{"id":9830,"date":"2008-11-18T07:09:38","date_gmt":"2008-11-18T07:09:38","guid":{"rendered":"http:\/\/cardiophile.info\/?p=54"},"modified":"2022-09-01T04:49:52","modified_gmt":"2022-08-31T23:19:52","slug":"cardiac-arrhythmia-management","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/","title":{"rendered":"Management of cardiac arrhythmia: Tachyarrhythmias"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/mfjeurThYdw\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<h2 class=\"title single-title\"><span style=\"color: #008000;\">Management of cardiac arrhythmia: Tachyarrhythmias<\/span><\/h2>\n<p><strong><span style=\"color: #0000ff;\">What causes cardiac arrhythmia?<\/span><\/strong><\/p>\n<ol>\n<li>Myocardial factors like ischemia, infarction and myocarditis<\/li>\n<li>Autonomic imbalance like sympathetic and parasympathetic overactivity or underactivity<\/li>\n<li>Electrolyte imbalance like hypokalemia and hypomagnesemia,<br \/>\nhypoxia<\/li>\n<li>Drugs like antiarrhythmic agents and psychotropic agents<\/li>\n<li>Genetic disorders &#8211; Channelopathies like Brugada syndrome, long QT syndrome and short QT syndrome<\/li>\n<\/ol>\n<p><strong><span style=\"color: #0000ff;\">Common supraventricular tachyarrhythmias<\/span><\/strong><\/p>\n<ol>\n<li>Atrial fibrillation<\/li>\n<li>Atrial flutter<\/li>\n<li>AV-nodal reentrant tachycardia<\/li>\n<li>Atrioventricular reentrant tachycardia<\/li>\n<li>Atrial ectopic tachycardia<\/li>\n<li>Preexcitation syndromes combined with atrial fibrillation<\/li>\n<li>Multifocal atrial tachycardia<\/li>\n<\/ol>\n<p><strong><span style=\"color: #0000ff;\">Common ventricular tachyarrhythmias<\/span><\/strong><\/p>\n<ol>\n<li>Ventricular tachycardia: monomorphic \/ polymorphic<\/li>\n<li>Ventricular fibrillation<\/li>\n<\/ol>\n<p><strong><span style=\"color: #0000ff;\">Investigations in a case of cardiac arrhythmia<\/span><\/strong><\/p>\n<ol>\n<li>ECG is ideally recorded during the arrhythmia in addition to a routine baseline recording<\/li>\n<li>Holter monitoring &#8211; used for 24 to 48 hour monitoring with cassette \/ solid state recorder<\/li>\n<li>Loop recorder is an event recorder which monitors continuously and records events<\/li>\n<li>Implantable loop recorder can be used for long term recording, upto 18 months<\/li>\n<li>Head up tilt test for evaluation of vasovagal syncope<\/li>\n<li>Echocardiography to exclude structural heart disease<\/li>\n<li>Invasive electrophysiological studies &#8211; conventional catheter mapping and programmed stimulation<\/li>\n<li>Cardiac mapping using newer modalities like Carto and electroanatomical mapping (3-D mapping)<\/li>\n<\/ol>\n<p><strong><span style=\"color: #0000ff;\">Therapy of cardiac arrhythmia<\/span><\/strong><\/p>\n<p><em><strong><span style=\"color: #0000ff;\">Historical aspects<\/span><\/strong><\/em><\/p>\n<p>1960s: Bulky pacemakers with limited battery life; Surgery for WPW, VT, SVT<br \/>\n1980s: Catheter ablation &#8211; direct current \/ radiofrequency, ICD<br \/>\n2000s: Refinements in radiofrequency ablation \/ ICD; newer energy sources like Cryo, Ultrasound<\/p>\n<p><em><strong><span style=\"color: #0000ff;\">Management of atrial fibrillation<\/span><\/strong><\/em><\/p>\n<p><span style=\"color: #0000ff;\">Options in atrial fibrillation are: Rate control with anticoagulation vs rhythm control.<\/span> Termination can be achieved by synchronized DC Cardioversion. Direct current cardioversion is indicated in atrial fibrillation if there is hemodynamic compromise with hypotension, angina or pulmonary edema.&nbsp;Rate control can be achieved by digoxin, beta blockers or non &#8211; dihydropyridine group of calcium channel blockers (verapamil and diltiazem). All these agents can be given orally as well as intravenously depending on the situation. Rhythm control can be achieved by amiodarone, flecainide, quinidine, sotalol or ibutilide.