Dr. Usman's Cardiology Notes

Mitral Valve Prolapse – When the Heart’s Door Sways a Little Too Much The human heart is a marvel of design, pumping tirelessly day and night. Among its four doors – or valves – the mitral valve holds a special place. It sits between the left atrium and left ventricle, making sure blood flows in one direction: forward, not backward. But sometimes, this valve is a little “too flexible,” and instead of shutting firmly, it bows backward. That’s what we call mitral valve prolapse (MVP). What really happens in MVP? Imagine a double door with two curtain-like flaps. These flaps are tethered by thin strings (the chordae tendineae) to keep them from swinging the wrong way. In mitral valve prolapse, the flaps are slightly floppy or oversized. So when the heart squeezes, instead of closing flat and tight, they bulge into the atrium like a balloon pushed against a frame. This bulging is usually harmless – most people never even know they have it. But in some, the valve doesn’t seal properly, lead...

  Welcome to cardiology toacs mock exam , there will be 40 stations, time for each station is usually 3 mins in the exam but in this video it will be, 1 min. you can pause the video if you need more time.  Answer key is also shown in the video after 40 stations.

 Atrioventricular Septal Defect AVSD on echocardiogram stands for Atrioventricular Septal Defect, also known as atrioventricular canal defect or endocardial cushion defect. It is a congenital (present at birth) heart defect that involves abnormal development of the central part of the heart where the atrial and ventricular septa meet and where the tricuspid and mitral valves form. --- 💡 Key Echocardiographic Features of AVSD: There are three main types of AVSD seen on echocardiogram: 1. Complete AVSD Single common AV valve (instead of separate mitral and tricuspid valves). Large defect in the atrial septum (ostium primum ASD). Large defect in the ventricular septum (inlet VSD). Commonly seen in Down syndrome. 2. Partial (or Incomplete) AVSD Ostium primum ASD present. No VSD. Two separate AV valves, but the mitral valve is cleft, causing mitral regurgitation. 3. Transitional (or Intermediate) AVSD Like partial AVSD but with a small VSD beneath the common valve. --- 🫀 On Echocardio...

 Mitral Fibrous Ring Causing Mitral Stenosis Mitral annular calcification (MAC) or mitral fibrous ring can cause mitral stenosis, particularly in elderly patients. The calcification or fibrosis of the mitral annulus can extend to the leaflets, causing restricted mobility and stenosis. Causes - Degenerative changes - Aging - Hypertension - Atherosclerosis - Chronic kidney disease Echo Findings - Mitral annular calcification or fibrosis on 2D echo - Restricted mobility of the mitral leaflets - Reduced mitral valve area - Increased transmitral gradient - Doppler echo can estimate the mitral valve area and gradient Severity Assessment - Mild MAC: small, localized calcification - Moderate MAC: larger calcification with restricted leaflet mobility - Severe MAC: extensive calcification with significant leaflet immobility and stenosis Clinical Implications - Mitral stenosis can lead to symptoms like dyspnea, fatigue, and palpitations - Severe MAC can increase the risk of cardiovascular eve...

Mitral Valve Prolapse: A Comprehensive Review Mitral Valve Prolapse (MVP) is a common valvular heart condition characterized by the displacement of the mitral valve leaflets into the left atrium during systole. This article provides an in-depth look at the diagnosis, echo findings, and auscultation maneuvers used to identify MVP. Pathophysiology In MVP, the mitral valve leaflets bulge backward into the left atrium due to: 1. Myxomatous degeneration: Thickening and redundancy of the valve leaflets. 2. Chordal elongation: Stretching or rupture of the chordae tendineae. Echo Findings Echocardiography is the primary diagnostic tool for MVP. Key findings include: 1. Leaflet displacement: > 2 mm displacement of the leaflets beyond the mitral annular plane. 2. Leaflet thickening: Thickening of the leaflets (> 5 mm). 3. Mitral regurgitation: Color Doppler assessment of regurgitant flow. 4. Left atrial enlargement: Enlargement of the left atrium due to chronic regurgitation. Auscultation ...

