Dr. Usman's Cardiology Notes

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,...

The 2026 ESC Guidelines for the Management of Heart Failure, published on 28 August 2026, have substantially changed the terminology and treatment framework compared with the 2016 guideline. In particular, HFmrEF has been removed, and HFrEF now includes patients with LVEF <50%.  2026 ESC Guidelines for the Diagnosis and Management of Heart Failure With Reduced Ejection Fraction The 2026 European Society of Cardiology (ESC) Guidelines for the Management of Heart Failure introduce important changes in the definition, classification, diagnosis and treatment of heart failure. Published in August 2026, the guideline simplifies the traditional heart-failure phenotype classification, introduces stages of heart failure from A to D, and establishes a new framework for pharmacological and interventional treatment. One of the most important changes is the redefinition of heart failure with reduced ejection fraction (HFrEF). The previous distinction between HFrEF and HFmrEF has been removed...

Recommendations for Patients With Preserved LVEF (≥50%): A Practical Guide to HFpEF Treatment Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized form of heart failure in which patients have symptoms and signs of heart failure despite a relatively preserved left ventricular ejection fraction. According to the 2022 AHA/ACC/HFSA Heart Failure Guideline, HFpEF is defined as heart failure with an LVEF ≥50% together with evidence supporting increased left ventricular filling pressures.  Unlike HFrEF, where several therapies have established mortality benefits, treatment of HFpEF has historically focused on controlling congestion, blood pressure, atrial fibrillation, ischemic heart disease and other associated conditions. However, the therapeutic landscape has changed substantially, particularly with the introduction of SGLT2 inhibitors. The 2022 AHA/ACC/HFSA guideline provides a practical framework for the treatment of symptomatic patients with HFpEF. TR...