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...

  Echocardiographic Assessment of Atrial Septal Defect (ASD): A Practical Guide Atrial septal defect (ASD) is one of the most common congenital heart defects encountered in adults. Echocardiography is the cornerstone of diagnosis because it not only demonstrates the defect but also determines its anatomical type, size, direction of shunting, hemodynamic significance, effects on the right heart, pulmonary artery pressure, and suitability for device closure. A good ASD echocardiographic examination should therefore answer more than simply: “Is an ASD present?” It should answer: What type of ASD is present? How large is the defect? What is the direction and magnitude of the shunt? Is there right ventricular volume overload? Is pulmonary hypertension present? Are the pulmonary veins normally connected? Is the anatomy suitable for transcatheter device closure? These elements form the basis of a systematic echocardiographic assessment. --- Types of Atrial Septal Defect An ASD should firs...

  PASP Calculation on Echocardiography: ASE 2025 Guide, Interpretation, Pitfalls, and Clinical Significance Pulmonary artery systolic pressure (PASP) is one of the most frequently reported measurements on transthoracic echocardiography (TTE). It provides a non-invasive estimate of pulmonary artery pressure and serves as an important screening tool for pulmonary hypertension (PH). However, PASP should never be interpreted in isolation. The latest American Society of Echocardiography (ASE) guidelines emphasize a multiparametric, probability-based approach rather than relying solely on a numerical PASP value. This article reviews the latest ASE recommendations, explains how PASP is calculated, discusses common pitfalls, and highlights how to interpret PASP accurately in daily clinical practice. ──────────────────────── What is PASP? Pulmonary artery systolic pressure (PASP) represents the peak systolic pressure within the pulmonary artery. In the absence of pulmonic valve stenosis or ...

  Tenting of the Mitral Valve: Understanding an Important Echocardiographic Marker Introduction Mitral valve tenting is an important echocardiographic finding frequently encountered in patients with functional or secondary mitral regurgitation (MR). It reflects distortion of the normal mitral valve geometry due to left ventricular remodeling and papillary muscle displacement, resulting in incomplete leaflet coaptation. Recognition and quantification of mitral valve tenting provide valuable information regarding the severity of ventricular remodeling, the mechanism of mitral regurgitation, and potential treatment strategies. --- What is Mitral Valve Tenting? Mitral valve tenting refers to the apical displacement of the mitral leaflets during systole below the plane of the mitral annulus, creating a characteristic "tent-like" appearance on echocardiography. Normally, mitral leaflets coapt at or slightly above the annular plane. When ventricular dilation or remodeling pulls the ...

  Mavacamten: Indications, Monitoring, and Practical Clinical Use in Obstructive Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiac diseases, affecting approximately 1 in 500 people. While many patients remain asymptomatic, others develop significant symptoms due to obstruction of the left ventricular outflow tract (LVOT). Until recently, treatment options mainly focused on reducing symptoms with medications or relieving obstruction through invasive septal reduction procedures. The introduction of mavacamten has changed the management of symptomatic obstructive HCM. Rather than simply controlling heart rate or contractility, mavacamten directly targets the underlying disease mechanism, making it the first disease-specific medical therapy approved for obstructive HCM. This article reviews its mechanism of action, indications, patient selection, monitoring requirements, and practical clinical considerations. --- What is Mavacamte...

📌 Tissue Doppler Imaging (TDI): Understanding S′, e′, a′ and the Tei Index Tissue Doppler Imaging (TDI) is a valuable echocardiographic technique used to assess both systolic and diastolic myocardial function through measurement of mitral annular velocities. 🔹 S′ (Systolic Velocity) • Represents longitudinal LV systolic contraction. • Measured during ventricular systole. • Reduced S′ suggests impaired LV systolic function. 🔹 e′ (Early Diastolic Velocity) • Reflects active myocardial relaxation. • A key parameter for assessing LV diastolic function. • Reduced e′ indicates impaired relaxation and diastolic dysfunction. 🔹 a′ (Late Diastolic Velocity) • Generated by atrial contraction. • Becomes more prominent when ventricular relaxation is impaired. 📏 Important Time Intervals ⏱ IVCT (Isovolumic Contraction Time) • Interval between mitral valve closure and aortic valve opening. ⏱ ET (Ejection Time) • Duration of ventricular ejection. ⏱ IVRT (Isovolumic Relaxation Time) • Interval betw...

Inferior Vena Cava (IVC) Obstruction: Causes, Diagnosis, and Management Introduction Inferior vena cava (IVC) obstruction is an uncommon but clinically important condition resulting from partial or complete blockage of venous blood flow through the IVC. Because the IVC is the major venous conduit returning blood from the lower extremities, pelvis, and abdomen to the heart, obstruction can lead to significant venous congestion, edema, and thromboembolic complications. Early recognition is essential, as timely treatment can prevent morbidity and improve quality of life. --- Anatomy of the Inferior Vena Cava The IVC is the largest vein in the body and is formed by the confluence of the common iliac veins at the level of L5. It ascends through the abdomen, receives blood from the renal and hepatic veins, and enters the right atrium. Obstruction may occur at: - Infrarenal IVC - Suprarenal IVC - Hepatic segment of the IVC - Cavoatrial junction --- Causes of IVC Obstruction 1. Thrombotic Caus...