Dr. Usman's Cardiology Notes

How to Measure Pulmonary Blood Flow (Qp) by Echocardiography: Step-by-Step Guide Pulmonary blood flow (Qp) is an important echocardiographic parameter used to assess blood flow through the pulmonary circulation. It is particularly useful in evaluating congenital heart disease, intracardiac shunts, and conditions associated with abnormal pulmonary blood flow. In Doppler echocardiography, pulmonary stroke volume can be calculated by multiplying the cross-sectional area of the pulmonary valve annulus by the velocity-time integral (VTI) of blood flow in the right ventricular outflow tract (RVOT). Key Formula Pulmonary Stroke Volume (Qp per beat) = Pulmonary Valve Annular Area × Pulmonary VTI Qp = π × (D/2)² × VTI D = Pulmonary valve annulus diameter VTI = Velocity-time integral in cm Result = Stroke volume in mL/beat 1. Measure the Pulmonary Valve Annulus Diameter The first step is to measure the diameter of the pulmonary valve annulus. Because the diameter is squared whe...

  Measurement of Right Ventricular Function: TAPSE on Echocardiography Tricuspid Annular Plane Systolic Excursion (TAPSE) is a simple, reproducible echocardiographic measurement used to assess right ventricular (RV) systolic function. It measures the longitudinal movement of the lateral tricuspid annulus toward the cardiac apex during systole. TAPSE is widely used because it is easy to obtain, requires minimal calculation, and is available on most echocardiography systems. What Is TAPSE? TAPSE reflects the longitudinal contraction of the right ventricle. During systole, the lateral tricuspid annulus moves toward the apex. M-mode echocardiography records this movement, allowing the distance travelled by the annulus to be measured in millimetres. Although TAPSE is a useful marker of RV systolic function, it primarily assesses longitudinal motion and should not be used as the sole measure of right ventricular performance. Normal TAPSE Value Normal TAPSE: >17 mm A T...

RV Enlargement on Echocardiography: ASE 2025 Grading, Causes and Clinical Interpretation Right ventricular enlargement is an important echocardiographic finding that may reflect pressure overload, volume overload or intrinsic myocardial disease. However, RV dilatation is not a diagnosis by itself, and its significance depends on the underlying clinical condition and associated echocardiographic abnormalities. In Part 1, we reviewed the updated 2025 American Society of Echocardiography (ASE) normal reference values and measurement techniques for RV basal, mid-ventricular and longitudinal dimensions. In this second part, we discuss the grading of RV enlargement, its clinical interpretation, associated echocardiographic parameters, common measurement errors and practical reporting. 1. What Is Right Ventricular Enlargement? Right ventricular enlargement refers to an increase in RV cavity dimensions beyond the expected reference range. It may involve the basal region, mid-ventricu...

  Cardiac Resynchronization Therapy (CRT): Indications, Guidelines and Clinical Decision-Making A practical, guideline-based guide for cardiologists, electrophysiologists, postgraduate trainees and medical students. Introduction Cardiac resynchronization therapy (CRT) is a device-based treatment for selected patients with heart failure and ventricular electrical dyssynchrony. By coordinating right and left ventricular activation, CRT can improve left ventricular systolic function, reduce heart failure hospitalizations, improve functional status and, in appropriately selected patients, reduce mortality. Patient selection is critical. The greatest benefit is generally observed in patients with heart failure with reduced ejection fraction (HFrEF), left bundle branch block (LBBB), and a markedly prolonged QRS duration. Key clinical message The classic CRT candidate has LVEF ≤35%, persistent symptoms despite guideline-directed medical therapy (GDMT), sinus rhythm, LBBB mo...

2026 ESC Heart Failure Guidelines: Classification, Diagnosis and Treatment A practical clinical review for cardiologists, physicians, postgraduate trainees and medical students. Introduction The 2026 European Society of Cardiology (ESC) Guidelines for the Management of Heart Failure introduce important changes in the classification, prevention, diagnosis and treatment of heart failure (HF). Published on 28 August 2026, these guidelines update the previous ESC recommendations and emphasize early diagnosis, prevention of disease progression and individualized treatment. The major changes include a simplified classification based on left ventricular ejection fraction (LVEF), adoption of HF stages A–D, revised terminology for medical therapies and updated recommendations for pharmacological and device-based treatment. Key update: The 2026 ESC guidelines eliminate the separate HFmrEF category. HFrEF is defined by LVEF below 50%, whereas HFpEF is defined by LVEF of 50% or higher,...

  Cardiovascular Features of Connective Tissue Diseases Connective tissue disorders are a diverse group of inherited conditions that can affect the cardiovascular system, particularly the aorta, systemic arteries, cardiac valves, and myocardium. Some of these disorders are associated with a significant risk of aortic aneurysm, dissection, arterial rupture, or premature vascular disease. Recognizing the characteristic cardiovascular phenotype of each disorder is important for early diagnosis, appropriate imaging surveillance, family screening, and prevention of life-threatening complications. Marfan Syndrome Marfan syndrome is an autosomal dominant connective tissue disorder caused primarily by pathogenic variants in the FBN1 gene, which encodes fibrillin-1. The most important cardiovascular manifestation is aortic root dilatation , particularly involving the sinuses of Valsalva. Progressive aortic enlargement can result in aortic aneurysm, aortic regurgitation, and aortic dissect...

Temporary Pacemaker (TPM) Lead Settings and Troubleshooting: A Practical Guide Temporary pacemakers (TPMs) are commonly used for patients with symptomatic bradycardia, high-grade AV block, sinus node dysfunction, post-cardiac surgery conduction disturbances, acute myocardial infarction, drug-induced bradyarrhythmias, and during electrophysiology procedures. Safe temporary pacing requires an understanding of the pacing rate, output, sensitivity, capture threshold, sensing threshold, pacing mode, and lead integrity. This article provides a practical approach to temporary pacemaker lead settings, threshold testing, and troubleshooting. 1. Basic Components of a Temporary Pacemaker System A temporary pacing system consists of: Temporary pacing lead External pulse generator Connecting cable Battery/power source ECG and haemodynamic monitoring The pacing lead has two major functions: Pacing: delivering an electrical stimulus to the myocardium. Sensing: detecting intrin...