Dr. Usman's Cardiology Notes

The 2026 ESC Guidelines for the Management of Heart Failure, published on 28 August 2026, have substantially changed the terminology and treatment framework compared with the 2016 guideline. In particular, HFmrEF has been removed, and HFrEF now includes patients with LVEF <50%.  2026 ESC Guidelines for the Diagnosis and Management of Heart Failure With Reduced Ejection Fraction The 2026 European Society of Cardiology (ESC) Guidelines for the Management of Heart Failure introduce important changes in the definition, classification, diagnosis and treatment of heart failure. Published in August 2026, the guideline simplifies the traditional heart-failure phenotype classification, introduces stages of heart failure from A to D, and establishes a new framework for pharmacological and interventional treatment. One of the most important changes is the redefinition of heart failure with reduced ejection fraction (HFrEF). The previous distinction between HFrEF and HFmrEF has been removed...

Recommendations for Patients With Preserved LVEF (≥50%): A Practical Guide to HFpEF Treatment Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized form of heart failure in which patients have symptoms and signs of heart failure despite a relatively preserved left ventricular ejection fraction. According to the 2022 AHA/ACC/HFSA Heart Failure Guideline, HFpEF is defined as heart failure with an LVEF ≥50% together with evidence supporting increased left ventricular filling pressures.  Unlike HFrEF, where several therapies have established mortality benefits, treatment of HFpEF has historically focused on controlling congestion, blood pressure, atrial fibrillation, ischemic heart disease and other associated conditions. However, the therapeutic landscape has changed substantially, particularly with the introduction of SGLT2 inhibitors. The 2022 AHA/ACC/HFSA guideline provides a practical framework for the treatment of symptomatic patients with HFpEF. TR...

  Heart Blocks on ECG: A Practical Guide to First-, Second- and Third-Degree AV Block Atrioventricular (AV) block is one of the most important conduction abnormalities encountered on ECG. Correctly identifying the pattern—particularly distinguishing Mobitz I from Mobitz II—has major implications for prognosis, monitoring and pacemaker therapy. The key is to systematically assess the relationship between P waves, PR intervals and QRS complexes. --- 1. What is AV Block? AV block occurs when conduction of electrical impulses from the atria to the ventricles is delayed or interrupted at the AV node, His bundle or Purkinje system. It is broadly classified as: 1. First-degree AV block 2. Second-degree AV block Mobitz I / Wenckebach Mobitz II 2:1 AV block High-grade/advanced AV block 3. Third-degree AV block / complete heart block The ECG diagnosis depends primarily on identifying: P-wave behavior → PR interval → conducted/dropped QRS complexes → atrial–ventricular relationship. --- 2. Fi...

 5th Universal Definition of Myocardial Infarction (2026) The Major Changes You Need to Know The Fifth Universal Definition of Myocardial Infarction (5th UDMI), published in 2026, represents a major evolution in how myocardial infarction (MI) is defined and classified. For the first time, the document has been developed jointly by the European Society of Cardiology (ESC), American College of Cardiology (ACC), American Heart Association (AHA), and World Heart Federation (WHF). The major conceptual change is simple: Instead of asking, “Is this Type 1, 2, 3, 4 or 5 MI?” the clinician should now ask: Is this a primary MI, secondary MI, or procedure-related MI? The new classification is designed to better reflect pathophysiology and clinical decision-making. --- 1. What is Myocardial Infarction? Myocardial infarction is myocardial cell death caused by prolonged myocardial ischaemia. Importantly, an elevated troponin level alone does NOT diagnose MI. The clinical diagnosis requires: Acut...

 🫀 MECHANICAL AORTIC VALVE — ECHOCARDIOGRAPHIC ASSESSMENT 🔍 How to assess a mechanical aortic prosthesis by Echo? Mechanical prosthetic valves require a systematic echocardiographic assessment. The most important point is: ⚠️ DO NOT diagnose prosthetic valve obstruction from a high gradient alone! --- 1️⃣ 2D ECHOCARDIOGRAPHY Assess: 🔹 Valve position and seating 🔹 Prosthetic leaflet/disc mobility when visible 🔹 Abnormal rocking motion of the prosthesis 🔹 Thrombus 🔹 Pannus 🔹 Vegetation 🔹 Dehiscence 🔹 Paravalvular abnormalities 🔹 Aortic root and ascending aorta 🔹 LV size, wall thickness and systolic function ⚠️ Mechanical valves produce significant acoustic shadowing and reverberation, therefore the prosthetic leaflets may not always be adequately visualized by TTE. --- 2️⃣ DOPPLER ASSESSMENT The essential Doppler parameters include: ✅ Peak velocity (Vmax) ✅ Peak gradient ✅ Mean gradient ✅ Dimensionless Velocity Index (DVI) ✅ Acceleration time (AT) ✅ Effective orifice area...

2026 ESC Guidelines for the Management of Heart Failure — What Has Changed? The European Society of Cardiology has released the 2026 ESC Guidelines for the Management of Heart Failure, representing a major update to the contemporary approach to prevention, diagnosis, classification and treatment of heart failure. The new guideline moves beyond simply categorising patients according to left ventricular ejection fraction (LVEF). It introduces a more clinically oriented framework incorporating disease stages, phenotype, comorbidities, congestion, risk and treatment response. 1. A New Approach to Heart Failure Classification One of the important changes is refinement of the classification of HF according to LVEF. Rather than viewing HF as a single disease, the guideline emphasises the spectrum of ventricular function and the importance of recognising patients at different stages of disease. Broadly, clinical phenotypes continue to include: - HFrEF - HF with mildly reduced EF - HFpEF - HF w...