Dr. Usman's Cardiology Notes

Types of Ventricular Septal Defects and their Echocardiogram Features:   BROWSE FREE ECHO LIBRARY HERE >>  Ventricular septal defects are the most common congenital heart defects, accounting for approximately 25% of all congenital heart defects. A ventricular septal defect is a hole in the septum, the wall of tissue that separates the right and left ventricles of the heart. There are several types of ventricular septal defects, each with distinct echocardiogram features. Membranous ventricular septal defects are the most common type, accounting for approximately 75% of all ventricular septal defects. They occur in the membranous portion of the septum, near the aortic valve. On echocardiogram, a membranous ventricular septal defect appears as a hole in the membranous septum, typically located near the aortic valve. Turbulent flow through the defect is visible on color Doppler, and left-to-right shunting of blood is visible on spectral Doppler. Muscular ventricular septal ...

A 65-year-old man with a history of complete heart block underwent pacemaker implantation. A few months later, he presented with symptoms of fatigue and shortness of breath. An echocardiogram was performed, which showed significant tricuspid regurgitation. The video below shows the echocardiogram images, which clearly demonstrate the pacing lead interfering with the tricuspid valve and causing regurgitation. Browse FREE ECHO LIBRARY>> As shown in the video, the pacing lead is seen to be interfering with the normal coaptation of the tricuspid valve leaflets, leading to significant regurgitation. This is a classic example of pacing lead-induced tricuspid regurgitation. The patient's symptoms were attributed to the regurgitation, and he underwent lead repositioning, which resolved the issue. Pacing lead-induced tricuspid regurgitation is a complication that can arise in patients with permanent pacemakers. It occurs when the pacing lead, which is inserted through a vein and guide...

How to measure Pulmonary regurgitation Jet Width in PSAX view of Echocardiography, Here is how you take measurements:     As we know PR jet covering more than 50% of RVOT width suggests severe PR     Measuring the PR jet in the parasternal short-axis (PSAX) view of an echocardiogram: Step-by-Step Guide: 1. Obtain a PSAX view: Position the ultrasound probe to obtain a PSAX view of the aortic valve and left ventricular outflow tract. 2. Identify the PR jet: Look for the PR jet, which appears as a turbulent, high-velocity flow signal originating from the pulmonary valve and directed towards the septum. 3. Measure the PR jet: Measure the PR jet using the following methods: Diameter Measurement 1. Place the cursor: Place the cursor at the point of maximum jet diameter, usually at the pulmonary valve annulus. 2. Measure the diameter: Measure the diameter of the PR jet at this point. Other methods to assess PR:  VTI Measurement 1. Place the cursor: Place the cursor at ...

  Acute pericarditis is a condition characterized by inflammation of the pericardium, the sac surrounding the heart. This inflammation can lead to a range of symptoms, including chest pain, fever, and fatigue. One of the key diagnostic tools for acute pericarditis is the electrocardiogram (ECG), which can reveal a number of characteristic changes. In the early stages of acute pericarditis, the ECG may show a pattern of widespread ST-segment elevation. This is often accompanied by a slight elevation of the PR segment, and a decrease in the amplitude of the QRS complex. The ST-segment elevation is typically concave upwards, and may be seen in all leads except aVR. This pattern of ST-segment elevation is often referred to as a "saddle-shaped" or "dome-shaped" appearance. As the condition progresses, the ECG may show a number of additional changes. One of the most characteristic features of acute pericarditis is the development of PR-segment depression. This is often se...

Health is more than a state of physical fitness—it’s about the harmony of mind, body, and spirit. In our fast-paced world, maintaining balance can feel challenging. However, without health, everything else takes a backseat. Good health isn’t just about avoiding illness; it’s about thriving. Let’s explore how physical, mental, and preventative practices can improve your overall well-being. ---------------------------------------- The Foundations of Physical Health Physical health forms the backbone of overall wellness. By focusing on nutrition, exercise, and sleep, you can create a strong base for a healthy life. Nutrition: Building a Balanced Diet Food is your body’s fuel. If you give it the right nutrients, it runs smoothly; if not, things break down over time. A balanced diet includes proteins, carbohydrates, fats, vitamins, and minerals. Proteins help build muscles and repair tissues. You can find them in lean meats, fish, eggs, beans, and tofu. Carbs supply energy, and healthy opti...