<\/p>\n<p>Anticoagulation has to initiated with heparin and maintained on warfarin with a target INR of 2 &#8211; 3 or non-vitamin K oral anticoagulants (NOAC). Long term anticoagulation is decided based on the risk factors using standard scores. Anticoagulation prior to elective cardioversion is given for three weeks if AF has presumably lasted more than 48 hours. Alternate option in case of need for early cardioversion is transesophageal echocardiogram to exclude left atrial thrombus.<\/p>\n<p><strong><em><span style=\"color: #0000ff;\">Management of atrial flutter<\/span><\/em><\/strong><\/p>\n<p>If there is acute hemodynamic collapse or heart failure, emergent synchronized DC Version is needed.<\/p>\n<p>Energies less than 50 J may be sufficient as atrial flutter is highly sensitive to cardioversion, being a macro-reentrant arrhythmia. Atrial \/ transesophageal pacing may also be able to terminate atrial flutter. Intravenous ibutilide has a 76% success rate. Rate control can be achieved by diltiazem, verapamil, beta blocker or digoxin.<\/p>\n<p><em><strong><span style=\"color: #0000ff;\">Management of supraventricular tachycardia<\/span><\/strong><\/em><\/p>\n<p>Vagal maneuvers like carotid sinus massage or pressure over the eyeballs can be initially tried. In an infant, the <span style=\"color: #0000ff;\">dive reflex<\/span> can be activated by placing ice packs over the face. Adenosine as a bolus injection of 6 -12 mg is very useful in terminating an episode of supraventricular tachycardia. If a second bolus at a higher dose is required, it should not be an add on dose, but a higher dose as the half life of adenosine is very short. Adenosine is contraindicated in asthmatics as it can induce bronchospasm, which can persist upto 30 minutes. Verapamil 5 to 10 mg IV, diltiazem: 0.25 mg\/kg over 2 minutes or esmolol: 0.5 mg\/kg\/min for 1 minute followed by infusion at a rate of 0.05 mg\/kg\/min for 4 minutes are other options for termination of supraventricular tachycardia.<\/p>\n<p><strong><em><span style=\"color: #0000ff;\">Management of multifocal atrial tachycardia<\/span><\/em><\/strong><\/p>\n<p><span style=\"color: #0000ff;\">Three or more P waves with different morphology at a rate above 100 per minute<\/span> qualify for a diagnosis of multifocal atrial tachycardia (MAT). ECG of multifocal atrial tachycardia resembles that of atrial fibrillation and flutter. Multifocal atrial tachycardia occurs in seriously ill, elderly individuals, mostly in those with chronic obstructive pulmonary disease. Treatment is that of the underlying condition.<\/p>\n<p><strong><em><span style=\"color: #0000ff;\">Management of ventricular tachycardia<\/span><\/em><\/strong><\/p>\n<p>Lignocaine as 50 \u2013 100 mg intravenous bolus (25 -50 mg\/min) followed by 1- 4 mg\/min infusion was the sheet anchor of treatment of ventricular tachycardia earlier.<\/p>\n<p>Now amiodarone 150 mg bolus over 10 min followed by an infusion at a rate of 1 mg\/ min 6 hrs (360 mg) and 0.5 mg\/min 18 hrs (540 mg) is more popular. A word of caution is needed regarding amiodarone infusion. Occasional serious acute pulmonary toxicity can occur and hence the duration of therapy should not exceed 24 to 48 hrs, except when absolutely necessary. Maintenance with oral dosage of amiodarone is necessary for recurrent ventricular tachycardia.<\/p>\n<p>Mexiletine intravenously followed by oral dosage for maintenance is another option.<\/p>\n<p>Ventricular tachycardia with hemodynamic compromise is treated by synchronized direct current cardioversion followed by suppressive therapy as outlined above.<\/p>\n<p><strong><em><span style=\"color: #0000ff;\">Role of magnesium in the treatment of cardiac arrhythmia<\/span><\/em><\/strong><\/p>\n<p>Intravenous magnesium is drug which is often very useful in the management of polymorphic ventricular tachycardia. Deficiency of magnesium is associated with cardiac arrhythmias and&nbsp;can precipitate refractory ventricular fibrillation.<\/p>\n<p>Magnesium deficiency will also hinder replenishment of intracellular potassium as magnesium is a cofactor for the enzyme involved in potassium transport.<\/p>\n<p>1 &#8211; 2 g MgSO4 is helpful to suppress life-threatening ventricular tachyarrhythmias and is administered IV over 1 to 2 min. Magnesium is also reported to be useful in digitoxicity.