of bleeding
Hemostatic abnormalities e.g. GI bleed are often corrected after AV replacement
Valve replacement is only recommended for cardiac symptoms
Vincentelli A, Susen S, et al. Acquired von Willebrand Syndrome in Aortic Stenosis. N Engl J Med 2003; 349:343-349
Keywords: Brugada syndrome (PubMed Search)
Mizusawa Y, Wilde A. Brugada Syndrome. Circ Arrhythm Electrophysiol. 2012;5:606-616.
Keywords: mean arterial pressure, blood pressure (PubMed Search)
Which patient has a better blood pressure, the patient with a blood pressure of 110/40 or the patient with a blood pressure of 90/60?
Mean arterial pressure (MAP) is generally considered to be the organ perfusion pressure in an individual. Because MAP requires an inconvenient calculation, we've all been taught...misled perhaps...into focusing on systolic blood pressure (SBP) as a marker of how well-perfused a patient is, and we tend to ignore the diastolic blood pressure (DBP).
It's important to remember, however, that we spend most of our lives in diastole, not systole. As a result, our organs spend more time being perfused during diastole than systole. The MAP takes this into account: MAP = (SBP + DBP + DBP)/3. DBP is more important than SBP!
So which patient is perfusing his vital organs better, the one with a BP of 110/40 or the one with a BP of 90/60? Do the MAP calculation...90/60 is better than 110/40!
Pay more attention to those diastolic BPs!
Keywords: Lyme disease, Lyme carditis, AV block (PubMed Search)
Lyme disease is the most prevalent arthropod zoonosis in the Northern hemisphere
Rostoff P, Gajos G, Konduracka E, Gackowski A, Nessler J, Piwowarsk W. Lyme carditis: Epidemiology, pathophysiology, and clinical features in endemic areas. International Journal Cardiology
Keywords: ARVD, ARVC, cardiomyopathy, triangle of dysplasia, ICD (PubMed Search)
Arrhythmogenic right ventricular dysplasia (ARVD) is a heritable form of cardiomyopathy, characterized by the replacement of myocytes with adipose and fibrous tissue leading to arrhythmias, right ventricular failure, and sudden cardiac death (SCD)
ECG findings include T-wave inversions in V1–V3 (85% ), epsilon waves (in 33%), as well as a QRS duration >110 ms in V1-V3 (64%)
Azaouagh A, Churzidse S, Konorza T, Erbel R. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a review and update. Clin Res Cardiol (2011) 100:383–394.