Dr. Usman's Cardiology Notes

Mitral Valve Prolapse: A Comprehensive Review Mitral Valve Prolapse (MVP) is a common valvular heart condition characterized by the displacement of the mitral valve leaflets into the left atrium during systole. This article provides an in-depth look at the diagnosis, echo findings, and auscultation maneuvers used to identify MVP. Pathophysiology In MVP, the mitral valve leaflets bulge backward into the left atrium due to: 1. Myxomatous degeneration: Thickening and redundancy of the valve leaflets. 2. Chordal elongation: Stretching or rupture of the chordae tendineae. Echo Findings Echocardiography is the primary diagnostic tool for MVP. Key findings include: 1. Leaflet displacement: > 2 mm displacement of the leaflets beyond the mitral annular plane. 2. Leaflet thickening: Thickening of the leaflets (> 5 mm). 3. Mitral regurgitation: Color Doppler assessment of regurgitant flow. 4. Left atrial enlargement: Enlargement of the left atrium due to chronic regurgitation. Auscultation ...

✔Bidirectional VT The tachycardia with an identity crisis. What you'll see: Beat-to-beat alternation in QRS axis (often ~180) RBBB-like morphology, most visible in lead Il or aVF Regular rhythm, but clearly not your standard VT Why it most likely happens: Triggered activity (delayed afterdepolarizations) Classically: two competing ventricular foci or alternating fascicular exits Top causes: Digoxin toxicity (check that level!) CPVT (stress-induced VT in the young) Andersen-Tawil syndrome Rare: aconite poisoning, myocarditis Key point:  BiVT is rare - but when you see it, it narrows the differential dramatically.

  A Gerbode defect is a rare congenital heart defect characterized by a direct communication between the left ventricle (LV) and the right atrium (RA). This defect allows oxygenated blood to flow from the LV into the RA, bypassing the normal pathway through the aorta. Types of Gerbode Defects There are two main types of Gerbode defects: 1. Congenital Gerbode defect: This type is present at birth and is often associated with other congenital heart defects. 2. Acquired Gerbode defect: This type can occur due to trauma, infection, or as a complication of cardiac surgery. Clinical Presentation Patients with a Gerbode defect may present with: 1. Symptoms of heart failure (e.g., shortness of breath, fatigue) 2. Murmurs or abnormal heart sounds 3. Increased risk of endocarditis Diagnosis Diagnosis of a Gerbode defect typically involves: 1. Echocardiography: This can show the abnormal communication between the LV and RA. 2. Cardiac catheterization: This can help confirm the diagnosis and a...

  Case of Mahaim Fiber pathway related Tachycardia: During atrial pacing, the above tachycardia is induced. In Differentiating wide complex tachycardia following points should be considered. During atrial pacing (the 1st beat), the His catheter has the activation sequence proximal to distal (antegrade His activation). During the 2nd paced beat, the His deflection (on proximal His) gets buried within the ventricle (block of the AV node, maximal preexcitation) and antidromic tachycardia is induced. During tachycardia, the His activation sequence is reversed, and distal His is before proximal His. Therefore, the activation of the His bundle is retrograde during tachycardia, but still before ventricular activation. This is only possible in the presence of an extranodal pathway inserting in the fascicle just below the His bundle, most frequently the right bundle (Mahaim). Careful examination of the sequence of His bundle activation can lead to the correct diagnosis already at first gla...

The Link Between Red Meat and Heart Disease: Understanding the Role of Saturated Fat and TMAO Red meat has long been associated with an increased risk of heart disease, and recent research has shed light on the potential mechanisms behind this link. Two key factors that contribute to this association are high saturated fat levels in red meat and the production of Trimethylamine N-oxide (TMAO), a dietary byproduct formed by gut bacteria during digestion. Saturated Fat: A Contributor to Heart Disease Saturated fat, found in high levels in red meat, can increase the risk of heart disease by: 1. Raising low-density lipoprotein (LDL) cholesterol: LDL cholesterol can accumulate in the walls of arteries, forming plaques that narrow the blood vessels and restrict blood flow. 2. Increasing inflammation: Saturated fat can trigger inflammation in the body, which can further damage blood vessels and increase the risk of heart disease. TMAO: A Hidden Culprit Trimethylamine N-oxide (TMAO) is a dieta...

The Power of Positioning: How a Simple Adjustment Can Make a Big Difference As healthcare providers, we've all witnessed the transformative impact of a well-placed pillow or a strategically adjusted bed. Patient positioning is more than just a matter of comfort – it's a crucial aspect of medical care that can significantly influence patient outcomes. Let's dive into the world of patient positioning and explore how different positions can be used to improve care. 1. Prop-Up Position (Semi-Fowler's): Breathing Easy Imagine you're a patient struggling to catch your breath due to heart failure or COPD. The prop-up position can be a lifesaver. By elevating the head of the bed 30-45 degrees, we can reduce venous return and pulmonary congestion, making it easier for patients to breathe. This position is especially helpful for patients with respiratory distress, as it allows them to expand their lungs more efficiently. 2. Fowler's Position: Post-Op Comfort After abdomin...

Junctional escape or junctional rhythm !  Let me explain these in more detail !!!! So I know lots of confusion exists in the minds of Drs especially the very Jnr regarding some commonly heard terminologies & they always fumble when they come across any such tracings ! So the commonly heard terminologies are 1. junctional beat !  2. Junctional (escape) beat ! 3. (Premature) junctional complex (PJC) /beat !!!!!! So I will try to create a difference or differentiation among them Some other terms which are used very frequently & mostly wrongly interchanged !  1. Ventricular escape beats  3. ventricular extra systoles  4. vs ventricular escape Rhythm  Ventricular escape beats may occur when there is a significant pause in the sinus and also total lack of junctional escape complexes!!!  Morphologically the complex’s will be quite variable depending on site of origin ! Usually QRS wide and bizarre, consistent with ventricular origin!!!! As described ...