Dr. Usman's Cardiology Notes

  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...

  Tenting of the Mitral Valve: Understanding an Important Echocardiographic Marker Introduction Mitral valve tenting is an important echocardiographic finding frequently encountered in patients with functional or secondary mitral regurgitation (MR). It reflects distortion of the normal mitral valve geometry due to left ventricular remodeling and papillary muscle displacement, resulting in incomplete leaflet coaptation. Recognition and quantification of mitral valve tenting provide valuable information regarding the severity of ventricular remodeling, the mechanism of mitral regurgitation, and potential treatment strategies. --- What is Mitral Valve Tenting? Mitral valve tenting refers to the apical displacement of the mitral leaflets during systole below the plane of the mitral annulus, creating a characteristic "tent-like" appearance on echocardiography. Normally, mitral leaflets coapt at or slightly above the annular plane. When ventricular dilation or remodeling pulls the ...

Management of Calcified Coronary Lesions: A Practical Guide for Interventional Cardiologists Coronary artery calcification (CAC) is one of the most challenging scenarios encountered during percutaneous coronary intervention (PCI). Calcified plaques reduce vessel compliance, make lesion crossing difficult, impair stent expansion, and increase the risk of procedural complications. As the population ages and diabetes and chronic kidney disease become more prevalent, interventional cardiologists are encountering heavily calcified lesions with increasing frequency. Modern PCI success depends not only on opening the artery but also on achieving optimal lesion preparation before stent implantation. Inadequately treated calcium remains one of the strongest predictors of stent failure. --- Why Calcified Lesions Matter Calcified plaques are associated with: Difficult guidewire and device delivery Balloon-resistant lesions Poor stent expansion Stent malapposition Edge dissection Stent thrombosis ...

  Selatogrel: A Potential Game-Changer in the Early Treatment of Acute Coronary Syndrome (ACS) Acute coronary syndrome (ACS) remains one of the leading causes of death and disability worldwide. In patients with myocardial infarction, every minute of delayed treatment increases the amount of irreversible myocardial damage. While rapid reperfusion with primary PCI remains the cornerstone of management, early and effective platelet inhibition is equally critical to prevent thrombus propagation and recurrent ischemic events. Current oral P2Y12 inhibitors such as clopidogrel, prasugrel, and ticagrelor are effective but have important limitations. Their onset may be delayed by impaired gastrointestinal absorption, especially in patients with STEMI, cardiogenic shock, opioid use, or persistent vomiting. This has driven the search for a rapidly acting, easily administered antiplatelet agent that can be given before hospital arrival. Selatogrel is one of the most promising investigational d...