Dr. Usman's Cardiology Notes

Exam favorite questions about ESR 1. ESR >100 mm/hr Giant Cell Arteritis (Temporal Arteritis) • Age >50, new onset headache, scalp tenderness • Jaw claudication, visual symptoms • ESR usually >100 • Start prednisolone 40–60 mg immediately to prevent blindness • Closely linked with PMR Polymyalgia Rheumatica (PMR)  • Age >50, morning stiffness in shoulders/hips  • ↑ ESR, normal CK  • Dramatic response to low-dose steroids Tuberculosis  • Chronic cough, fever, weight loss, night sweats  • Markedly ↑ ESR — especially in extrapulmonary TB Multiple Myeloma  • Elderly, bone pain (back/ribs), anemia, renal impairment  • Very high ESR due to rouleaux formation from monoclonal proteins Advanced / Metastatic Malignancy  • ESR correlates with systemic inflammation and tumor burden   Normal or Low ESR → “False Negatives” Inflammation present but ESR misleadingly low.  • Polycythemia Vera → high RBC mass → slow sedimentation  • Sickl...

How to Do Echo - Complete Protocol Step By Step  Above Video explains all the standard steps for performing transthoracic Echocardiogram as per ASE Guidelines. American Society of Echocardiography 

 #️⃣ TCA TOXICITY: EMERGENCY MANAGEMENT 💊 MECHANISMS OF TOXICITY 1️⃣ Sodium Channel Blockade → Wide QRS, VT/VF 2️⃣ Alpha-1 Antagonism → Hypotension 3️⃣ Anticholinergic → “Hot as a hare, dry as a bone” 4️⃣ GABA Antagonism → Seizures 📊 ECG FINDINGS • QRS Duration Predicts Risk: •100ms: 33% seizure risk •160ms: 50% arrhythmia risk • aVR Clues: •R wave ≥3mm •R/S ratio >0.7 ⚠️ ANTIDOTES & CONTRAINDICATIONS • Sodium Bicarbonate (1-2 mEq/kg): •For QRS >100ms or arrhythmias •Mechanism: Alkalemia → ↑ sodium channel recovery • Avoid: •Phenytoin (worsens sodium blockade) •Class Ia/Ic antiarrhythmics 🚨 RESUSCITATION PRIORITIES 1️⃣ ABCs: •Intubate early (rapid clinical decline) 2️⃣ Decontaminate: •Activated charcoal (if <1h post-ingestion) 3️⃣ Seizures: •Benzodiazepines (diazepam/lorazepam) 4️⃣ Hypotension: •NS bolus + norepinephrine 📌 CLINICAL PEARLS • “30-50 rule”: QRS >100ms → ICU admission • ECG Monitoring: Continue until QRS narrows (<100ms) for 24h • Deadly Dose: 10...

Shock Index (SI) is a quick bedside marker used to assess the severity of shock and early hemodynamic compromise. --- Definition Shock Index = Heart Rate (HR) ÷ Systolic Blood Pressure (SBP) Example: HR 120 bpm / SBP 100 mmHg → SI = 1.2 --- Normal Value Normal SI: 0.5 – 0.7 --- Abnormal (Suggestive of Shock) SI ≥ 0.9 → Early indicator of circulatory failure, even when BP is still “normal.” SI ≥ 1.0 → Strong predictor of significant shock, need for urgent intervention. SI ≥ 1.3 → Associated with high risk of mortality, ICU admission, transfusion, and severe shock. --- Why It’s Useful Very sensitive for early shock detection (trauma, sepsis, hemorrhage, cardiogenic shock). Better than systolic BP alone, particularly in young or compensated patients. Helpful in triage and predicting need for massive transfusion in trauma. --- Clinical Interpretation Shock Index Interpretation 0.5–0.7 Normal 0.7–0.9 Mild concern / compensated shock ≥ 0.9 Significant shock risk → acts earlier than BP drop ≥...

🫀 Redefining Heart Failure Subtypes According to Skeletal Muscle Mass Recent research suggests that heart failure classification is no longer limited to cardiac function alone. Skeletal muscle mass has emerged as a key factor that can refine how we understand and categorize heart failure. 🔍 Why does muscle mass matter? Because it is closely linked to exercise capacity, inflammation levels, treatment response, and even survival rates in heart failure patients. 📌 What’s new? Patients can now be better stratified based on: Skeletal muscle strength and mass Presence of muscle wasting (sarcopenia) The interaction between cardiac health and muscular condition 💡 Who benefits from this? Clinicians, researchers, patients, and anyone interested in prevention through improved fitness and muscle health. 🏋️‍♂️ Bottom line: Enhancing skeletal muscle mass may not only improve general fitness—it could reshape the way heart failure is diagnosed and managed in the future. --- Background — Tradition...

Right Ventricular Infarction – Recognition, Diagnosis & Management Right ventricular (RV) infarction is a commonly overlooked but clinically significant subset of acute myocardial infarction (AMI). It most often occurs in association with inferior wall MI, especially when the culprit lesion involves the proximal right coronary artery (RCA). Early recognition is crucial because RV infarction behaves very differently from left-sided infarcts and requires unique management strategies. --- 🔎 Pathophysiology The RV is supplied primarily by the RCA in most individuals. An occlusion proximal to the RV marginal branches leads to ischemia of the RV free wall. Key consequences include: Reduced RV contractility Decreased RV output → reduced LV preload Systemic hypotension despite clear lungs High sensitivity to nitrates/diuretics RV function greatly depends on preload, so anything that reduces venous return can precipitate collapse. --- 🧩 Clinical Presentation The classic triad of RV infarc...

Key Management points for Idiopathic Infantile Arterial Calcification (IIAC / GACI): 1. Bisphosphonate therapy (etidronate, pamidronate) 2. Management of heart failure 3. Control of severe hypertension 4. Supportive care for end-organ dysfunction 5. Monitoring and management of electrolyte abnormalities 6. Genotype-guided care (ENPP1 vs ABCC6) 7. Treatment of ENPP1-related hypophosphatemic rickets (if develops later) 8. Consider experimental therapies (e.g., ENPP1 enzyme replacement—investigational) 9. Genetic counseling for family 10. Regular imaging follow-up (echo, CT/MRI for  calcification progression) --- Management of Idiopathic Infantile Arterial Calcification (GACI): A Detailed Review Idiopathic Infantile Arterial Calcification (IIAC), also known as Generalized Arterial Calcification of Infancy (GACI), is a rare but life-threatening disorder characterized by extensive calcification and stenosis of medium and large arteries. It typically presents in the neonatal period with ...