Murmonyms-Murmurs with an eponym

I believe names associated with clinical signs or murmurs help to bring curiosity and are a tribute to the inventor. These are called eponyms. Below is a summary list of various murmurs with eponyms or we may call it murmonyms.

Mitral valve

Cary coombs murmur-Rheumatic fever mitral valvulitis.Other mechanisms are choral rupture,annular dilatation.

Tricuspid valve

Rivero Carvallo sign-Inspiratory augmentation of tricuspid regurgitation murmur.

Reverse Rivero carvallo sign -Inspiratory decrease of TR murmur in right sided HCM and straight back syndrome.

Aortic valve

Austin flint murmur-MDM in severe aortic regurgitation.

Key Hodgkin murmur-Murmur with a quality of “sawing wood” in AR due to cusp retroflexion.

Cole Cecil murmur -AR murmur heard in axilla.

Cooing dove murmur -Cusp prolapse in acute AR.Also heard in acute MR.

Some physicians have described it as sound produced by rubbing leather of shoe 👞 with each other.

Pulmonary valve

Graham steell murmur-Early decrescendo diastolic murmur in pulmonary hypertension which increases with inspiration.

Congenital heart disease

Roger murmur -Loud murmur of small ventricular septal defect.

Train in tunnel/Gibson murmur- Continous murmur of PDA with eddy sounds in between.

High flow situation

Cabot Locke murmur-Early diastolic murmur at the base in anemia.

Lerman Means scratch -Midsystolic murmur in basal areas in hyperthyroidism.

Stills vibratory murmur-Medium to long systolic murmur at the left lower sternal border due to vibration of chordae in children.

CAD

Dock’s murmur-Diastolic murmur in proximal left anterior descending artery stenosis.

Arrhythmia

Rytand murmur- Middiastolic murmur in complete AV block.

Dietary approaches in hypertension

Can your diet change your BP ? Studies say YES. Read below to know how

Two diet patterns have been studied most regarding BP control. One is Mediterranean diet pattern other is DASH diet (Dietary Approaches to Stop Hypertension diet)

Mediterranean diet includes nuts,olive oil,fresh fruits and vegetables and whole grain. Stress is on good fat intake.

But DASH diet is rich in protein,fiber,magnesium calcium,fresh veggies and fruits but low in fat.

DASH diet has got better evidence for utility

Salt and BP control-The relation between salt intake and hypertension is complicated like a J curve.Optimal salt is better,less than 2.3 g/day is good,too less is also worse.

As they say sprinkle the salt “just right”!

There are many other food items,minerals implicated in BP control,rather I say speculated.

What exactly cause hypertension ?

Still remain as an enigma.Modern medicine is playing hide and seek behind veil of fancy terms “idiopathic “/”essential” .No one really knows the truth.

A quiz on myocarditis

  1. Most common manifestation of Lyme myocarditis is ?
  2. A 38 year old male presented with orthopnea, fever, fatigue and chronic diarrhea. Echocardiography showed mitral stenosis and aortic valve regurgitation. His work up for chronic diarrhea revealed rod-shaped organisms in intestine biopsy under electron microscopy. What is the most probable diagnosis?
  3. A 26-year-old man presented with heart failure and recurrent constipation. ECG showed BBB and echocardiography revealed apical thinning with clot.
Connect these images

4.A 60 year old male presented with deep vein thrombosis and pleural effusion. He remembers having pepperoni pizza 2 weeks back from a restaurant. Investigations show peripheral eosinophilia and frequent VPC in ECG. Echo showed LV global hypokinesia and dilated LV. He underwent an endomyocardial biopsy for futher evaluation. What finding u expect in his EMB?

5.Clozapine myocarditis-Peak incidence occurs after how many weeks of initiation of drug?

6.Fulminant myocarditis may be caused by combination immune check point blockade by?

7.Cardiac infection of B19 V can be demonstrated in myocardial cells.True or false?

8.An early consideration for ICD should be taken  in which all myocarditis?

9.Multifocal inflammatory infiltrate of lymphocyte and multinucleated giant cells without granuloma is seen in EMB in ?

10.A 20 year old female presented with AV block. Echo showed basal septal thinning and metabolism-perfusion mismatch in Ru-FDG PET. Diagnosis ?

Trials on device monitoring in HF

TRIALCOMMENT
HOMEOSTASISImplantable LAP monitor (HeartPOD)
REDUCE HFStopped premature due to RV lead problems
EVOLVOICD alarms in detecting early HF and reduced emergency admissions noted
SENSE HFLow predictive value of device in HF
REM-HFNo benefit with device for HF device
IN-TIMETele monitoring using ICDs or cardiac resynchronisation defibrillators (CRT-Ds) with telemonitoring function are useful.
CHAMPION-HFUse of PA pressure monitor by cardiomems is useful, Only FDA approved device

Reference: Eur Heart J Suppl. 21(Suppl M): M50-M

Try this quiz on Aortic aneurysm

Level:Intermediate

  1. Part of aorta maximum vulnerable to deceleration trauma?
  2. Infrarenal aorta has got more vasa vasora. True or false?
  3. AAA is abdominal aorta diameter greater than _______ ?
  4. Over what age SVS (society of vascular surgeons) recommend screening for AAA in tobacco in male smokers?
  5. Antibiotic studied for its action on reducing AAA by acting on MMP enzyme?
  6. In 100 patients with large AAA, how many may have a co-existent TAA as per current literature?
  7. 5-year risk of rupture for AAA larger than 7 cm?
  8. Endoleak resulting from leak through graft fabric is type ___?
  9. Name a trial comparing open surgery and EVAR?
  10. Endotension size increase mandating a surgical correction is ?

