Dr. Usman's Cardiology Notes

Watch the above video for 16 most important views to get on TEE. Here is a comprehensive Transesophageal Echocardiography (TEE) protocol with tips and tricks: Pre-Procedure Preparation 1. *Patient preparation*: Ensure the patient is fasting for at least 4-6 hours before the procedure. 2. *Informed consent*: Obtain informed consent from the patient, explaining the procedure, risks, and benefits. 3. *Vital sign assessment*: Assess the patient's vital signs, including blood pressure, heart rate, and oxygen saturation. 4. *Medication review*: Review the patient's medications and consider withholding anticoagulants or adjusting sedation as needed. Equipment Preparation 1. *TEE probe*: Ensure the TEE probe is properly cleaned, disinfected, and ready for use. 2. *Ultrasound system*: Set up the ultrasound system, selecting the TEE probe and adjusting settings as needed. 3. *Monitoring equipment*: Ensure monitoring equipment, such as ECG, blood pressure, and oxygen saturation monitors, ...

Same Patient with Arm Pulled down towards Knee. If you have difficulty in getting Axillary Access, ask patient or someone to pull arm downward towards knee, as it's occluded in this position sometimes Between rib & Clavicle.

Here are simple estimates of pericardial effusion volume based on echo measurements: - Mild: < 100 mL (echo size < 1 cm) - Moderate: 100-500 mL (echo size 1-3 cm) - Severe: > 500 mL (echo size > 3 cm) To estimate the volume of pericardial effusion (in mL) based on the size measured on echocardiography, you can use the following formula: Volume (mL) = [ (D1 x D2 x D3) / 3 ] x 4 Where: D1, D2, and D3 are the diameters of the effusion (in cm) measured in three different views: - D1: Anteroposterior diameter (measured in the parasternal long-axis view) - D2: Transverse diameter (measured in the parasternal short-axis view) - D3: Inferosuperior diameter (measured in the apical four-chamber view) Note: This formula is an estimate and may not always accurately reflect the actual volume of the effusion. Here are the key points for signs of cardiac tamponade: *Clinical Signs:* 1. *Beck's Triad*:     - Hypotension (low blood pressure)     - Muffled heart sounds ...

A 50 years old female with normal angiography and normal Echo ,with recurrent tachycardia, came to emergency in cardiac Hospital,patient reverted to sinus rhythm with sedation, lignocaine and magnesium sulphate,normal troponin and electrolytes ,Cardiac MR dome last year was also normal ,what should be best management plan for this ? What is the location of this tachycardia or VT? Is ablation possible for this patient as she doesn't tolerate this rhythm well? Few things seems to be eye catching but keeping in mind that surface ecg being only 12 leads has lots & lots of shortfalls for exact identification of endocardial source of arrhythmia ! Hence as you know , as the EP catheters are multipolars so much much more helpful in pin pointing the exact endocardial source of arrhythmias   1. The arrhythmias seem to be Ventricular driven  2. ⁠morphologically , it’s seems mono morphic rather than polymorphic , hence supporting a single focus  3. ⁠the shortest way to furt...

  Post-Ventricular Atrial Refractory Period (PVARP ): • PVARP is a programmable period after a ventricular paced or sensed event in which sensed atrial events do not initiate timing cycles or inhibit atrial pacing. PVARP may prevent the tracking of retrograde atrial events initiated in the ventricle that could trigger PMT in a dual chamber device programmed to a tracking mode. • The initial section of PVARP is the cross-chamber blanking period (composed of absolute refractory and noise window) followed by the fixed refractory period • Events that fall into the absolute refractory window of cross-chamber blanking are not sensed or marked • Events that fall into the noise window are marked as [AS]; there is no noise window for SMART blanking • Events in fixed refractory are marked as (AS), (AF), or (PAC) • Although sensed events in the PVARP fixed refractory window do not initiate timing cycles, they do count toward ATR Entry Counts, AFR, and are included in counters/hi...

Watch the above video and try to calculate RVSP, mean PAP and Diastolic Pulmonary pressure. Formulas: PASP = RVSP (in the absence of RVOT Obstruction or pulmonic stenosis) So RVSP = 4V² + RAP Where V is the peak TR Velocity The mean and end diastolic pressures in the pulmonary artery are directly assessed by measuring peak and end-diastolic velocities of the pulmonary regurgitant (PR) jet Diastolic PA pressure (PAPd) = PR end diastolic pressure gradient + RA pressure Mean PA pressure (PAPm) = PR peak pressure gradient + RA pressure Estimating RA Pressure/CVP: Easiest way to remember the specific RAP value is to understand the normal and high pressure, everything else will fall in the middle category simply! Normal IVC with  normal collapsibility = LOW (3 mmHg) Abnormal IVC with  abnormal collapsibility = HIGH (15 mmHg) Any combination of Abnormal & Normal  values = INTERMEDIATE (8 mmHg) Abnormal IVC, normal collapsibility Abnormalcollapsibility, norm...

  ECG Case: A 71 year old man presented with recurrent episodes of syncope, What are the findings in this EKG, How will you manage? Click the button below to view answer: Show Answer