Dr. Usman's Cardiology Notes

McConnell’s sign is a classic echocardiographic finding described in acute pulmonary embolism (PE), characterized by a distinctive pattern of right ventricular (RV) regional wall motion abnormality. Definition McConnell’s sign refers to akinesia or severe hypokinesia of the mid-free wall of the right ventricle with preserved or hyperdynamic apical contraction on transthoracic echocardiography. Historical Background First described in 1996 by McConnell et al., the sign was proposed as a specific echocardiographic marker of acute massive pulmonary embolism, helping differentiate acute from chronic RV pressure overload. Echocardiographic Description The hallmark components include: Marked hypokinesia or akinesia of the RV mid-free wall Normal or hyperdynamic contraction of the RV apex (apical sparing) Often accompanied by RV dilatation Reduced tricuspid annular plane systolic excursion (TAPSE) Elevated pulmonary artery pressures (may be underestimated early) This peculiar pattern gives th...

Summary of Various ECG Criteria for Left Ventricular Hypertrophy (LVH) Left ventricular hypertrophy (LVH) is an increase in left ventricular myocardial mass, most commonly caused by long-standing hypertension, aortic stenosis, and cardiomyopathies. While echocardiography is the diagnostic gold standard, the electrocardiogram (ECG) remains a widely used screening and prognostic tool. Multiple ECG criteria have been developed to improve detection of LVH, each with its own strengths and limitations. --- Voltage-Based Criteria Sokolow–Lyon Criteria This is the most traditional and commonly taught criterion. LVH is suggested when the sum of the S wave in V1 and the R wave in V5 or V6 is ≥35 mm, or when the R wave in V5 or V6 alone is ≥26 mm. Although easy to remember, its sensitivity is low, particularly in obese individuals and older adults. Cornell Voltage Criteria LVH is present when the sum of the S wave in V3 and the R wave in aVL exceeds 28 mm in men or 20 mm in women. Compared with S...

  Clinical Approach to ARVC ✅ECG features of Arrhythmogenic Right Ventricular Dysplasia (ARVD) with: 🔹 TWI in precordial leads, in absence of RBBB. 🔹 Epsilon wave (most specific finding). 🔹 Localised widened QRS in V1-V3 (due to delayed RV activation). ARVD: - Genetic disorder of fibrofatty infiltration of myocardium.  - Most common symptoms are palpitations/ syncope during exercise.  - VT with LBBB pattern can become VF, usually triggered by adrenergic stimulation (e.g. exercise). Arrhythmogenic Right Ventricular Dysplasia (ARVD), also termed Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), is an inherited myocardial disease characterized by progressive fibrofatty replacement of right ventricular myocardium, leading to ventricular arrhythmias and sudden cardiac death, particularly in young individuals and athletes. --- Definition and Pathophysiology ARVD is a genetic cardiomyopathy, most commonly inherited in an autosomal dominant pattern. It primarily involves...

  Coronary Angiogram Explained – Understanding Each Angiographic View Coronary angiography is the gold standard investigation to visualize coronary artery anatomy, detect stenosis, and guide interventional decisions. Correct interpretation depends on understanding standard angiographic views and knowing which coronary segments are best seen in each projection. Basic Coronary Anatomy Left Main Coronary Artery (LM) divides into the Left Anterior Descending (LAD) and Left Circumflex (LCX). LAD gives diagonal branches and septal perforators. LCX gives obtuse marginal branches. Right Coronary Artery (RCA) gives conus, SA nodal, acute marginal branches and usually the PDA. Left Coronary System Views LAO Caudal View (Spider View) Best for left main coronary artery, LM bifurcation, proximal LAD and proximal LCX. The LM resembles a spider body with LAD and LCX as legs. This is the most important view to assess left main disease and ostial LCX lesions. RAO Caudal View Best for LCX and obtuse...

2025 ACC/AHA Guideline on Treatment of Hypertension — What’s New in Management and Therapy Introduction The 2025 American College of Cardiology / American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults updates and replaces the 2017 guideline, providing clinicians with the latest evidence-based recommendations to improve outcomes in patients with hypertension.  --- 1. Goals of Treatment Target Blood Pressure • Universal goal of treatment is <130/80 mm Hg for most adults with hypertension.  • Encouragement to achieve even lower systolic targets (e.g., <120 mm Hg) in selected individuals if tolerated.  Risk-Guided Therapy • Treatment decisions incorporate individualized cardiovascular risk estimation using the PREVENT risk calculator, replacing the Pooled Cohort Equation. This tool includes social determinants and improves risk prediction.  --- 2. When to Start Treatment Lifestyle Fi...

Vereckei Algorithm for Ventricular Tachycardia (VT) A Detailed ECG-Based Diagnostic Guide Wide complex tachycardia (WCT) is a common and critical ECG challenge. The most important rule in clinical cardiology is: any WCT should be considered VT until proven otherwise. The Vereckei algorithm is a simplified, stepwise ECG approach developed to differentiate VT from supraventricular tachycardia with aberrant conduction (SVT-A), using mainly lead aVR and avoiding complex morphological criteria. This algorithm is especially useful in emergency settings, critical care, and examinations. --- Background and Rationale Traditional algorithms (Brugada, Wellens) rely on multiple precordial lead patterns and can be difficult to apply quickly. Vereckei et al. proposed a simpler method based on the observation that initial ventricular activation during VT is abnormal, whereas SVT conducts rapidly through the His–Purkinje system. The algorithm answers one question at each step. If the answer is “yes,” ...

  Evaluation of Peak Velocity Through a Prosthetic Aortic Valve Introduction Assessment of peak transvalvular velocity is a cornerstone in the echocardiographic evaluation of prosthetic aortic heart valves. It helps differentiate normal prosthetic function from obstruction due to thrombosis, pannus, or patient–prosthesis mismatch (PPM). Because prosthetic valves are inherently obstructive compared with native valves, interpretation requires prosthesis-specific knowledge and integration with other Doppler parameters. Physiological Basis Peak velocity across a prosthetic aortic valve reflects the pressure gradient generated as blood flows through the effective orifice area of the valve. According to the modified Bernoulli equation: Peak gradient (mmHg) = 4 × (Peak velocity)² Higher velocities may result from: • True prosthetic obstruction • Small valve size relative to body size (PPM) • High flow states (anemia, fever, sepsis, pregnancy) • Measurement errors (malalignment, LVOT conta...