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Management of cardiac arrhythmias I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia &#8211; ventricular and supra ventricular, as well as important investigations and therapeutic options.<\/p>\n","protected":false},"author":1,"featured_media":40707,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6],"tags":[1174,2301,4214],"class_list":["post-9830","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","tag-dive-reflex","tag-mat","tag-vt"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment<\/title>\n<meta name=\"description\" content=\"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment\" \/>\n<meta property=\"og:description\" content=\"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2008-11-18T07:09:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-08-31T23:19:52+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Management of cardiac arrhythmia: Tachyarrhythmias\",\"datePublished\":\"2008-11-18T07:09:38+00:00\",\"dateModified\":\"2022-08-31T23:19:52+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/\"},\"wordCount\":867,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"keywords\":[\"dive reflex\",\"MAT\",\"VT\"],\"articleSection\":[\"ECG \\\/ Electrophysiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/\",\"name\":\"Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"datePublished\":\"2008-11-18T07:09:38+00:00\",\"dateModified\":\"2022-08-31T23:19:52+00:00\",\"description\":\"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#primaryimage\",\"url\":\"\",\"contentUrl\":\"\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/cardiac-arrhythmia-management\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Management of cardiac arrhythmia: Tachyarrhythmias\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment","description":"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/","og_locale":"en_US","og_type":"article","og_title":"Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment","og_description":"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.","og_url":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2008-11-18T07:09:38+00:00","article_modified_time":"2022-08-31T23:19:52+00:00","author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Management of cardiac arrhythmia: Tachyarrhythmias","datePublished":"2008-11-18T07:09:38+00:00","dateModified":"2022-08-31T23:19:52+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/"},"wordCount":867,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#primaryimage"},"thumbnailUrl":"","keywords":["dive reflex","MAT","VT"],"articleSection":["ECG \/ Electrophysiology"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/","url":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/","name":"Management of cardiac arrhythmia I: Tachyarrhythmias - causes, types, treatment","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#primaryimage"},"thumbnailUrl":"","datePublished":"2008-11-18T07:09:38+00:00","dateModified":"2022-08-31T23:19:52+00:00","description":"Management of cardiac arrhythmia I: Tachyarrhythmias: Discusses various causes of cardiac arrhythmia, types of tachyarrhythmia - ventricular and supra ventricular, as well as important investigations and therapeutic options.","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#primaryimage","url":"","contentUrl":""},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/cardiac-arrhythmia-management\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Management of cardiac arrhythmia: Tachyarrhythmias"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/9830","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=9830"}],"version-history":[{"count":4,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/9830\/revisions"}],"predecessor-version":[{"id":54777,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/9830\/revisions\/54777"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=9830"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=9830"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=9830"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}