  A Gerbode defect is a rare congenital heart defect characterized by a direct communication between the left ventricle (LV) and the right atrium (RA). This defect allows oxygenated blood to flow from the LV into the RA, bypassing the normal pathway through the aorta. Types of Gerbode Defects There are two main types of Gerbode defects: 1. Congenital Gerbode defect: This type is present at birth and is often associated with other congenital heart defects. 2. Acquired Gerbode defect: This type can occur due to trauma, infection, or as a complication of cardiac surgery. Clinical Presentation Patients with a Gerbode defect may present with: 1. Symptoms of heart failure (e.g., shortness of breath, fatigue) 2. Murmurs or abnormal heart sounds 3. Increased risk of endocarditis Diagnosis Diagnosis of a Gerbode defect typically involves: 1. Echocardiography: This can show the abnormal communication between the LV and RA. 2. Cardiac catheterization: This can help confirm the diagnosis and a...

McConnell's sign is defined as right ventricular free wall akinesis with sparing of the apex suggests Massive Pulmonary Embolism  Echocardiogram Findings of Pulmonary Embolism (PE)

  Anomalous Pulmonary Venous drainage into Coronary Sinus:  So, let's talk about two congenital heart defects that can seem similar but have some key differences: sinus venosus atrial septal defect, or ASD, and anomalous pulmonary venous drainage into the coronary sinus. Sinus venosus ASD is a type of defect located near where the superior or inferior vena cava meets the right atrium. It's characterized by a defect in the sinus venosus part of the atrial septum, and often, there's anomalous pulmonary venous drainage associated with it. On the other hand, anomalous pulmonary venous drainage into the coronary sinus is a condition where the pulmonary veins drain into the coronary sinus instead of the left atrium. This can be partial or total anomalous pulmonary venous connection. The main differences between these two conditions are the location and type of defect, the pattern of pulmonary venous drainage, and the approach to surgical repair. To figure out which one someone ha...

  The Xario Toshiba echo machine is an advanced ultrasound system designed for high-quality imaging in various clinical applications, including cardiology, radiology, and obstetrics. Here's an overview: The Xario Toshiba echo machine features cutting-edge technology, providing exceptional image quality and diagnostic confidence. Its advanced signal processing and innovative transducer technology enable detailed visualization of cardiac structures, allowing clinicians to accurately assess cardiac function and diagnose various conditions. The Xario system's user-friendly interface and ergonomic design make it easy to operate, reducing user fatigue and improving workflow efficiency. Its compact size and lightweight design also make it suitable for use in various clinical settings, from cardiology clinics to operating rooms. With its advanced features and capabilities, the Xario Toshiba echo machine is an excellent choice for clinicians seeking high-quality imaging and diagnostic a...

  Watch above example case and try to estimate LAP with the given information. Left atrial pressure (LAP) is a crucial hemodynamic parameter that reflects the pressure within the left atrium. Echocardiography provides a non-invasive means to estimate LAP using various parameters. To estimate LAP, several parameters are used, including mitral inflow pattern, tissue Doppler imaging (TDI) of the mitral annulus, pulmonary venous flow, and left atrial volume index (LAVI). 1. Mitral inflow pattern is assessed by measuring the peak velocity of the early diastolic filling (E wave) and late diastolic filling (A wave) using pulsed-wave Doppler. The E/A ratio can indicate diastolic function and LAP. 2. TDI of the mitral annulus measures the early diastolic velocity (E') of the mitral annulus. The E/E' ratio correlates well with LAP. 3. Pulmonary venous flow is assessed using pulsed-wave Doppler, measuring the systolic (S) and diastolic (D) flow velocities and calculating the S/D ratio. 4....

