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Reading ECG (electrocardiogram) can be a tricky thing. It needs a clear understanding of the underlying physiology. ECG is a graphical representation of the heart's electrical activity. With the help of the ECG, we can determine the heart rate, rhythm, axis or any other abnormality of the electrical conduction system. When ECG is not normal it means there is some problem in the conduction system. The cause of this problem is usually damage to the myocardium. The damaged myocardium or an abnormal myocardium can't conduct the electrical charges in a normal way and these abnormal conductions are reflected on an electrocardiogram (ECG). Axis can also be determined with the help of an ECG. Cardiac axis can deviate to right or left. But please keep in mind in pure right bundle branch block or in pure left bundle branch block cardiac axis remains normal. Thus, if you find a right axis deviation or a left axis deviation think of a pathology. Please note that the right axis devia...

In heart failure, the heart fails to pump enough blood to maintain sufficient blood flow throughout the body. The goal of the heart is to maintain the cardiac output, which is the amount of blood which is pumped by the heart in one minute. Our body tries to compensate by  Increasing the heart rate.  Activating the Renin-Angiotensin-Aldosterone-System (RAAS), which cause an increase in blood volume and vasodilatation.  Sympathetic activation, which causes tachycardia and cardiac remoulding.  The release of BNP, in response to stretch of cardiac muscle which causes natriuresis and inhibition of aldosterone. These compensatory mechanisms increase the load on the failing heart. Our goal is to inhibit these compensatory mechanisms to decrease the further load on the failing heart which these compensatory mechanisms (especially activation of RAAS and sympathetic system) put. The BNP release is not enough in the presence of activated RAAS.  Thus,...

Pericardial effusion is the collection of fluid around the heart. In this brief article, we will be discussing the signs of pericardial effusion on physical examination. Following are the 4 signs of pericardial effusion.  1. Pulsus Paradoxus.      Pulsus Paradoxus means a decrease in systolic blood pressure of more than 10mm of Hg during inspiration. The fall occurs due to increase in intrathoracic negative pressure during inspiration. In cardiac tamponade, Pulsus Paradoxus is exaggerated and a fall of more than 10 mm of Hg occurs during inspiration. An arterial line for blood pressure measurement is a good tool to measure inspiratory and expiratory blood pressures.  2. Ewart's sign     In case of a large pericardial effusion, dullness is present below the left scapular angle along with bronchial breathing. this sign is called Ewart's sign.  3. Increased Cardiac dullness.      The area of cardiac dullness increases upon the per...

Pulmonary artery hypertension can be caused by a number of drugs. Some drugs are known to cause pulmonary arterial hypertension, while others are thought to be involved. Below is the list of drugs that may cause pulmonary arterial hypertension (PAH) Definitive causes of Pulmonary Artery Hypertension  Aminorex : A drug which was previously prescribed for weight loss, later withdrawn from the market when it was noticed that it causes pulmonary artery hypertension.  Fenfluramine : Another drug which was used in past for the purpose of weight loss, it is an anorectic drug, and decreases appetite. It was also withdrawn because it causes pulmonary artery hypertension.  Dexfenfluramine : An isomer of fenfluramine, was being used to induce weight loss.  Topical rapeseed oil : used as an anti-ageing agent.  Benfluorex : similar structure as that of fenfluramine.  Likely causes of Pulmonary Artery Hypertension.  Amphetamines : CNS stimulant Try...

Our heart has this ability to regulate its rate depending on the blood volume and pressure. Our heart has to maintain adequate brain perfusion. Due to any reason, if brain blood flow decreases, the heart increases its rate and force of contraction in order to counter-increase the blood flow to the brain. Some people complain of an increase in heart rate when they stand up from a sitting or lying position.  The reason for this problem is that when you stand up from a lying or sitting position your blood pools in the veins of legs. The venous blood return to the heart decreases, which in turn decreases the cardiac output, blood pressure and brain blood flow. So in order to compensate for that, the heart increases its rate and force of contraction and thus try to maintain the adequate brain blood flow. The affected person feels the sensation of palpitations, dizziness, headache, nausea or even he may faint. The increased heart rate or tachycardia continues until the venous ret...

