Saturday, 30 June 2012

- Permanent Pacemaker implanation animation.

Permanent Pacemaker implanation animation.  

Friday, 29 June 2012

- How to use the transvenous pacemaker?

How to use the transvenous pacemaker ?
This is short video explaning How to use the transvenous temporary pacemaker.

Thursday, 28 June 2012

- Temporary cardiac Pacemakers.

Temporary cardiac Pacemakers.

Temporary Pacemakers may be:-
  1. Epicardial pacing:- is used during open heart surgery when the surgical procedure create atrio ventricular block. The electrodes are placed in contact with the outer wall of the ventricle (epicardium) to maintain satisfactory cardiac output until a temporary transvenous electrode has been inserted.
  2. Transvenous pacing:- Temporary transvenous pacing involves two components, ie obtaining central venous access and intracardiac placement of the pacing wire.A pacemaker wire is placed into a vein (internal jugular vein , subclavian or femoral veins) under sterile conditions, and then passed into the right atrium then right ventricle. The pacing wire is then connected to an external pacemaker outside the body. Transvenous pacing is often used as a bridge to permanent pacemaker placement. It can be kept in place until a permanent pacemaker is implanted or until there is no longer a need for a pacemaker and then it is removed. Transvenous pacing usually done under imaging for proper positioning of the electrodes.

Wednesday, 27 June 2012

- Artificial cardiac pacemaker.

Artificial cardiac pacemaker.

It is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart so it mimics the action of your natural pacemaker..

Pacemakers can be temporary (here) or permanent.

Pacemaker consists of two parts:
  1. The pulse generator: This small metal container houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart.
  2.  Leads: These flexible, insulated wires deliver the electrical pulses to your heart.
Pacemakers monitor your heartbeat and, if it's too slow, the pacemaker will speed up your heart rate by sending electrical signals to your heart. In addition, most pacemakers have sensors that detect body motion or breathing rate, which signals the pacemaker to increase your heart rate during exercise to meet your body's increased need for blood and oxygen. 

Dr Ibrahim Samaha

Sunday, 24 June 2012

-Child CPR.

Child CPR

Note that the main difference between the adult CPR and child CPR is the intial 5 breaths and the usage of one hand if the child is small in size.

Friday, 22 June 2012

- The Chain of Survival.

 The Chain of Survival.

The series of actions linking the victim of sudden cardiac arrest with survival are called the "Chain of Survival".
All four links of the chain must be strong.

Thursday, 21 June 2012

- Vegetations On Mitral Valve.

Vegetations On Mitral Valve.
Vegetations On Mitral Valve seen by portable echo in 18 years old Egyptian female with mitral regurgitation..Complaining of Fever,had CS 15 days ago..
With pansystolic murmur heard maximally over the apex of the heart.

This  Diagnosing a case of "Infective Endocarditis"

 Dr Ibrahim

Wednesday, 20 June 2012

- Types of ST segment depression in ECG.

Types of ST segment depression in ECG.

  •  ST segment take 2-3 small squares from "J" point where "S" wave ends..
  • "J" point is small square after "R" wave when "s" wave not found.
  •  ST depression is significant if it is more than small square below the isoelectric line.
*There are three types of ST depression:

Tuesday, 19 June 2012

- Recording a 12 Lead ECG.

Recording a 12 Lead ECG.

This film is designed to give clinical students and professionals an insight into the procedure.

Monday, 18 June 2012

- Contents of Posterior mediastinum.

Contents of Posterior mediastinum:

  •  Descending aorta
  •  Azygos and hemiazygous veins
  •  Thoracic duct
  •  Esophagus
  •  Sympathetic trunk/ganglia

Sunday, 17 June 2012

- Captopril side effects.

Captopril side effects (an ACE inhibitor)

  • Cough
  • Angioedema/ Agranulocystosis
  • Proteinuria/ Potassium excess
  • Taste changes
  • Orthostatic hypotension
  • Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
  • Renal failure (and renal artery stenosis contraindication)/ Rash
  • Indomethacin inhibition
  • Leukopenia/ Liver toxicity

Saturday, 16 June 2012

- Beck's triad of cardiac temponade.

Beck's triad of cardiac temponade:-
  1. Decrease of systolic blood pressure.
  2. Distended jugular vein.
  3. Diminished heart sounds (quite heart).

Friday, 15 June 2012

- Parasites affecting Heart.

Parasites affecting Heart
"Heart Team
Heterophyes heterophyes (Eggs)

Taenia solium (cysticercosis), 
Trichinella spiralis (Trichina capsule),
Trypanosoma cruzi (Leishmanial form),
Toxoplasma gondii (true tissue cyst).

