Dr. Usman's Cardiology Notes

Measurement of Fractional Area Change (FAC) of the Right Ventricle Introduction Assessment of right ventricular (RV) systolic function is an essential component of echocardiography, as RV dysfunction carries important diagnostic and prognostic implications in many cardiovascular diseases. Fractional Area Change (FAC) is a simple, reproducible, and guideline-recommended echocardiographic parameter used to quantify global RV systolic function. What is Right Ventricular Fractional Area Change (RV FAC)? RV FAC is a two-dimensional echocardiographic measurement that represents the percentage change in RV cavity area between end-diastole and end-systole. It reflects longitudinal and radial contraction of the RV and correlates reasonably well with RV ejection fraction measured by cardiac MRI. Formula for RV FAC RV FAC (%) = [(RV End-Diastolic Area − RV End-Systolic Area) ÷ RV End-Diastolic Area] × 100 Echocardiographic View Required • RV-focused apical four-chamber view • The RV should be cen...

📍 Medical Triads Medical triads are sets of three important clinical features (symptoms, signs, or findings) that tend to appear together and help clinicians quickly identify and diagnose specific conditions. 🚨 Why medical triads matter 🎓 Simple to memorize for exams ⚡ Aid in fast bedside diagnosis 📚 Frequently tested in medicine, nursing, and allied health sciences

Top 10 Cardiology Mnemonics 1. Causes of Chest Pain – RAT PLACES R – Reflux A – Aortic dissection T – Trauma P – Pneumonia / Pneumothorax L – Lung (PE) A – Angina / MI C – Costochondritis E – Esophageal spasm S – Shingles 2. Causes of Reversible Secondary Hypertension – CHAPS C – Coarctation of aorta H – Hyperaldosteronism A – Apnea (OSA) P – Pheochromocytoma S – Stenosis (renal artery) 3. Diastolic Murmurs – PR ARD P – Pulmonary regurgitation R – Rheumatic (mitral stenosis) A – Austin Flint murmur R – Ruptured papillary muscle (functional MS) D – Aortic regurgitation 4. Causes of Dilated Cardiomyopathy – ABCD FRESH A – Alcohol B – Beriberi C – Coxsackie / Cocaine D – Doxorubicin F – Familial R – Rheumatic E – Endocrine S – Sepsis H – Hemochromatosis 5. ECG Causes of Tall T Waves – MI HAT M – Myocardial infarction (hyperacute) I – Ischemia H – Hyperkalemia A – Acute pericarditis T – Tall normal variant 6. Causes of Left Ventricular Hypertrophy – HARD H – Hypertension A – Aortic stenosi...

L Wave on Echo L-Wave on Echocardiography: The Hidden Doppler Clue to Advanced Diastolic Dysfunction What is the L-Wave? The L-wave is a mid-diastolic transmitral flow wave seen on pulsed-wave Doppler echocardiography, occurring between the E-wave (early diastolic filling) and A-wave (atrial contraction). It represents continued left ventricular (LV) filling during diastasis and is not a normal finding in adults. Its presence strongly suggests diastolic dysfunction with elevated left ventricular filling pressures. --- Normal Mitral Inflow Pattern (Recap) Normal transmitral Doppler flow consists of: E-wave → Early rapid LV filling due to pressure gradient between LA and LV Diastasis → Minimal or no flow A-wave → Atrial contraction There is no mid-diastolic flow in normal physiology. --- What Causes the L-Wave? The L-wave appears when: LV relaxation is impaired but LA pressure remains persistently elevated This creates a renewed pressure gradient during mid-diastole, allowing additional ...

  Persistent Left Superior Vena Cava (PLSVC): Embryology, Anatomy, and Clinical Significance --- Introduction Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous system. Although usually asymptomatic and discovered incidentally, it has important implications during central venous access, pacemaker implantation, cardiac surgery, and echocardiographic interpretation. --- Normal Embryology of the Systemic Venous System During early embryonic life (4th–8th week of gestation), venous drainage of the embryo is symmetrical and consists of: Right and left anterior cardinal veins – drain the cranial part Right and left posterior cardinal veins – drain the caudal part Each anterior and posterior vein joins to form a common cardinal vein, which drains into the sinus venosus Normal Development An anastomosis forms between the right and left anterior cardinal veins → becomes the left brachiocephalic (innominate) vein The right anterior cardina...

  Platypnea–Orthodeoxia Syndrome (POS): Causes, Mechanisms, Diagnosis, and Management Platypnea–orthodeoxia syndrome is a rare but important clinical condition characterized by positional dyspnea and arterial desaturation. Recognition is crucial because many cases are treatable once the underlying mechanism is identified. Definition Platypnea refers to worsening dyspnea in the upright position that improves when lying supine. Orthodeoxia refers to a fall in arterial oxygen saturation or PaO₂ on assuming an upright posture, with improvement in the supine position. Platypnea–orthodeoxia syndrome is defined by the coexistence of both features. Pathophysiology The hallmark of POS is position-dependent right-to-left shunting or severe ventilation–perfusion (V/Q) mismatch. When the patient stands or sits upright, anatomical or functional changes increase shunting or worsen perfusion of poorly ventilated lung zones, leading to hypoxemia. When supine, these abnormalities partially resolve....

  ECG Changes Associated With Prior Myocardial Infarction (In the Absence of LVH and LBBB) Myocardial infarction (MI) results in irreversible myocardial necrosis followed by healing with fibrotic scar formation. This scar tissue is electrically inactive and alters normal cardiac depolarization and repolarization, producing characteristic electrocardiographic (ECG) changes that may persist for life. Recognition of these ECG patterns is essential for diagnosing prior (old) MI, particularly in asymptomatic patients or those presenting later with heart failure, arrhythmias, or ischemic symptoms. Pathophysiological Basis Following MI, necrotic myocardium is replaced by fibrosis. Because scar tissue does not conduct electrical impulses normally, the direction and timing of ventricular activation change. These alterations lead to abnormal Q waves, QS complexes, fragmented QRS patterns, and abnormal R-wave progression. The ECG therefore becomes a surrogate marker of myocardial scar. Pathol...