Dr. Usman's Cardiology Notes

 ASD Rims to be assessed on Echocardiography These are usually assessed on Transesophageal Echocardiogram. 🚨 Watch TEE Protocol with labelled images >> ASD rims to be assessed to decide device closure vs surgical closure A practical, evidence-based clinical review Summary (TL;DR) When planning closure of a secundum atrial septal defect (ASD), careful assessment of the surrounding rims (tissue margins) is essential. Adequate rims (commonly ≥5 mm) allow safe transcatheter/device closure in most cases; deficient or absent rims (especially posteroinferior/IVC or very large defects with insufficient surrounding tissue) and other anatomic issues favour surgical repair. Modern imaging (TTE, TEE — including 3D TEE — and intracardiac echo) defines defect size, shape, number, and rim quality; device choice and sizing, patient age, comorbidities and operator experience then determine whether to attempt percutaneous closure or refer for surgery.  --- 1. Why rims matter — the anatom...

  Watch above video showing LVEF estimation by Simpson method. The Simpson method calculates left ventricular ejection fraction (LVEF) by tracing the endocardial border of the left ventricle in both apical four-chamber and two-chamber views. The volumes during diastole and systole are determined, and LVEF is calculated as the difference between these volumes divided by the end-diastolic volume. Steps to Calculate LVEF Using Simpson's Method Obtain Views : Acquire apical four-chamber and two-chamber views of the heart. Ensure optimal imaging quality to avoid foreshortening. Trace Endocardial Borders : In both views, trace the endocardial border of the left ventricle during end-diastole (maximum volume) and end-systole (minimum volume). Be careful to exclude structures like papillary muscles from the tracing. Calculate Volumes : Use the traced areas to calculate the left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). The vol...

Watch the above video for 16 most important views to get on TEE. Here is a comprehensive Transesophageal Echocardiography (TEE) protocol with tips and tricks: Pre-Procedure Preparation 1. *Patient preparation*: Ensure the patient is fasting for at least 4-6 hours before the procedure. 2. *Informed consent*: Obtain informed consent from the patient, explaining the procedure, risks, and benefits. 3. *Vital sign assessment*: Assess the patient's vital signs, including blood pressure, heart rate, and oxygen saturation. 4. *Medication review*: Review the patient's medications and consider withholding anticoagulants or adjusting sedation as needed. Equipment Preparation 1. *TEE probe*: Ensure the TEE probe is properly cleaned, disinfected, and ready for use. 2. *Ultrasound system*: Set up the ultrasound system, selecting the TEE probe and adjusting settings as needed. 3. *Monitoring equipment*: Ensure monitoring equipment, such as ECG, blood pressure, and oxygen saturation monitors, ...

Same Patient with Arm Pulled down towards Knee. If you have difficulty in getting Axillary Access, ask patient or someone to pull arm downward towards knee, as it's occluded in this position sometimes Between rib & Clavicle.

Here are simple estimates of pericardial effusion volume based on echo measurements: - Mild: < 100 mL (echo size < 1 cm) - Moderate: 100-500 mL (echo size 1-3 cm) - Severe: > 500 mL (echo size > 3 cm) To estimate the volume of pericardial effusion (in mL) based on the size measured on echocardiography, you can use the following formula: Volume (mL) = [ (D1 x D2 x D3) / 3 ] x 4 Where: D1, D2, and D3 are the diameters of the effusion (in cm) measured in three different views: - D1: Anteroposterior diameter (measured in the parasternal long-axis view) - D2: Transverse diameter (measured in the parasternal short-axis view) - D3: Inferosuperior diameter (measured in the apical four-chamber view) Note: This formula is an estimate and may not always accurately reflect the actual volume of the effusion. Here are the key points for signs of cardiac tamponade: *Clinical Signs:* 1. *Beck's Triad*:     - Hypotension (low blood pressure)     - Muffled heart sounds ...

A 50 years old female with normal angiography and normal Echo ,with recurrent tachycardia, came to emergency in cardiac Hospital,patient reverted to sinus rhythm with sedation, lignocaine and magnesium sulphate,normal troponin and electrolytes ,Cardiac MR dome last year was also normal ,what should be best management plan for this ? What is the location of this tachycardia or VT? Is ablation possible for this patient as she doesn't tolerate this rhythm well? Few things seems to be eye catching but keeping in mind that surface ecg being only 12 leads has lots & lots of shortfalls for exact identification of endocardial source of arrhythmia ! Hence as you know , as the EP catheters are multipolars so much much more helpful in pin pointing the exact endocardial source of arrhythmias   1. The arrhythmias seem to be Ventricular driven  2. ⁠morphologically , it’s seems mono morphic rather than polymorphic , hence supporting a single focus  3. ⁠the shortest way to furt...