If you are a patient of heart failure and you are worried whether it is safe to resume sexual activity after heart failure then you are at the right place. In this article, we will discuss various aspects of heart failure regarding sexual life and different ways to overcome the risks. One thing you should keep in mind that immediately after a heart attack, your heart may become comparatively weaker for some period of time. It may not be able to tolerate the increase in cardiac load. It needs time and medicines to heal and normalize its activity but once your heart gains it's normal or near normal strength then you may resume sexual activity without any fear. We will discuss this in detail in subsequent paragraphs. Effects of heart failure on sexual activity Sexual stimulation activates both sympathetic and parasympathetic nervous systems. Sympathetic stimulation has a particular role in ejaculation and orgasm, while the parasympathetic system plays its role in arousal and plat...

Lutembacher syndrome is a rare form of a cardiovascular syndrome characterized by the presence of Mitral Stenosis and Atrial Septal Defect at the same time. In simple words, if a patient has both atrial septal defect and mitral stenosis at the same time then you can label such patient as a case of Lutembacher syndrome. Pathophysiology or Mechanism of Lutembacher syndrome Lutembacher syndrome is the name of the presence of both atrial septal defect and mitral stenosis in the same patient and at the same time. The cause these two conditions that is, atrial septal defect and mitral stenosis can be anything. It doesn’t matter what causes these two conditions, if these two conditions are present in a patient at the same time then this is a case of Lutembacher syndrome. The most common cause of mitral stenosis is valvular heart disease or rheumatic heart disease . Rheumatic heart disease may lead to mitral stenosis or MS can be congenital. On the other hand, the atrial septal defect c...

Author: Kashif Rauf Mechanical Ventilation When the patient continues to deteriorate or fails to improve with other measures and oxygen therapy, he needs some respiratory support with mechanical ventilation. Mechanical ventilation improves C02 elimination (confirmed by performing ABG Test ) and removes work of breathing, gives relief from exhaustion by giving rest to the respiratory muscles. Types of Mechanical Ventilation: Mechanical ventilation may be non-invasive or invasive. 1. Non- invasive mechanical ventilation In non- invasive respiration is supported with a face mask or nasal mask so that, endotracheal intubation is avoided. The patient should be conscious, cooperative, be able to breathe spontaneously and cough effectively. This technique is commonly used in acute exacerbation of COPD and pneumonia . 2. Invasive mechanical ventilation In invasive mechanical ventilation endotracheal tube is passed. The patient may require full or partial support. In full Support...

Hello, I have a problem with PVCs and Tachy Тhis thing happens 5 times in 3 years,2 of which there were pauses during tachycardia like this (beat.beat.beat...beat.beat...beat.beat) at very high rates. When this tachycardia starts i feel very dizzy and stomach ache, Pressure in the chest.I think it was somewhere about 200bpm without success for ECG recording. 5 days ago I was admitted to hospital in the cardiology department.Аt the hospital did blood tests (cardiac enzymes, electrolytes - which were normal), EKG's, ECG stress test and echocardiogram. Echo: slight mitral valve prolapse Ecg`s: Early Repolarization Stress Test: Heart Rate 130bpm at 150W (was stopped because of leg fatigue) doctors say that there is nothing. But I worry about the high heart rate`s which happened several times as I mentioned. Mainly worried about V-Tach and V-Fib. In order to go to EP Doc or EP Study, I should have recorded arrhythmia (the problem is in the recording) ...

