My approach to heart murmurs

February 17, 2024 Andrew To

3D echo image of mitral valve prolapse with flail of P2 scallop

Murmurs could be benign, up to 10% of adults, 30% of children, and could be exacerbated by conditions such as anaemia, pregnancy, fever, hyperthyroidism. Murmurs could also pathological, including valvular lesions and structural abnormalities.

Here is my approach.

My approach to palpitations

February 17, 2024 Andrew To

The two top reasons for patients seeking medical attention for palpitations are

Symptoms being bothersome
Is there something wrong? Is there a risk of sudden death?

The top priority for physician though is whether the murmur is benign or malignant.

QT interval

February 12, 2022 Andrew To

We are often asked about how best to calculate the QT interval. This is the simplest way.

Use leads II, V5
Count the number of small boxes for the QT
Note heart rate

Use this website, and put in the two numbers, to get QTc

My approach to chest pain

September 7, 2019 Andrew To

Severe coronary non-calcified atherosclerosis with severe stenosis, on CT coronary angiography

Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:

Making sense of an echocardiogram report - for GPs!

January 29, 2019 Andrew To

GPs often receive echocardiogram reports and are asked to interpret them. Here is a grossly simplified version of how.

CT coronary angiography - Cases

March 6, 2016 Andrew To

Curved reconstruction in CT coronary angiography

A 45-year-old man with no prior cardiac history, but with cardiovascular risk factors including a 10-pack-year smoking history stopped last year, 5-year history of Type II diabetes on Metformin, obesity with BMI of 37, without a family history of premature coronary artery disease, now presented with exertional but inconsistent central chest tightness.

He was investigated extensively, including a negative exercise tolerance ECG at 13 minutes without symptom or ECG change. Despite reassurance, his chest pain continued at random, and has not resolved with a course of Omeprazole for presumed non-cardiac (possibly gastrointestinal reflux) chest pain.

What should we do?

- Reassure him that this pain is almost certainly non-cardiac

- Perform a stress echocardiogram as it has a higher sensitivity than an exercise ECG

- Perform an invasive angiography

CT coronary angiography - How good is it?

March 6, 2016 Andrew To

CT coronary angiography - volume rendered image of the left anterior descending artery and its branches

CT coronary angiography has now been routinely performed, at least in the Waitemata area since 2011, where we were the first to implement CTCA in the workup of acute chest pain in New Zealand.