Frequently asked Questions during morning sessions.
Note: You are requested to find out the answers by yourself. I have tried to provide some answers. If you have any suggestions or queries please send to the following email addresses:
Ventricular Septal defect:
- What is the age of onset of VSD murmur?
- 2-6 weeks after birth
- A murmur appearing before 18 hrs of age and later than 6 months is never due to isolated VSD.
- Why VSD murmur is not present at birth
- Delayed fall in neonatal PVR results in the delayed onset of the shunt and delayed onset of the murmur.
- What is the situation where VSD murmur is present at birth?
- VSD with LV to RA communication because shunt exists in utero and therefore exists at birth.
- What is peripheral amplication of blood pressure?
- Systolic pressure becomes higher and higher as one move farther peripherally. Diastolic pressure and mean pressure remain the same or decrease slightly
- There is a change in the arterial pressure waveform at different levels in an arterial tree as shown in figure. But the area under the curve decreases slightly in the peripheral sites.
- What is the width of BP cuff?
- The correct width of BP cuff is 40-50% of the circumference of the limb on which BP is being measured.
Atrial Septal defect
- What are the causes of thrill in the base of the heart in ASD?
- ASD with Pulmonary stenosis
- Lutembacher syndrome
- Which lung contributes more to shunt flow in ASD?
- Right lung
- What is crochetage in ASD ECG?
- A notch near the apex of the R waves in inferior leads of ostium secundum ASD and sinus venosus ASD.
- Crochetage has been correlated with shunt severity –large ASD
- Crochetage is a electrocardiographic marker of PFO associated with ischemic stroke
What is renal Guard therapy?
- A therapeutic approach to reducing Contrast-Induced Nephropathy
- designed to reduce the toxic effects that contrast media can have on the kidneys, which may lead to a reduction in the incidence of CIN in at-risk patients
Theory: “creating and maintaining a high urine output through the kidneys allows the body to rapidly eliminate contrast, reducing its toxic effects”
High urine rates may reduce the incidence of Contrast-Induced Nephropathy via a combination of known physiological factors, including:
- More rapid transit of contrast through the kidneys
- Less overall exposure to toxic contrast
- Reduced oxygen consumption in the medulla of the kidney
Renal Guard System: designed to measure urine output and replaces it in real-time with an equal volume of sterile saline. This matched fluid replacement aims to minimize the risk of over- or under-hydration which can lead to increased patient risks.