Chest pain is one of the most common problems which a common man may experience. It could be as serious as myocardial infarction ( to understand heart attack in simple language click here ) or just muscular pain. Chest pain may occur due to the pathology of structures present on and inside the chest. The chest is composed of skin, muscles, ribcage and important organs present inside the rib cage. Following important organs are present inside the chest cavity, and any damage to these organs may give rise to chest pain. - Intercostal Muscles, - Heart - Lungs - Blood vessels - Oesophagus - Nerves - Bones and Joints. - Breasts - Lymph nodes The following structures are not present in the chest cavity but are covered by the ribcage. - The upper end of the stomach - liver Now any abnormality or disease of the above structure can cause chest pain. Severe and localized chest pain, in which the patient can tell the exact location of the pain is mostly muscular in origin, which...

Congenital heart disease or congenital malformation of heart occur in 1 per cent of live birth. It means that 1 out of every 100 live birth will have congenital heart disease. Male babies are affected more as compared to female baby although some congenital heart diseases such as atrial septal defect (ASD) and Patent Ductus Arteriosus occur more commonly in females. Causes of Congenital Heart Diseases: Congenital heart diseases have the following associations. Maternal Rubella Infection: Congenital Patent Ductus Arteriosus, Congenital Pulmonary Stenosis, Congenital Aortic Stenosis Maternal Alcohol Abuse: Septal Defects (Ventricular and Atrial Septal Defects) Maternal Drug Treatment and Radiations Genetic Defects. Down’s Syndrome (chromosomal abnormality) Ventricular and atrial septal defects, congenital abnormalities of heart valves. Turner’s Syndrome (chromosomal abnormality) Coarc...

Abnormal heart sounds are called Murmurs. Murmurs are of various types. Here we will discuss common types of cardiac murmurs. Types of cardiac murmurs. Murmurs are grossly divided as systolic and diastolic murmurs. Murmurs heard between first heart sound and second heart sound are called systolic murmurs and murmurs heard between second heart sound and first heart sound are called diastolic murmurs. Now systolic murmurs are further divided into. 1. Mid-systolic murmurs 2. Pan-systolic murmurs 3. Late systolic murmurs and diastolic murmurs are further divided into; 1. Mid-diastolic murmurs 2. Early diastolic murmurs Murmurs can be present in both systolic and diastolic phase of the heart beat. Systolic Murmurs: Mid Systolic Murmurs: Aortic stenosis: narrowing aortic valve is called aortic stenosis. When left ventricle contracts, it forces blood into the aorta. Forced and fast movement of blood through aorta produces a harsh sound which can be heard as murmur. It is best h...

Complications of heart failure are common and preventive measures should be taken to decrease their severity. Heart failure can be acute or chronic. Heart failure is termed as acute when symptoms of heart failure develop over a period of few days and heart failure is termed as chronic when symptoms of heart failure develop over the period of months. Heart failure once occurs continue to progress unless intervened by pharmacological or non-pharmacological interventions. There are various complications of heart failure. Some complications of heart failure occur due to heart failure itself while other complications occur due to the pharmacological or non-pharmacological treatment of heart failure. Following are the few common complications of heart failure. Complications of Heart Failure: 1. Uremia: Uremia is a complication of heart failure. It may occur as a result of diuretic therapy. The low cardiac output which is present in heart failure contributes to the progression of urem...

Echocardiography is a technique in which ultrasound waves are used to detect any abnormality in the heart structure and function. The probe can be placed on the chest wall which is called trans-thoracic echocardiography or an endoscope-like probe is inserted into the oesophagus and then echocardiogram is taken. With the help of echocardiography one can detect; ( Benefits of Echocardiography ) 1. Size of all four chambers of the heart. 2. Ejection fraction, which corresponds to the assessment left the ventricular function 3. Myocardial Ischemia or infarction; The dead or ischemic wall will show an abnormal motion on echocardiography. 4. Papillary Muscle dysfunction, Mitral Regurgitation. 5. Left Ventricular Aneurysm. 6. Ventricular Septal Defect. 7. Left ventricular thrombus. ( also see an article on thrombus formation ) 8. Cardiac output. 9. Ventricular Hypertrophy. 10. Pericardial effusion. 11. Atrial septal defects. 12. Congenital abnormalities eg. tetralogy of Fallo...