Echinococcus granulosus (Hydatid cyst).
Acanthocheilonema perstans (Adult worm in the pericardium).
Mansonella ozzardi
(Adult worm in the pericardium).

or  Arabic students can use the word "Hatem"

Dr Ibrahim

Thursday, 14 June 2012

-No in ASD.

No in Atrial septal defect.
  • No murmur due to ASD itself but murmur of relative MS,PS.
  • No ACEIs if HF occur but give diuretics and digitalis.
  • No spontanous closure of ASD.
  • No symptoms or signs in small ASD.
Dr Ibrahim

Wednesday, 13 June 2012

-Complications of Tetralogy of fallot.

Complications of Tetralogy of fallot collected in the word..
  • Infective endocarditis,Low I.Q.
  • Neurological (e.g Brain abscess,cerebrovascular accidents)
  • Cyanotic spell,Clubbing.
  • Hematological(e.g polycythemia,IDA,Thrombosis).
  • Hyperuracemia and gout,Heart Failure (rare).
  • Exercise intolerance.
  • Squatting,Scoliosis,Stunted growth.
  Dr Ibrahim

Tuesday, 12 June 2012

- Painless myocardial infarction!

Causes of Painless myocardial infarction!
  • Dyspnea,DM
  • Impaired consciousness (e.g. coma or under anesthesia).
  • Elderly.
  • Transplanted heart.

Dr Ibrahim,,

Monday, 11 June 2012

- Emergency in mitral stenosis!

Emergency in mitral stenosis!

Mitral stenosis may came to ER with complications which need urgent interference..collected in the word "Chart"..
  • Cardiac asthma (Acute pulmonary edema)
  • Haemoptysis
  • Atrial fibrillation.
  • Rheumatic activity.
  • Thromboembolic complications e.g stroke.
Dr Ibrahim,,

Saturday, 9 June 2012

- Cardiovascular Examination video.

The cardiovascular examination: narrated and illustrated.  
  • Introduction.
  • general examination.
  • pericordial examination.
  • final consideration.

Friday, 8 June 2012

- Peripheral Signs of Infective Endocarditis.

Peripheral Signs of Infective Endocarditis.

1-Roth’s spots: Oval shaped, white centered hemorrhages present on the retina of some patients with infective endocarditis on the funduscopic examinations.
Roth’s spots,Infective Endocarditis
(From the collection of Sanjay Sharma, St George’s University of London, UK) 
NB: Roth's spots, or white-centered retinal hemorrhages, may be seen in a variety of conditions, including: leukemia, subacute bacterial endocarditis, ischemic events associated with elevated venous pressure, and systemic vascular conditions with capillary fragility.

Wednesday, 6 June 2012

- Heart Anatomy Animated Video..

Heart Anatomy Animated Video..
A Doctor walks you through an animated video about the amazing human heart.

Tuesday, 5 June 2012

- Quick facts about heart anatomy and physiology.

Quick facts about heart anatomy and physiology.

  • Your heart is located between your lungs in the middle of your chest, immediately behind and slightly to the left of your sternum.
  • In this location, it is protected by the sternum  in front, the spinal column in back, and the ribs and lungs on the sides.
  •  It weighs approximately 250 to 300 grams (9 to 11 oz) in females and 300 to 350 grams (11 to 12 oz) in males.(1)
  • The heart is about the size of a human fist.
  • The pericardium is a double-walled sac containing the heart and the roots of the great vessels. Pericardium is a tough double layered membrane which covers the heart. The space between the two layers of it is filled with a pericardium fluid which protects the heart from any kind of external trauma..the outermost fibrous pericardium and the inner serous pericardium.
  • The heart actually pumps blood through two very distinct circulatory systems  ... Systemic system and Pulmonary system..
  • The systemic system is the system in which fresh oxygenated blood pumps out through the arteries and in which deoxygenated blood returns to the heart through the veins.
  • The pulmonary system is the system  in which Deoxygenated blood is pumped out of the heart through the pulmonary arteries into the lungs, and recharged oxygenated blood returns to the heart through the pulmonary veins. It is this recharged oxygenated blood that gets pumped out through the systemic circulatory system..
  • The only veins which carry oxygenated blood are the 4 pulmonary veins.
  • The only artery which carry deoxygenated blood is the pulmonary artery.

(1)Kumar, Abbas, Fausto: Robbins and Cotran Pathologic Basis of Disease, 7th Ed. p. 556

Monday, 4 June 2012

- Conductive system of the Heart.

Conductive system of the Heart.

The Function of the heart is to contract rhythmically and pump blood to the lungs for oxygenation and then to pump this oxygenated blood into the general (systemic) circulation.

The signal for cardiac contraction is the spread of electrical currents through the heart muscle.
In normal Conditions, these electrical currents are produced by  pacemaker cells of the Sinoatrial node (SAN), located on top of the right atrium near the opening of the superior vena cava at a rate of 100 per minute.