Dr. Usman's Cardiology Notes

  Mitral valve prolapse is a structural abnormality of the mitral valve that arises when part of its supporting apparatus—such as the leaflets, chordae tendineae, or papillary muscles—undergoes changes leading to altered valve function. These changes, often due to increased leaflet and chordal flexibility, elongation, or redundancy, cause one or both valve leaflets to bulge backward into the left atrium during systole. The condition is most frequently linked to myxomatous degeneration of the leaflets and chordae. The severity of associated mitral regurgitation depends on how much the prolapse interferes with proper leaflet coaptation. While mitral valve prolapse can occur without an identifiable cause, it is also seen in several inherited disorders, typically autosomal dominant or X-linked, such as Marfan syndrome, Ehlers-Danlos syndrome, adult polycystic kidney disease, osteogenesis imperfecta, pseudoxanthoma elasticum, systemic lupus erythematosus, polyarteritis nodosa, and muscu...

 In electrophysiology (EP) study), the term "wobble" usually refers to: 👉 Variation in the cycle length of a tachycardia from beat to beat — especially during AV nodal reentrant tachycardia (AVNRT) or other reentrant arrhythmias. In reentrant circuits, the conduction time around the circuit may fluctuate slightly due to changes in refractoriness or conduction velocity. This produces small irregularity in the tachycardia cycle length (not perfectly fixed as in atrial flutter). On intracardiac recordings, this is seen as beat-to-beat variation in interval timing (wobbling). 🔹 Clinical importance: Helps differentiate reentrant tachycardias (which may “wobble”) from automatic tachycardias (which are usually more regular). In AV nodal physiology, wobble of the AH interval or tachycardia cycle length during induction/termination gives clues to mechanism. 🔹 Example 1: AH interval wobble in AVNRT During AV nodal reentrant tachycardia, the conduction through the AV node (AH interva...

  A patient who had cardiac transplantation and has undergone multiple right ventricular, endocardial biopsies. Spot the findings shown in these echocardiography clips and make a diagnosis. The answer will be shown after 1 min. Case 137 Answer:  In apical four chamber view there is a turbulent flow near the apex, M Mode and Continuous wave doppler confirmed high velocity flow through out the cardiac cycle.So its an Iatrogenic Coronary Artery to Right ventricular Fistula. which is a Common complication  due to multiple biopsies after heart transplant. ✅ FREE ECHO LIBRARY >> Echocardiography for beginners  #echocardiography #cardiology  #echo #echocardiogram  #2dEcho #echo #heart #cardiology #pocus #sonography #123sonography #echolady #nejm #pocus101 #radiology Topics: Echo test for heart echocardiography test echocardiography for beginners echocardiography report kaise padhe echocardiography lectures echocardiography test kaise hota hai echocardiograph...

  AV Node in the Triangle of Koch  Here’s a detailed note on the Triangle of Koch, important in cardiology and electrophysiology: --- Triangle of Koch – Overview The Triangle of Koch is an important anatomical landmark located in the right atrium of the heart. It serves as a guide to locate the atrioventricular (AV) node, which is crucial for the cardiac conduction system. Knowledge of this triangle is essential in electrophysiology procedures such as AV nodal ablation, slow pathway ablation for AV nodal reentrant tachycardia (AVNRT), and in avoiding iatrogenic AV block. Anatomical Boundaries: The triangle is defined by three key structures: 1. Tendon of Todaro – a fibrous band running from the Eustachian valve (at the IVC) to the central fibrous body. 2. Ostium of the coronary sinus (CS) – located at the base of the triangle. 3. Septal leaflet of the tricuspid valve – forming the anterior boundary. Thus, the triangle is bounded: Posteriorly by the Tendon of Todaro Inferiorly ...

Eccentric Mitral Valve Regurgitation: A Clinical Overview Mitral regurgitation (MR) is one of the most common valvular heart conditions encountered in cardiology practice. It occurs when the mitral valve fails to close properly, allowing blood to leak backward from the left ventricle into the left atrium during systole. While central MR jets are often straightforward to diagnose, eccentric mitral regurgitation presents a unique diagnostic challenge due to its atypical jet direction, variability in auscultatory findings, and sometimes deceptive imaging features. A strong understanding of its mechanisms, clinical presentation, and echocardiographic assessment is essential for accurate diagnosis and management.   Understanding Eccentric Mitral Regurgitation Eccentric MR refers to a regurgitant jet that is directed toward one of the atrial walls, rather than flowing centrally into the left atrium. This pattern often results from asymmetric mitral valve pathology, such as prolapse of a ...

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.