Ischemic stroke Concept:  The ischemic stroke is occlusion of a blood vessel that stops blood flow to a specific region of the brain, interfering with the neurological functions dependent on the region affected, producing deficit symptoms or characteristics, around 80% of strokes are ischemic. Ischemia can be permanent or temporary. In temporary cases, blood starts flowing back after some time. Such Ischemia is popularly known as "threat of stroke" (or Transient Ischemic Attack in medical terms). This is important because it is a sign that permanent ischemia can occur at any time if nothing is done to avoid them patient may get attacked by stroke. Signs and Symptoms:  Difficulty in speaking or understanding, loss of sensation in the limbs and balance unfold in minutes and get worse over the hours. The lack of irrigation in the brain may have given some warning sign weeks or even months before in the form of "mini attacks" in which signs appears and disappears s...

Hypertension in Elderly Management/Treatment Hypertension in the elderly is a common problem. An old patient may come to you with normal appearance and physical signs with slight symptoms of dizziness and the occasional headache. but when you check his blood pressure, you find that it is higher (for example, > 170 mm of Hg). Let’s take the following case as an example. “A 76-year-old man visits his physician with the problem of occasional mild headache with no other noticeable symptom; he came to see the doctor because his wife compelled him to do so. Past Medical History :   No history of heart disease, no stroke, no diabetes, no asthma, no TB. Medications : Not significant Allergies :   No known drug allergies Social History :   Business Man, smoked during his 20’s for 5 years, wine 2-3 times per week Family History :   Father died of MI, Mother died of Stroke, one brother with coronary artery disease and a sister with stroke and hypertensio...

Cardiovascular System Personal history : Special habits:- Smoking increases the risk of; *Cor pulmonale (disorders predispose to cor pulmonale read here) *Coronary H. D. *Atherosclerosis * Arrhythmia I. V drug Addiction increases the risk of getting Endocarditis (fungal, Staph) A- Analysis of complaint B- Ask Leading questions about Cardiovascular symptoms: 1-Symptoms of pulmonary venous Congestion (explained below) 2-Symptoms of systemic venous Congestion. 3- Symptoms of low Cardiac output. 4-Chest pain. 5-Cyanosis & jaundice. 6-Palpitation. 7-Symptoms of Peripheral vascular disease. 8-Toxic symptoms Pulmonary Venous Congestion: Causes:- LVF (left ventricular failure) M. S (Mitral Stenosis) Manifestations : - Dyspnoea -Orthopnea - P.N. Dyspnoea -Cardiac asthma -Cough -Haemoptysis Cardiac Dyspnoea: Dyspnoea = Breathlessness =uncomfortable awareness of breathing. It is mainly due to reduced elastic properties of the lung (reduced pulmonary complianc...

Local Cardiac examination: Inspection and Palpation. Percussion. Auscultation. Inspection and Palpation A- Shape of the precordium: -Precordial bulge®denotes cardiac enlargement since childhood. -Skeletal deformities : Such As kyphosis, scoliosis or pectus excavatum. These may cause alteration of the position of the heart and great vessel which may predispose to heart failure. Apex Beat: Examine for : 1-Visible or not. (causes of invisible apex ? ) 2-Site: (Apex beat is the outermost and lowermost palpable impulse on the chest wall. ) * Normally in the left 5th intercostal space, just inside the Midclavicular line (MCL) (9 cm from the mid line ). *Abnormalities in site : -Outward displacement----®Right ventricular enlargement, chest disease. -Outward and downward ®Left ventricular enlargement, ventricular Aneurysm -Displacement to Rt.-------®congenital Dextrocardia, chest disease 3-Extent : Localized apex: Normal apical impulse do not exceed an inch in diameter ( L...