Dr. Usman's Cardiology Notes

Major Echocardiographic Views and Normal Dimensions of the Right Ventricle (RV) and Right Atrium (RA) Right heart assessment is essential in pulmonary hypertension, congenital heart disease, RV infarction, cardiomyopathy, and advanced left-sided heart disease. Accurate chamber quantification should follow the recommendations of the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI). Right heart measurements are ideally obtained at end-diastole (for RV size) and end-systole (for RA area), using RV-focused views whenever possible. ━━━━━━━━━━━━━━━━━━ 1. Apical 4-Chamber View (RV-Focused View) This is the most important view for quantitative RV and RA assessment. Technique: • Optimize by centering and enlarging the RV • Avoid LV foreshortening • Measure RV at end-diastole • Measure RA at end-systole Right Ventricle – Normal Dimensions (End-Diastole) • RV Basal Diameter (RVD1): 25–41 mm • RV Mid Cavity Diameter (RVD2): 19–35 mm • RV Lon...

  How to diagnose Dextrocardia on ECG? DEXTROCARDIA – ECG SUMMARY (High-Yield) Classic ECG Findings Limb Leads Lead I: inverted P, QRS, T (often QS) aVR: upright P, QRS, T Inferior leads (II, III, aVF): usually positive Precordial Leads (Left-sided placement) Absent R-wave progression Dominant S waves V1–V6 All QRS predominantly negative Key Concept Electrical forces directed rightward because heart is located on right side. --- Confirmation 1. Apex beat on right side 2. Chest X-ray → right-sided cardiac shadow 3. Repeat ECG with right-sided leads (V1R–V6R) → normal R progression appears --- Differential Diagnosis 1) RA–LA Limb Lead Reversal (Most common mimic) Lead I negative aVR positive BUT normal R-wave progression in chest leads → Chest leads differentiate it --- 2) Extreme Right Axis Deviation Lead I negative Inferior leads may vary Normal precordial progression → Does NOT give global negative V1–V6 --- 3) Severe COPD / Vertical heart Low voltage Delayed R progression Not glo...

 

The most dangerous ECGs don’t always have the biggest ST elevation. If you’re staring at V2–V3 trying to decide between Early Repolarization and a subtle LAD occlusion, stop looking at the ST segment and look at the Terminal QRS. What is Terminal QRS Distortion? It’s a binary finding. In V2 or V3, ask yourself: Is the S-wave gone? Is the J-wave gone? If the answer to both is YES, you are looking at Grade III ischemia. The Stats: Specificity: ~100% vs. Early Repolarization. BER simply doesn’t do this. Sensitivity: ~20–35%. It won’t catch every STEMI, but when it’s there, it’s a “rule-in” sign. Risk: Associated with larger infarct size (CMR-proven) and higher rates of heart failure. The Logic: This is depolarization failing in real-time. Severe ischemia slows conduction so much that the end of the QRS gets “swallowed” by the repolarization phase. Takeaway: Millimeters can lie. Morphology rarely does. If the S-wave is missing in the anterior leads, call the lab.

Assessment of Pulmonary Embolism (PE) Pulmonary embolism (PE) is a potentially life-threatening condition requiring rapid, structured, and guideline-directed evaluation. Early risk stratification determines urgency of imaging, need for thrombolysis, and level of care. This post summarizes a practical, ESC-aligned approach to assessment of PE. 1. Clinical Suspicion Always think of PE in patients with: Acute unexplained dyspnea Pleuritic chest pain Hemoptysis Syncope Unexplained tachycardia New hypoxia Risk Factors Recent surgery or immobilization Active cancer Previous VTE Pregnancy/postpartum OCP use Thrombophilia Obesity 2. Hemodynamic Assessment (First Step) Immediately determine if the patient is: A. Hemodynamically Unstable (High-Risk PE) SBP <90 mmHg Drop in SBP ≥40 mmHg Shock or cardiac arrest → Urgent bedside echocardiography → If RV dysfunction present → treat as high-risk PE (consider thrombolysis) 3. Clinical Probability Assessment Use ...

Dyslipidemia Primary Prevention Guidelines (focusing on preventing first cardiovascular events) 1. Cardiovascular Risk Assessment • All adults should have their ASCVD risk estimated using a validated risk calculator (e.g., ACC/AHA pooled cohort risk score, QRISK3, Framingham Risk Score) to guide prevention strategies. Risk factors include age, sex, blood pressure, smoking, diabetes, lipid levels, family history, and others.  • Reassess risk periodically (e.g., every 4–6 years in adults without disease).  2. Lifestyle Modification (First-Line in All Individuals) • Healthy diet: Emphasize vegetables, fruits, whole grains, lean proteins, legumes, nuts; reduce saturated fat, trans fats and dietary cholesterol.  • Physical activity: ≥150 minutes/week of moderate-intensity or ≥75 minutes/week of vigorous aerobic exercise.  • Weight management: Aim for BMI 18.5–24.9 and waist circumference reduction.  • Smoking cessation and blood pressure/glucose control.  3. Lip...

  Pulmonary Vein (PV) Doppler Patterns – Normal and in Disease Pulmonary vein Doppler is recorded using pulsed-wave Doppler (usually from apical 4-chamber view for right upper PV or by TEE). It reflects left atrial (LA) pressure and compliance, and is essential in diastology and mitral valve assessment. ━━━━━━━━━━━━━━━━━━ 1. Normal Pulmonary Vein Doppler Pattern Normal waveform has three components: 1️⃣ S wave (Systolic forward flow) • Occurs during LV systole • Blood flows from pulmonary veins → LA • Normally S ≥ D in younger adults • Reflects LA relaxation and descent of mitral annulus 2️⃣ D wave (Diastolic forward flow) • Occurs during early LV diastole • Corresponds to mitral E wave • Reflects LA pressure and LV relaxation 3️⃣ Ar wave (Atrial reversal) • Occurs during atrial contraction • Small retrograde flow into pulmonary veins • Normally: Ar velocity < 35 cm/s Ar duration < mitral A duration 👉 Normal Pattern: S wave dominant or equal to D Small Ar reversal ━━━━━━━━━━...