Quiz-Narrow complex tachycardia

Here is a short quiz on narrow QRS complex tachycardia.Questions range from easy to difficult as you progress through.

QUIZ

  1. Second most common narrow complex tachycardia (NCT)?
  2. 95% of AVRT is of which type —–
  3. Three or more different P wave morphologies, with associated irregular PR and R–R intervals are diagnostic of  ?
  4. For differentiating regular vs Irregular NCT, variability in R to R interval greater than ——
  5. Alpha limb of perinodal circuit in AVNRT is —–conducting(slow/fast)
  6. INhalation of Flecainide to Convert Recent Onset SympTomatic Atrial Fibrillation to siNus rhythm was tested in which trial ?tested
  7. PJRT is a —–RP tachycardia ?
  8. Most common mechanism of narrow complex tachycardia is ?
  9. Single P wave is followed by two narrow QRS complexes causing an irregular R–R tachycardia in ——
  10. NODE-1 is a clinical trial ongoing for an inhalational agent for terminating PSVT using —–?

Reference- Shah RL, Badhwar N. Heart 2020;106:772–783

Chloroquine and arrhythmia

Dear friends,

Now as US FDA has issued an emergency use authorization to allow hydroxychloroquine and chloroquine used for certain hospitalized patients with COVID-19, it is useful to know some risk predictors in those using drug in view of its much debated pro-arrhythmic potential.

American college of cardiology has recently published an article regarding same.

Following are some precautionary measures and we should evaluate Risk Vs Benefit in each case

  1. Baseline Evaluation
    1. Avoid all other non-critical QT prolonging agents.
    2. Assess a baseline ECG, renal function, hepatic function, serum potassium and serum magnesium.
    3. When possible, have an experienced cardiologist measure QTc.
    4. Baseline QT prolongation is a contraindication
    5. History of sudden cardiac death in family -rule out arrhythmic cause
    6. Calculate risk assessment (see below) in each case with risk benefit ratio.
  2. Ongoing monitoring, dose adjustment and drug discontinuation
    1. Place on telemetry prior to start of therapy.
    2. Monitor and optimize serum potassium daily.
    3. Acquire an ECG 2-3 hours after the second dose of hydroxychloroquine, and daily thereafter.
    4. If QTc increases by >60 msec or absolute QTc >500msec (or >530-550 msec if QRS >120 msec), discontinue azithromycin (if used) and/or reduce dose of hydroxychloroquine and repeat ECG daily.
    5. If QTc remains increased >60 msec and/or absolute QTc >500 msec (or >530-550 msec if QRS >120 msec), reevaluate the risk/benefit of ongoing therapy, consider consultation with an cardiologist and consider discontinuation of hydroxychloroquine.

Table 1. Tisdale Risk Score For Drug-Associated QTc Prolongation

Risk FactorsPoints
Age ≥68 y1
Female sex1
Loop diuretic1
Serum K+ ≤3.5 mEq/L2
Admission QTc ≥450 ms2
Acute MI2
≥2 QTc-prolonging drugs3
sepsis3
Heart failure3
One QTc-prolonging drug3
Maximum Risk Score21
K+ indicates potassium; and MI, myocardial infarction.

Table 2. Risk Levels For Drug-Associated QT Prolongation

Low risk = ≤6 points
Moderate risk = 7-10 points
High-risk = ≥11 points

For further reading log on to https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19

Hope it helps some one

Good day !

References

Timothy F. Simpson, MD, PharmD; Richard J. Kovacs, MD, FACC; and Eric C. Stecker, MD, MPH, FACC.Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19 Acc Cardiology magazine Mar 29 2020

Tisdale JE, Jayes HA, Kingery JR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013;6:479-487.

https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#covidtherapeutics

Ajmaline testing

IAjmaline testing in Brugada syndrome ECG courtesy ;Dr J Heuser

Ajmaline is a Rauwolfia derivative CLASS 1 A drug.It is mostly used for diagnosis of arrhythmias

USES

  1. Delta wave disappearance in WPW syndrome indicating accessory PW ERP >250 msec
  2. Demonstrating ST changes ,IVCD in occult chagasic myopathy
  3. In cases of BBB and syncope-to demonstrate etiology of heart block
  4. To induce Rt precordial STE in BRUGADA syndrome with normal ecg. (mc)

Adverse reactions

  1. Mild anticholinergic
  2. Mild depression of LV systolic fn
  3. Worsen AV conduction in His purkinje disease
  4. Rarely TdP occur
  5. Increase Defibrillation threshold

Ref-BW 11 th ed pg 677