As part of a comprehensive left ventricular (LV) diastolic assessment, doppler tissue imaging (DTI) of the medial and lateral aspects of the mitral valve (MV) annulus should be performed. In the image below, I have labeled a DTI of the lateral aspect of the MV derived from a mid-esophageal 4-chamber…
Amino acids are the building blocks of proteins. Some cannot be synthesized by our bodies and are therefore considered “essential” – they must be obtained from one’s diet. Tryptophan, an essential amino acid found in eggs, meats, chocolate, dairy, etc., regulates nitrogen balance. It’s also the precursor for the neurotransmitter…
Complete (3°) heart block (CHB) occurs when atrial signals do not reach the ventricle; therefore, the atria (P-waves) and ventricles (wide QRS complexes) pace themselves independently of each other. Symptoms can range from fatigue and dyspnea to syncope, chest pain, and sudden cardiac death. CHB can be caused by ischemia,…
Mitral valve endocarditis can affect any part(s) of the mitral valve apparatus – annulus, leaflets, and even chordae tendinae – resulting in acquired mitral valve regurgitation (MR) through leaflet perforation, rupture of chordae, and other damage to the leaflets. 3D transesophageal echocardiography (TEE) is incredibly powerful in diagnosing the mechanism…
Ertapenem (Invanz) is an intravenous carbapenem antibiotic. Compared to meropenem, ertapenem has a more limited spectrum of activity, notably lacking activity against Pseudomonas, Acinetobacter, and Enterococcus – some very important healthcare-associated organisms. Furthermore, it’s not an excellent option for penicillin-resistant pneumococci. Although I rarely use this antibiotic in my OR…
Ebstein anomaly is a rare (~0.005% of the general population) congenital heart condition characterized by the apical displacement of the septal tricuspid valve (TV) leaflet, a “sail-like,” long anterior TV leaflet, atrialization of the proximal right ventricle (RV), and a dilated TV annulus. These anatomic changes result in tricuspid regurgitation…
Patients with severe hyponatremia ([Na+] < 120 mEq/L) can present with altered mentation, seizures, lethargy, and even coma. After identifying the likely cause(s), treatment is centered around a combination of sodium replacement (usually with 3% hypertonic saline, HTS) and volume correction depending on if the patient is hypo-, eu-, or…
At the time of this writing, the V-Wave® Ventura® Interatrial Shunt system is an investigational device aiming to improve the quality of life (fewer symptoms, reduced hospital admissions, etc.) for patients with heart failure. The shunt is hourglass-shaped with a nitinol frame deployed through the interatrial septum (IAS). After accessing…
Off-pump coronary artery bypass grafting (OPCABG) is a surgical revascularization technique where grafts are anastomosed to coronary arteries to bypass occlusions without using cardiopulmonary bypass. As a result, the typical considerations for “on-pump” CABG (atrial cannulation, aortic cannulation, aortic cross-clamping, cardioplegia, suspension of mechanical ventilation, etc.) are not performed. Instead,…
Cangrelor (Kengreal) is an intravenous P2Y12 platelet inhibitor which is run as a continuous infusion. Unlike clopidogrel (Plavix) which is a prodrug requiring conversion to an active metabolite, cangrelor is already active and has a quick onset. Furthermore, stopping the infusion results in rapid restoration of platelet function in ~1…