 Understanding the Differences between Eustachian Valve and Chiari Network The Eustachian Valve and Chiari Network are both embryological remnants that can be observed in the right atrium of the heart. The Eustachian Valve is associated with the inferior vena cava (IVC), while the Chiari Network is a more extensive, net-like structure. Key Differences - Presence and Function :     - The Chiari Network is not present in every individual and has no known function.     - In contrast, the Eustachian Valve is present in every fetus and plays a role in directing IVC flow across the fossa ovalis during fetal development. - Structural Characteristics:     - The Chiari Network is described as a net-like structure that is highly mobile.     - The Eustachian Valve is characterized as a ridge of tissue that is rarely mobile. - Origin:     - The Chiari Network usually arises from the vicinity of the IVC not attached to the septum.     ...

  New Prosthetic Valve Dehiscence or Rocking Motion is always Endocarditis until proven otherwise. Dehiscence or rocking motion of a prosthetic valve is a highly suggestive sign of endocarditis. This abnormal movement indicates that the valve is not securely attached to the surrounding tissue, often due to infection and subsequent detachment. Echocardiography can detect this motion, which is a critical finding in diagnosing prosthetic valve endocarditis, a serious and potentially life-threatening complication. Prompt recognition and treatment are essential to prevent further complications and improve patient outcomes.

  In this MOCK Exam there are twenty five echocardiography cases, each case is of about one to two minutes, with initial half to view the case and in the next half clips are repeated with answer so you can relate the answer with echo clips. Into the world of echocardiography with our comprehensive video series, where we explore 25 intriguing cases, each with labelled findings. This video is perfect for medical professionals, students, and anyone interested in cardiac imaging. What You'll Learn - In-depth analysis of various cardiac conditions through echocardiography - Labelled findings to help you understand and identify key features - Real-life cases to enhance your diagnostic skills We examine a rare condition known as mitral valve arcade. This anomaly is characterized by abnormal chordal structures connecting the papillary muscles directly to the mitral valve leaflets, bypassing the normal chordae tendineae. Echocardiography reveals thickened, dysplastic leaflets with restri...

  Tricuspid Atresia: Understanding this Rare Heart Condition Tricuspid atresia is a rare congenital heart defect that affects the tricuspid valve, which is responsible for regulating blood flow between the right atrium and right ventricle. In this condition, the tricuspid valve is completely blocked or absent, preventing blood from flowing normally through the heart. Let's take a closer look at tricuspid atresia and explore its causes, symptoms, diagnosis, and treatment options. What Causes Tricuspid Atresia? Tricuspid atresia occurs during fetal development, when the heart is forming. The exact cause is unknown, but it's thought to be related to genetic mutations or environmental factors that affect the development of the heart. Symptoms of Tricuspid Atresia The symptoms of tricuspid atresia can vary depending on the severity of the condition. Some common symptoms include: - Cyanosis (blue discoloration of the skin and mucous membranes) - Shortness of breath - Fatigue - Poor a...

  Differentiating Lipomatous Hypertrophy of the Interatrial Septum (LASH) from atrial tumors on echocardiography can be challenging, but here are some key features to help with the distinction. Its Fatty infiltration of the proximal and distal portions of the atrial septum, generally with sparing of the fossa ovalis, without a stalk and most commonly seen in the elderly and obese. Characteristics of LASH on Echo: 1. Location: LASH typically involves the interatrial septum, sparing the fossa ovalis. 2. Appearance: LASH appears as a homogeneous, hyperechoic (bright) mass with a smooth, well-defined border. 3. Size: LASH can be quite large, but it typically does not exceed 2-3 cm in thickness. 4. Shape: LASH often has a characteristic "dumbbell" or "hourglass" shape, with the narrowest part at the fossa ovalis. 5. Mobility: LASH is typically fixed and does not move with the cardiac cycle. Characteristics of Atrial Tumors on Echo 1. Location: Atrial tumors can occur any...

Above video demonstrate the10 Basic Views to master in Intracardiac Echocardiography also known as ICE, presented in simple form with real time images labeled with important structures. Home view is usually the first view when we insert intra-cardiac echo catheter or ICE catheter into right atrium.  Types of Intracardiac Echocardiography:   There are two types of ICE - phased array and radial. ○ Phased array: more common as it creates a view that is easier to interpret as it resembles a TTE or TEE. ○ Radial ICE: greater resolution, but is more difficult to interpret and is best for discriminating near-field structures and therefore requires transseptal puncture to visualize left heart structures. Process: ● Insert catheter through the femoral vein up through the IVC to the right atrium (most commonly), “the home base” for the ICE catheter. The catheter can also be inserted via the right IJ or left subclavian and then through the SVC however this will give “upsidedown” image...

