Dr. Usman's Cardiology Notes

Understanding LV Diastolic Dysfunction via Mitral Inflow Doppler: Mitral inflow Doppler patterns reflect LV diastolic function. Pulsed-wave Doppler at the mitral valve leaflets shows E (early filling) and A (atrial contraction) waves. Here’s how the patterns change: 1️⃣ Normal Filling: - E/A >1 - Deceleration Time (DT) <220 ms - Normal relaxation and compliance. 2️⃣ Grade I – Mild Dysfunction (Impaired Relaxation): - E/A <1 - DT >220 ms - Relaxation is delayed, atrial kick becomes dominant. 3️⃣ Grade II – Moderate Dysfunction (Pseudonormal): - E/A >1 (appears normal!) - DT 150–200 ms - LA pressure increases to "normalize" filling—requires Tissue Doppler to unmask. 4️⃣Grade III – Severe Dysfunction (Restrictive Pattern): - E/A >1.5 - DT <150 ms - Very high LA pressures, stiff LV—hallmark of poor prognosis. ⚠️Always correlate with tissue Doppler (E/e’), LA size, pulmonary vein flow, and clinical picture. A pseudonormal pattern can be misleading without thes...

Mortality Reducing Therapies in Chronic HFrEF: Evidence, Trials & Clinical Impact Heart failure with reduced ejection fraction (HFrEF) remains a major global cause of morbidity and mortality. Over the past three decades, rigorous randomized controlled trials (RCTs) have transformed management and proven that specific drugs and devices significantly reduce all-cause and cardiovascular mortality. Below is a comprehensive overview of each mortality-reducing therapy, its approximate relative mortality reduction, and the key landmark trials that shaped current guideline recommendations (AHA/ACC/HFSA & ESC). --- 1. Angiotensin Receptor Blockers (ARBs) — ~12% Mortality Reduction ARBs emerged as alternatives for patients intolerant to ACE inhibitors. They reduce afterload, neurohormonal activation, and remodeling. Landmark Trials • CHARM-Alternative (2003) Demonstrated mortality reduction in ACE-intolerant HFrEF patients with candesartan. • Val-HeFT (2001) Showed decreased HF hospitali...

  How to Differentiate Mitral Regurgitation (MR) vs Aortic Stenosis (AS) on CW Doppler and CW envelope SHAPE 1. Timing MR Holosystolic signal (throughout systole). Starts with isovolumic contraction and ends after A2 sometimes. No clear envelope edges. AS Mid-systolic envelope (starts after IVCT, ends before A2). Well-defined start and end. --- 2. Shape of CW Envelope Mitral Regurgitation (MR) Tall, dense, triangular (early-peaking) “V-shaped” or triangular because MR is often pressure-dependent. Peak velocity early then falls → early systolic peak (unless severe chronic MR → rounded). Aortic Stenosis (AS) Parabolic, rounded, symmetric envelope “Bullet shape” Peaks mid-systole (late peak if severe). --- 3. Velocity MR usually has higher velocity (5–6 m/s common). AS varies depending on severity but usually 3–5 m/s. --- 4. Direction & Position of CW Line MR CW is obtained from the apex directed posteriorly into the LA. AS CW is obtained in multiple windows (RUP parasternal, ap...

  A cup of coffee a day may cut AF recurrence — the DECAF trial (AHA late-breaking science) A surprising randomized trial presented as late-breaking science at the American Heart Association’s Scientific Sessions 2025 — and published in JAMA — found that patients with atrial fibrillation (AF) who were instructed to drink at least one cup of caffeinated coffee daily had fewer recurrences of AF or atrial flutter than those asked to abstain from all caffeine. The finding challenges long-standing advice that people with AF should avoid caffeinated beverages.  What the DECAF trial did DECAF (Does Eliminating Coffee Avoid Fibrillation?) was a randomized clinical trial that enrolled about 200 adults who had AF (or atrial flutter) and had recently undergone cardioversion. Participants were randomized 1:1 to (a) consume at least one cup of caffeinated coffee per day for six months or (b) completely abstain from coffee and other sources of caffeine for six months. The trial ran across m...

 A cup of coffee a day may cut AF recurrence — the DECAF trial (AHA late-breaking science) A surprising randomized trial presented as late-breaking science at the American Heart Association’s Scientific Sessions 2025 — and published in JAMA — found that patients with atrial fibrillation (AF) who were instructed to drink at least one cup of caffeinated coffee daily had fewer recurrences of AF or atrial flutter than those asked to abstain from all caffeine. The finding challenges long-standing advice that people with AF should avoid caffeinated beverages.  What the DECAF trial did DECAF (Does Eliminating Coffee Avoid Fibrillation?) was a randomized clinical trial that enrolled about 200 adults who had AF (or atrial flutter) and had recently undergone cardioversion. Participants were randomized 1:1 to (a) consume at least one cup of caffeinated coffee per day for six months or (b) completely abstain from coffee and other sources of caffeine for six months. The trial ran across mu...

  Primary Electrical Cardiac Diseases: A Clinician’s Overview of Mechanisms & Management Primary electrical cardiac diseases—often called channelopathies or primary arrhythmic disorders—are conditions where the heart’s electrical system is abnormal despite a structurally normal heart. These disorders can cause palpitations, syncope, seizures, or sudden cardiac death, especially in young individuals with otherwise normal echocardiograms. Below is a simple, practical guide to the major primary electrical cardiac diseases and their management. --- 1. Long QT Syndrome (LQTS) A genetic disorder of delayed myocardial repolarization, leading to prolonged QT interval and risk of torsades de pointes. Red Flags Syncope with emotion, exertion, or swimming Family history of sudden death QTc ≥ 480–500 ms on ECG Management β-blockers (Nadolol or Propranolol preferred) Avoid QT-prolonging medications ICD for high-risk or survivors of cardiac arrest Left cardiac sympathetic denervation (LCSD) ...

Restrictive vs Constrictive Cardiomyopathy: A Complete, Clinician-Friendly Comparison Restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP) often present with similar clinical features—especially right-sided heart failure with preserved ejection fraction. Yet their underlying pathology, diagnostic clues, and management differ drastically. Distinguishing the two is crucial because RCM is a myocardial disease, while CP is a potentially reversible pericardial disorder. This article provides a crisp, high-yield comparison for clinicians. --- 🔹 1. Definition Restrictive Cardiomyopathy (RCM) A myocardial disorder characterized by stiff, non-compliant ventricles due to infiltration or fibrosis. → Filling is restricted, systolic function usually preserved until late. Constrictive Pericarditis (CP) A pericardial disease in which a thickened, fibrotic, or calcified pericardium limits ventricular expansion. → Ventricles cannot fill normally due to an external shell. --- 🔹 2. Etiol...