Dr. Usman's Cardiology Notes

Pulmonary Artery Systolic Pressure (PASP) Calculation on Echocardiography Introduction Pulmonary artery systolic pressure (PASP) is a key echocardiographic parameter used to assess pulmonary hemodynamics and screen for pulmonary hypertension. It is non-invasively estimated using Doppler interrogation of tricuspid regurgitation (TR). --- Principle PASP is derived from the pressure gradient between the right ventricle (RV) and right atrium (RA) during systole, using the modified Bernoulli equation. \Delta P = 4V^2 Where: ΔP = pressure gradient between RV and RA V = peak velocity of tricuspid regurgitation (m/s) --- PASP Formula PASP = 4V^2 + RAP Where: PASP = Pulmonary artery systolic pressure V = Peak TR velocity (m/s) RAP = Right atrial pressure (mmHg) --- Step-by-Step Calculation 1. Measure TR Velocity Use continuous-wave Doppler across tricuspid valve Align Doppler beam parallel to TR jet Record peak TR velocity (V) 2. Calculate Pressure Gradient Apply Bernoulli equation: ΔP = 4V² 3....

 Hypertrophic Cardiomyopathy (HCM) Definition Hypertrophic cardiomyopathy is a genetic cardiac disorder characterized by unexplained left ventricular hypertrophy (LVH), often asymmetric, in the absence of abnormal loading conditions such as hypertension or valvular disease. --- Etiology Autosomal dominant mutations (most common) Sarcomeric protein gene mutations: β-myosin heavy chain Myosin-binding protein C Troponin T/I --- Pathophysiology Myocyte hypertrophy and disarray Interstitial fibrosis Dynamic LVOT (left ventricular outflow tract) obstruction Diastolic dysfunction (impaired relaxation) Mitral valve systolic anterior motion (SAM) --- Types Asymmetric septal hypertrophy (ASH) – most common Concentric hypertrophy Apical HCM Mid-ventricular obstruction variant --- Clinical Features Often asymptomatic Dyspnea (most common) Chest pain (angina-like) Syncope or presyncope (especially exertional) Palpitations Sudden cardiac death (SCD), especially in young individuals/athletes --- ...

  Mitral Stenosis on Echocardiography – Concise Reporting Guide Introduction Mitral stenosis (MS) remains a clinically significant valvular lesion, especially in regions where rheumatic heart disease is prevalent. Echocardiography is the gold standard for diagnosis, severity assessment, and procedural planning. A structured, concise reporting style improves clarity, clinical decision-making, and reproducibility. --- Why Concise Reporting Matters Avoids ambiguity in severity grading Helps cardiologists quickly interpret hemodynamic impact Essential for intervention planning (e.g., PTMC) Improves communication between imaging and clinical teams --- Core Components of an Echo Report in Mitral Stenosis 1. Valve Morphology Focus on etiology and suitability for intervention: Leaflets: thickening, calcification, doming Mobility: restricted vs preserved Commissural fusion: present or absent Subvalvular apparatus: chordal thickening/shortening 👉 Suggestive of rheumatic MS: doming anterior ...

  Cardiac Resynchronization Therapy (CRT): Indications Introduction Cardiac Resynchronization Therapy (CRT) is an established device-based treatment for patients with heart failure and electrical dyssynchrony, particularly in the setting of prolonged QRS duration. It improves symptoms, reduces hospitalizations, and decreases mortality in appropriately selected patients. --- Pathophysiologic Basis Ventricular dyssynchrony (especially with LBBB) → inefficient LV contraction Reduced stroke volume and increased mitral regurgitation CRT restores coordinated ventricular contraction → improves cardiac output --- Core Indications (Guideline-Based) Strong Indications (Class I) CRT is recommended in patients with: Symptomatic heart failure (NYHA class II–IV despite optimal medical therapy) LVEF ≤35% Sinus rhythm Left bundle branch block (LBBB) morphology QRS duration ≥150 ms Key takeaway: 👉 Best responders = LBBB + wide QRS ≥150 ms --- Moderate Indications (Class IIa) CRT should be consider...

Cerebral T Waves on ECG Introduction Cerebral T waves are deep, symmetric T-wave inversions on electrocardiography (ECG) associated with acute central nervous system (CNS) injury. These ECG changes are most commonly seen in intracranial hemorrhage, particularly subarachnoid hemorrhage (SAH), but may occur in other acute neurologic catastrophes. Recognition of cerebral T waves is important because they can mimic myocardial ischemia, potentially leading to misdiagnosis and inappropriate cardiac interventions. --- Definition Cerebral T waves are characterized by: Deep (≥5 mm) Symmetric Broad-based T-wave inversions Usually seen in the precordial leads (V2–V6) and sometimes in limb leads. These changes occur due to autonomic nervous system dysregulation and catecholamine surge triggered by acute brain injury. --- ECG Characteristics Typical ECG findings include: 1. Deep Symmetric T-Wave Inversions Most prominent in anterior and lateral leads Often giant T wave inversions 2. QT Interval Pro...

  E-point septal separation (EPSS) E-point septal separation (EPSS) is a simple M-mode echocardiographic measurement used to assess left ventricular (LV) systolic function. 🔹 Definition ▪︎ EPSS = distance (in mm) between: ○ The E-point (maximal early diastolic opening of the anterior mitral valve leaflet) ○ And the interventricular septum ▪︎ Measured in parasternal long-axis view (PLAX) using M-mode. 🔹 Normal vs Abnormal ▪︎ Normal: ≤ 5–7 mm ▪︎ Mildly increased: 7–10 mm ▪︎ Severely increased: > 10 mm 🔹 Clinical Significance 👉 EPSS is inversely related to LV ejection fraction (EF) ▪︎ Small EPSS → normal EF ▪︎ Large EPSS → reduced EF EPSS – Key Equation (Clinical Estimation of EF) 👉 LVEF (%) ≈ 75.5 − (2.5 × EPSS in mm) 🔹 Example EPSS = 10 mm → EF ≈ 75.5 − (2.5 × 10) → EF ≈ 50% EPSS on Echocardiography E-Point Septal Separation --- Definition EPSS (E-Point Septal Separation) is the minimal distance between the anterior mitral valve leaflet (E-point) and the interventricular se...

  Echo Evaluation of PS and PR Pulmonary valve disease is commonly encountered in congenital and adult cardiology practice. Echocardiography remains the primary tool for diagnosis, severity assessment, and follow-up of Pulmonary Stenosis (PS) and Pulmonary Regurgitation (PR). A systematic echocardiographic approach helps determine valve morphology, hemodynamic severity, and the impact on right ventricular function. --- INTRODUCTION Pulmonary valve pathology may occur as isolated congenital disease, after surgical repair of congenital heart defects, or secondary to pulmonary hypertension and endocarditis. Echocardiography provides comprehensive evaluation through: • Valve morphology • Doppler hemodynamics • Right ventricular size and function • Associated congenital abnormalities Both PS and PR primarily affect the right heart, making careful right-sided assessment essential. --- ECHOCARDIOGRAPHIC VIEWS FOR PULMONARY VALVE The pulmonary valve can be visualized in several standard ec...