Dr. Usman's Cardiology Notes

  A patient who had cardiac transplantation and has undergone multiple right ventricular, endocardial biopsies. Spot the findings shown in these echocardiography clips and make a diagnosis. The answer will be shown after 1 min. Case 137 Answer:  In apical four chamber view there is a turbulent flow near the apex, M Mode and Continuous wave doppler confirmed high velocity flow through out the cardiac cycle.So its an Iatrogenic Coronary Artery to Right ventricular Fistula. which is a Common complication  due to multiple biopsies after heart transplant. ✅ FREE ECHO LIBRARY >> Echocardiography for beginners  #echocardiography #cardiology  #echo #echocardiogram  #2dEcho #echo #heart #cardiology #pocus #sonography #123sonography #echolady #nejm #pocus101 #radiology Topics: Echo test for heart echocardiography test echocardiography for beginners echocardiography report kaise padhe echocardiography lectures echocardiography test kaise hota hai echocardiograph...

  AV Node in the Triangle of Koch  Here’s a detailed note on the Triangle of Koch, important in cardiology and electrophysiology: --- Triangle of Koch – Overview The Triangle of Koch is an important anatomical landmark located in the right atrium of the heart. It serves as a guide to locate the atrioventricular (AV) node, which is crucial for the cardiac conduction system. Knowledge of this triangle is essential in electrophysiology procedures such as AV nodal ablation, slow pathway ablation for AV nodal reentrant tachycardia (AVNRT), and in avoiding iatrogenic AV block. Anatomical Boundaries: The triangle is defined by three key structures: 1. Tendon of Todaro – a fibrous band running from the Eustachian valve (at the IVC) to the central fibrous body. 2. Ostium of the coronary sinus (CS) – located at the base of the triangle. 3. Septal leaflet of the tricuspid valve – forming the anterior boundary. Thus, the triangle is bounded: Posteriorly by the Tendon of Todaro Inferiorly ...

Eccentric Mitral Valve Regurgitation: A Clinical Overview Mitral regurgitation (MR) is one of the most common valvular heart conditions encountered in cardiology practice. It occurs when the mitral valve fails to close properly, allowing blood to leak backward from the left ventricle into the left atrium during systole. While central MR jets are often straightforward to diagnose, eccentric mitral regurgitation presents a unique diagnostic challenge due to its atypical jet direction, variability in auscultatory findings, and sometimes deceptive imaging features. A strong understanding of its mechanisms, clinical presentation, and echocardiographic assessment is essential for accurate diagnosis and management.   Understanding Eccentric Mitral Regurgitation Eccentric MR refers to a regurgitant jet that is directed toward one of the atrial walls, rather than flowing centrally into the left atrium. This pattern often results from asymmetric mitral valve pathology, such as prolapse of a ...

Mitral Valve Prolapse – When the Heart’s Door Sways a Little Too Much The human heart is a marvel of design, pumping tirelessly day and night. Among its four doors – or valves – the mitral valve holds a special place. It sits between the left atrium and left ventricle, making sure blood flows in one direction: forward, not backward. But sometimes, this valve is a little “too flexible,” and instead of shutting firmly, it bows backward. That’s what we call mitral valve prolapse (MVP). What really happens in MVP? Imagine a double door with two curtain-like flaps. These flaps are tethered by thin strings (the chordae tendineae) to keep them from swinging the wrong way. In mitral valve prolapse, the flaps are slightly floppy or oversized. So when the heart squeezes, instead of closing flat and tight, they bulge into the atrium like a balloon pushed against a frame. This bulging is usually harmless – most people never even know they have it. But in some, the valve doesn’t seal properly, lead...

Katz-Wachtel phenomenon (sometimes written as Katz-Wachtel waves). On ECG: It refers to the presence of giant, biphasic QRS complexes in the mid-precordial leads (V2–V5). The QRS complexes are very tall, often more than 50 mm, with both positive and negative deflections in the same complex. It reflects biventricular hypertrophy (both RVH and LVH present), because forces of both ventricles are so strong and opposing that they produce large biphasic complexes. Classically described in congenital heart diseases with large left-to-right shunts such as ventricular septal defect (VSD), endocardial cushion defect, or PDA with pulmonary hypertension. 👉 So in one line: Katz-Wachtel phenomenon = giant biphasic QRS complexes in mid-precordial leads, indicating biventricular hypertrophy, typically seen in large VSD or similar shunt lesions.

 👉 In practice, ablation is often considered when VT is drug-refractory, recurrent, or causing ICD shocks, provided the patient can safely undergo the procedure. How isoprenaline (isoproterenol) controls VT ? The way isoprenaline (isoproterenol) controls VT depends on the mechanism of arrhythmia. 1. Idiopathic VF / Brugada / Early repolarization syndrome These arrhythmias are triggered by phase-2 reentry or Purkinje PVCs. At slow heart rates, abnormal repolarization (J-wave accentuation, action potential heterogeneity) favors PVCs and VF. Isoprenaline (β-agonist) increases sympathetic tone → raises heart rate → shortens action potential duration and suppresses early afterdepolarizations. This reduces dispersion of repolarization and stabilizes the ventricular myocardium. Net effect: PVC suppression → VF/VT storm breaks. 2. General mechanism β-1 stimulation → increases HR and conduction → overrides pause-dependent triggers. β-2 stimulation → increases calcium influx → suppresses ph...

2025 AHA/ACC Hypertension: Stepwise Management Updates Diagnosis & Initiation BP ≥140/90: Initiate pharmacotherapy immediately. BP 130–139/80–89: Start drugs for high-risk (CVD, CKD, diabetes, PREVENT 10-yr risk ≥7.5%); otherwise, lifestyle modification, reassess in 3–6 months. Initial Therapy Monotherapy: ACEI/ARB, CCB, or thiazide. Stage 2 (≥140/90 or >20/10 above goal): Dual therapy (prefer ACEI/ARB + CCB/thiazide SPC). Escalation Uncontrolled: Triple therapy (ACEI/ARB + CCB + thiazide-like diuretic). Resistant HTN (≥3 drugs): Add MRA (spironolactone/eplerenone). Refractory HTN Assess adherence, exclude secondary causes. Consider RDN (Class IIb, LOE 8-R) with multidisciplinary input. Lifestyle Foundation: Salt restriction, DASH diet, weight loss, exercise, alcohol moderation, smoking cessation. #Hypertension