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...

Katz-Wachtel phenomenon (sometimes written as Katz-Wachtel waves). On ECG: It refers to the presence of giant, biphasic QRS complexes in the mid-precordial leads (V2–V5). The QRS complexes are very tall, often more than 50 mm, with both positive and negative deflections in the same complex. It reflects biventricular hypertrophy (both RVH and LVH present), because forces of both ventricles are so strong and opposing that they produce large biphasic complexes. Classically described in congenital heart diseases with large left-to-right shunts such as ventricular septal defect (VSD), endocardial cushion defect, or PDA with pulmonary hypertension. 👉 So in one line: Katz-Wachtel phenomenon = giant biphasic QRS complexes in mid-precordial leads, indicating biventricular hypertrophy, typically seen in large VSD or similar shunt lesions.

 👉 In practice, ablation is often considered when VT is drug-refractory, recurrent, or causing ICD shocks, provided the patient can safely undergo the procedure. How isoprenaline (isoproterenol) controls VT ? The way isoprenaline (isoproterenol) controls VT depends on the mechanism of arrhythmia. 1. Idiopathic VF / Brugada / Early repolarization syndrome These arrhythmias are triggered by phase-2 reentry or Purkinje PVCs. At slow heart rates, abnormal repolarization (J-wave accentuation, action potential heterogeneity) favors PVCs and VF. Isoprenaline (β-agonist) increases sympathetic tone → raises heart rate → shortens action potential duration and suppresses early afterdepolarizations. This reduces dispersion of repolarization and stabilizes the ventricular myocardium. Net effect: PVC suppression → VF/VT storm breaks. 2. General mechanism β-1 stimulation → increases HR and conduction → overrides pause-dependent triggers. β-2 stimulation → increases calcium influx → suppresses ph...

2025 AHA/ACC Hypertension: Stepwise Management Updates Diagnosis & Initiation BP ≥140/90: Initiate pharmacotherapy immediately. BP 130–139/80–89: Start drugs for high-risk (CVD, CKD, diabetes, PREVENT 10-yr risk ≥7.5%); otherwise, lifestyle modification, reassess in 3–6 months. Initial Therapy Monotherapy: ACEI/ARB, CCB, or thiazide. Stage 2 (≥140/90 or >20/10 above goal): Dual therapy (prefer ACEI/ARB + CCB/thiazide SPC). Escalation Uncontrolled: Triple therapy (ACEI/ARB + CCB + thiazide-like diuretic). Resistant HTN (≥3 drugs): Add MRA (spironolactone/eplerenone). Refractory HTN Assess adherence, exclude secondary causes. Consider RDN (Class IIb, LOE 8-R) with multidisciplinary input. Lifestyle Foundation: Salt restriction, DASH diet, weight loss, exercise, alcohol moderation, smoking cessation. #Hypertension

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.