Dr. Usman's Cardiology Notes

  Oral Antiplatelet Dosing in ACS — High-Yield Guide Acute coronary syndrome (ACS) includes STEMI, NSTEMI, and unstable angina. Antiplatelet therapy is a cornerstone of treatment because platelet activation and aggregation play a central role in coronary thrombus formation. In most patients with ACS, treatment involves dual antiplatelet therapy (DAPT): Aspirin + a P2Y12 receptor inhibitor The commonly used oral P2Y12 inhibitors are clopidogrel, prasugrel, and ticagrelor. --- 1. Aspirin Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing thromboxane A₂ production and platelet aggregation. Loading Dose 162–325 mg orally Chewable, non-enteric-coated aspirin is preferred when rapid platelet inhibition is required. Maintenance Dose 75–100 mg once daily A commonly used maintenance dose is 81 mg/day. High-Yield Point Aspirin should generally be given as early as possible in ACS unless there is a true contraindication, such as significant active bleeding or serious aspirin hyp...

Newly Approved Cardiology Drugs (2022–2026): The New Era of Precision Cardiovascular Medicine The field of cardiovascular medicine is undergoing one of its most exciting transformations in decades. Rather than relying solely on traditional therapies, clinicians now have access to highly targeted drugs that address the underlying mechanisms of disease. Between 2022 and 2026, several breakthrough medications have either gained regulatory approval or reached major milestones, offering new hope for patients with hypertrophic cardiomyopathy, dyslipidemia, hypertriglyceridemia, resistant hypertension, obesity, and arrhythmias. This article reviews these landmark therapies, their mechanisms of action, clinical indications, key trials, and future role in cardiovascular practice. --- Timeline of Recent Cardiovascular Drug Innovations • 2022 – Mavacamten • 2023 – Aficamten • 2024 – Semaglutide (Cardiovascular Risk Reduction) • 2025 – Etripamil • 2025 – Lerodalcibep • 2025 – Plozasiran • 2026 – O...

Have a look on his example fluoroscopy screen of Philips cath lab/fluoroscopy monitor during coronary angiography (CAG). Here's what the displayed parameters mean: Display Meaning CAG 15 f/s Coronary angiography at 15 frames/second (cine acquisition). Higher frame rate = smoother motion but higher radiation. LAO/RAO: 0° No Left Anterior Oblique or Right Anterior Oblique angulation. Straight AP view. CRA/CAU: 0° No cranial or caudal tilt. AP projection. SID: 95 cm Source-to-Image Distance = distance from X-ray tube focal spot to detector. 8" Field of view (FOV) is 8 inches. Smaller FOV provides magnification and better spatial resolution. 0° (rotation icon) Detector rotation is neutral. 89 cm Table height (approximately detector/patient positioning parameter). 38 cm Detector position or source-to-patient distance parameter (machine dependent). 1° Slight detector/head tilt. 0% Image processing/roadmap or contrast enhancement parameter (vendor-specific). Eye icon + L LIH (Last Im...

  Mavacamten: Mechanism of Action, Indications, Dosing, Monitoring, and Clinical Evidence in Obstructive Hypertrophic Cardiomyopathy (HCM) Introduction Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy, affecting approximately 1 in 500 individuals. In many patients, excessive myocardial contractility causes dynamic left ventricular outflow tract (LVOT) obstruction, leading to exertional dyspnea, chest pain, dizziness, syncope, and reduced exercise capacity. For decades, treatment consisted mainly of beta-blockers, non-dihydropyridine calcium channel blockers, disopyramide, and septal reduction therapy. The introduction of Mavacamten represents a major breakthrough because it is the first disease-specific medication that directly targets the underlying pathophysiology of obstructive HCM rather than simply relieving symptoms. Approved by the FDA in 2022 and recommended in contemporary ACC/AHA and ESC guidelines, Mavacamten has transformed the management of...

  PASP Calculation on Echocardiography: ASE 2025 Guide, Interpretation, Pitfalls, and Clinical Significance Pulmonary artery systolic pressure (PASP) is one of the most frequently reported measurements on transthoracic echocardiography (TTE). It provides a non-invasive estimate of pulmonary artery pressure and serves as an important screening tool for pulmonary hypertension (PH). However, PASP should never be interpreted in isolation. The latest American Society of Echocardiography (ASE) guidelines emphasize a multiparametric, probability-based approach rather than relying solely on a numerical PASP value. This article reviews the latest ASE recommendations, explains how PASP is calculated, discusses common pitfalls, and highlights how to interpret PASP accurately in daily clinical practice. ──────────────────────── What is PASP? Pulmonary artery systolic pressure (PASP) represents the peak systolic pressure within the pulmonary artery. In the absence of pulmonic valve stenosis or ...

  ECG Diagnostic Criteria for Right Ventricular Hypertrophy (RVH) Most commonly used criteria R in V1 > 7 mm R/S ratio in V1 > 1 S in V1 < 2 mm (supportive) S in V5 or V6 > 7 mm R/S ratio in V5 or V6 < 1 Right axis deviation (RAD): QRS axis > +90° R in V1 + S in V5 or V6 > 10.5 mm (Sokolow-Lyon RVH criterion) R in aVR > 5 mm or R/S ratio in aVR > 1 qR pattern in V1 (especially with severe RVH) Supporting features Right atrial enlargement (P pulmonale) Right ventricular strain pattern: ST depression and T-wave inversion in V1–V3/V4 Delayed R-wave transition (late transition to R > S) Key exam point The most important ECG combination suggestive of RVH is: RAD + dominant R wave in V1 (R/S >1) + RV strain pattern. Note: ECG has low sensitivity for RVH; a normal ECG does not exclude RV hypertrophy. Echo or cardiac MRI is preferred for confirmation.

Syntax Score in Coronary Artery Disease: A Detailed Guide Introduction When a patient is diagnosed with coronary artery disease (CAD), one of the most important questions for cardiologists is not only how many blockages are present, but also how complex those blockages are. Two patients may both have three blocked arteries, yet one may be easily treated with stenting while the other may benefit more from bypass surgery. This is where the SYNTAX Score becomes extremely valuable. The SYNTAX Score is an angiographic tool used to quantify the severity and complexity of coronary artery disease and helps guide decisions between Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG). --- What Does SYNTAX Stand For? SYNTAX stands for: Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery The score was originally developed during the landmark SYNTAX Trial. --- Why Was the SYNTAX Score Developed? Traditional methods focused mainly on the n...