Dr. Usman's Cardiology Notes

Watch the above case and try to solve the problem. When looking at a paced rhythm on ECG, it often creates a pattern that can mimic bundle branch blocks, and this can sometimes be confusing. Most ventricular paced rhythms resemble a left bundle branch block (LBBB) pattern, with a broad QRS complex and a dominant negative deflection in lead V1, because the pacing lead is usually placed in the right ventricle and the impulse spreads across the septum from right to left. In contrast, a true right bundle branch block (RBBB) has an rSR′ pattern in V1 and a different overall axis. A paced rhythm will generally not look like a typical RBBB unless the lead is placed in an unusual site such as the left ventricle or coronary sinus branch. So, in practical terms, when you see pacing spikes followed by a wide QRS resembling LBBB, it usually indicates conventional right ventricular pacing.

2025 AHA/ACC Hypertension Guidelines Summary: BP Categories - Normal: <120/<80 mmHg - Elevated: 120-129/<80 mmHg - Stage 1: 130-139 or 80-89 mmHg - Stage 2: ≥140 or ≥90 mmHg Lifestyle Modification (First-line for all) 1. DASH diet 2. ↓ Na (sodium reduction) 3. ↑ K (potassium increase, unless CKD) 4. Weight management 5. Moderate activity 6. Stress control 7. Limit alcohol When to Start Medications 👉👉- Always if BP ≥140/90 mmHg 👉👉If BP ≥130/80 mmHg with:     1. CVD     2. Stroke     3. DM (diabetes mellitus)     4. CKD (chronic kidney disease)     5. 10-year CVD risk ≥7.5% (using PREVENT calculator) - If risk <7.5%: start meds after 3-6 months lifestyle trial if BP still ≥130/80 mmHg Preferred Therapy - Stage 2 HTN: 2 first-line drugs in a single-pill combo to improve adherence & speed control. Special Considerations - Pregnancy: Treat ≥160/110 mmHg urgently; target <140/90 for chronic HTN; avoid certain medications...

  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.

First of all remember I said “This ecg of “ asymptomatic “ individual !  However even then the following needed to be known!!!!! As far as managment is concerned !! So indeed very prolong PR !!! Or in other words the “ the famous first degree AV block “  So technically The P to R interval is measured from the” beginning of the P complex to the beginning of the QRS complex “  The normal P to R interval in adults is 120 to 200 msecond. It is generally shorter in children and gets longer as one ages.  “ And this interval ! is actually representative of the time required for the current to flow from the atrium through the AV node, then His bundle , then BB and then system of PF until the ventricular myocardium begins to depolarise!!!!!” The biggest caveat or the biggest challenge !  Since normally almost all of the Drs & especially the Jnr Drs either don’t actually measure it & go on eye balling or if they do measure , they don’t know from where to start ...

PVC Localization on ECG: Lets start with this ECG Case: Premature ventricular contractions (PVCs) are common arrhythmias often seen on routine ECGs or Holter monitors. While isolated PVCs are frequently benign, identifying their site of origin can be clinically important—especially in patients with symptoms, frequent ectopy, or underlying structural heart disease. ECG morphology offers valuable clues to help localize the origin of these ectopic beats within the ventricles. Basic Principles: PVCs originate from a single focus in the ventricular myocardium. Because of this, the activation spreads outside the normal conduction system, creating wide and bizarre QRS complexes. The QRS morphology and axis during a PVC provide hints about where in the ventricles the beat originates. Key Clues to Localization: 1. Outflow Tract PVCs (RVOT/LVOT) Most common type in structurally normal hearts. LBBB pattern in V1 (dominant S wave). Inferior axis (positive QRS in II, III, aVF) — indicating superior...

 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...

 Atrial Septal Defect (ASD) Device Closure: A Comprehensive Overview Case Presentation: A 25-year-old female patient presented with complaints of shortness of breath on exertion and palpitations for the past 6 months. She had no significant past medical history and was not taking any medications. Physical Examination: - Vital signs: Blood pressure 120/80 mmHg, pulse rate 90 beats per minute, oxygen saturation 98% on room air. - Cardiovascular examination: Revealed a systolic ejection murmur at the left upper sternal border, with fixed splitting of the second heart sound. - Chest examination: Clear lungs, no peripheral edema. Diagnostic Tests: - Electrocardiogram (ECG): Showed sinus rhythm with right axis deviation and incomplete right bundle branch block. - Chest X-ray: Revealed cardiomegaly with increased pulmonary vascular markings. - Transthoracic echocardiogram (TTE): Demonstrated a secundum atrial septal defect (ASD) with left-to-right shunting, right ventricular enlargement, ...