History
Trials and Tribulations
Regard this M-Mode
Signs, signs, everywhere a sign
MIscellaneous
100
The first coronary balloon angioplasty was done by this German interventional radiologist and cardiologist.
Andreas Gruentzig
100
In this 1988 trial, in patients with acute MI, aspirin by itself, streptokinase by itself as well as aspirin + streptokinase decreased mortality at 5 weeks when compared to placebo.
ISIS-2
100
What is the arrow pointing to and what is the clinical significance?
"B-bump" suggests significantly elevated LVEDP (>15 mmHg)
100
Epigastric bulging seen in patient with severe pericardial effusion
Auenbrugger's sign
100
Ticagrelor can cause dyspnea and/or bradycardia by increasing extracellular concentration of this molecule.
Adenosine
200
What was the profession of Charles Stent, for which the word 'stent' was named after?
Dentist
200
In this 2002 trial, in patients with nonvalvular a-fib, rate control led to a trend towards increased survival with a lower risk of adverse events when compared to rhythm control.
AFFIRM
200
What pathology is suggested by this M-mode?
Mitral stenosis
Features:
- Reduced E-F Slope: Slow closing velocity of the anterior mitral valve leaflet after the initial opening (E point), reflecting elevated left atrial pressure.
- Anterior Posterior Leaflet Motion: The posterior leaflet moves anteriorly in diastole instead of posteriorly due to fusion and tethering, sometimes described as a "box-like" appearance with the anterior leaflet.
- Absent A Wave: In cases of atrial fibrillation (common in MS), the atrial contraction "A" wave is absent, or if in sinus rhythm, it may be significantly diminished due to high left atrial pressure.
- Left Atrial Enlargement: The posterior wall of the left atrium shows a separation > 20 mm, indicating left atrial dilation.
- Reduced Valve Opening: The total excursion of the anterior leaflet towards the septum is decreased.
200
What is the sign represented by the blue arrow?
Josephson's sign; notching near nadir of S-wave suggestive of VT
200
List the three component's of Beck's triad
1) Low BP
2) distended neck veins
3) muffled heart sounds
300
Elmquist and Senning developed the first one of these in 1959 at the University of Zurich.
internal pacemaker
300
In this 2024 trial, in patients with asymptomatic severe aortic stenosis, TAVR reduced the composite of death, stroke and unplanned hospitalization at over 3 year follow up when compared to routine clinical surveillance.
EARLY TAVR
300
What is the pathology represented by this M-mode?
SAM Systolic anterior motion of the mitral valve
300
A significant difference between the arms and legs seen in severe AR.
Hill's sign
300
ACEi studied in RCTs which improves walking distance and claudication in PAD patients
Ramipril
400
Considered the "Father of American Cardiology", he helped pioneer the concept of cardiovascular prevention.
Paul Dudley White
400
In the 2019 REDUCE-IT trial, in patients with CAD or diabetes and another risk factor and already on statin with residual hypertriglyceridemia, the addition of this medication reduced cardiovascular events and cardiovascular death at 4.0 year when compared to placebo.
icosapent ethyl
400
What pathology is represented by this M-mode?
left atrial myxoma
400
An increase in the volume of a tricuspid regurgitation murmur during inspiration, which helps distinguish it from mitral regurgitation.
Carvallo's sign
400
Warfarin skin necrosis occurs in patients with deficiency of this protein
Protein C
500
Japanese biochemist Akira Endo first isolated this agent widely used in treatment and prevention of cardiovascular disease.
HMG COA enzyme inhibitor
500
This 2001 trial showed that in patient with advanced heart failure (NYHA IV), LVAD decreased all-cause mortality when compared to optimum medical therapy alone.
REMATCH
500
What pathology is suggested by this M-mode?
Aortic Regurgitation
500
What are these called and associated with?
Janeway lesions
Infective endocarditis
500
What do A and B mode stand for?
A- Amplitude
B- Brightness