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:

1. 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.


2.  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.


3. 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.


Blood Pressure:

1. 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.


2. 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

1. What are the causes of thrill in the base of the heart in ASD?

  • ASD with Pulmonary stenosis
  • Lutembacher syndrome


2. Which lung contributes more to shunt flow in ASD?

  • Right lung


3. 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.




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