Types of Ventricular Septal Defects and their Echocardiogram Features:   BROWSE FREE ECHO LIBRARY HERE >>  Ventricular septal defects are the most common congenital heart defects, accounting for approximately 25% of all congenital heart defects. A ventricular septal defect is a hole in the septum, the wall of tissue that separates the right and left ventricles of the heart. There are several types of ventricular septal defects, each with distinct echocardiogram features. Membranous ventricular septal defects are the most common type, accounting for approximately 75% of all ventricular septal defects. They occur in the membranous portion of the septum, near the aortic valve. On echocardiogram, a membranous ventricular septal defect appears as a hole in the membranous septum, typically located near the aortic valve. Turbulent flow through the defect is visible on color Doppler, and left-to-right shunting of blood is visible on spectral Doppler. Muscular ventricular septal ...

A 65-year-old man with a history of complete heart block underwent pacemaker implantation. A few months later, he presented with symptoms of fatigue and shortness of breath. An echocardiogram was performed, which showed significant tricuspid regurgitation. The video below shows the echocardiogram images, which clearly demonstrate the pacing lead interfering with the tricuspid valve and causing regurgitation. Browse FREE ECHO LIBRARY>> As shown in the video, the pacing lead is seen to be interfering with the normal coaptation of the tricuspid valve leaflets, leading to significant regurgitation. This is a classic example of pacing lead-induced tricuspid regurgitation. The patient's symptoms were attributed to the regurgitation, and he underwent lead repositioning, which resolved the issue. Pacing lead-induced tricuspid regurgitation is a complication that can arise in patients with permanent pacemakers. It occurs when the pacing lead, which is inserted through a vein and guide...

How to measure Pulmonary regurgitation Jet Width in PSAX view of Echocardiography, Here is how you take measurements:     As we know PR jet covering more than 50% of RVOT width suggests severe PR     Measuring the PR jet in the parasternal short-axis (PSAX) view of an echocardiogram: Step-by-Step Guide: 1. Obtain a PSAX view: Position the ultrasound probe to obtain a PSAX view of the aortic valve and left ventricular outflow tract. 2. Identify the PR jet: Look for the PR jet, which appears as a turbulent, high-velocity flow signal originating from the pulmonary valve and directed towards the septum. 3. Measure the PR jet: Measure the PR jet using the following methods: Diameter Measurement 1. Place the cursor: Place the cursor at the point of maximum jet diameter, usually at the pulmonary valve annulus. 2. Measure the diameter: Measure the diameter of the PR jet at this point. Other methods to assess PR:  VTI Measurement 1. Place the cursor: Place the cursor at ...

  Watch above video to understand diastolic Dysfunction  Diastolic Dysfunction on Echo: Diastolic dysfunction refers to the heart's inability to relax and fill properly during diastole. Echo findings: Grading of Diastolic Dysfunction: 1. *Grade 1 (Mild)*: Abnormal relaxation, E/A ratio < 0.8 2. *Grade 2 (Moderate)*: Pseudonormal filling, E/A ratio 0.8-1.5 3. *Grade 3 (Severe)*: Restrictive filling, E/A ratio > 2 Echo Parameters: 1. *E/A Ratio*: Early diastolic filling velocity (E) to late diastolic filling velocity (A) ratio 2. *E-wave Deceleration Time (DT)*: Time for E-wave to decrease from peak to baseline 3. *Isovolumic Relaxation Time (IVRT)*: Time from aortic valve closure to mitral valve opening 4. *Tissue Doppler Imaging (TDI)*: Measures myocardial velocities, helping to assess diastolic function Clinical Significance: Diastolic dysfunction can lead to: 1. Heart failure with preserved ejection fraction (HFpEF) 2. Increased risk of cardiovascular events 3. Decreas...