  Watch above video to understand diastolic Dysfunction  Diastolic Dysfunction on Echo: Diastolic dysfunction refers to the heart's inability to relax and fill properly during diastole. Echo findings: Grading of Diastolic Dysfunction: 1. *Grade 1 (Mild)*: Abnormal relaxation, E/A ratio < 0.8 2. *Grade 2 (Moderate)*: Pseudonormal filling, E/A ratio 0.8-1.5 3. *Grade 3 (Severe)*: Restrictive filling, E/A ratio > 2 Echo Parameters: 1. *E/A Ratio*: Early diastolic filling velocity (E) to late diastolic filling velocity (A) ratio 2. *E-wave Deceleration Time (DT)*: Time for E-wave to decrease from peak to baseline 3. *Isovolumic Relaxation Time (IVRT)*: Time from aortic valve closure to mitral valve opening 4. *Tissue Doppler Imaging (TDI)*: Measures myocardial velocities, helping to assess diastolic function Clinical Significance: Diastolic dysfunction can lead to: 1. Heart failure with preserved ejection fraction (HFpEF) 2. Increased risk of cardiovascular events 3. Decreas...

  Tricuspid Valve Tumors: A Rare Entity Tricuspid valve tumors are extremely rare, accounting for only 3-5% of all heart valve tumors. These tumors can be benign or malignant, and their location on the tricuspid valve can lead to significant clinical consequences. Types of Tricuspid Valve Tumors: 1. Myxomas: The most common type of benign heart tumor, myxomas can occur on the tricuspid valve. 2. Papillary fibroelastomas: These benign tumors are the second most common type of heart valve tumor and can occur on the tricuspid valve. 3. Malignant tumors: Rarely, malignant tumors such as sarcomas or lymphomas can involve the tricuspid valve. Clinical Presentation: Symptoms may include: Dyspnea (shortness of breath) Fatigue Palpitations Chest pain Physical examination may reveal: Tricuspid regurgitation murmur Tricuspid stenosis murmur Signs of right heart failure Diagnosis: Echocardiography (transthoracic and transesophageal) Cardiac MRI or CT Right heart catheterization Treatment: Surg...

One of the probably most commonly seen pattern on ecg is the above!  “A regular & high-frequency "caterpillar" pattern, making it almost difficult to interpret the true underlying electrical activity of the heart!!!” This is also known as 60 hz or 60 cycle interference on ecg!  This is Common to areas where the source of electricity is “AC”With frequency of 60 hz !!! There electrical current can leak into other circuits and can results in this pattern on ecg . To help minimize 60 cycle interference one can set the mode of the 12-lead ECG monitor to 0.05 – 40 Hz!!!!! Electromagnetic interference (EMI) is defined as unwanted noise / artifacts/ interference in an electrical path or circuit caused by an outside of heart source.  Most Drs especially the jnr Drs do not have an understanding of the issue or how to resolve the problem and unfortunately accept ECG interference as something like normal !!!! Fatal arrhythmias may therefore go unnoticed! , and one can be confus...

  Healing Hearts, Restoring Rhythm: A Step-by-Step Guide to Percutaneous Transvenous Mitral Commissurotomy (PTMC) Keywords: PTMC, mitral stenosis, heart valve disease, minimally invasive procedure, interventional cardiology Introduction: Mitral stenosis, a narrowing of the mitral valve opening, affects millions worldwide, causing symptoms like shortness of breath, fatigue, and palpitations. Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a minimally invasive procedure that offers a life-changing solution for these patients. In this article, we'll delve into the world of PTMC, explaining the step-by-step process and shedding light on this remarkable treatment option. What is PTMC? PTMC is a non-surgical procedure used to treat mitral stenosis. It involves using a balloon catheter to widen the narrowed mitral valve, restoring normal blood flow and alleviating symptoms. Step-by-Step Guide to PTMC: Step 1: Preparation Patients undergo thorough evaluation, including echocardiog...

  Echocardiography 101: Unlocking the Secrets of Heart Imaging Did you know over 100 million echocardiograms are done worldwide each year? This non-invasive method is key in finding heart problems. It uses sound waves to show the heart's inside in real time. It helps doctors spot issues like valve problems or weak heart muscles. This guide will show you how echocardiography works and why it's important. Learn how it's changing heart care without surgery. Key Takeaways Echocardiography uses sound waves to create detailed heart images in real time. Over 100 million procedures are done annually, showing its critical role in heart care. Helps detect structural heart issues like valve defects or muscle weakness. Non-invasive and safe, making it a preferred alternative to more invasive methods. Essential for guiding treatment decisions and monitoring heart health over time. What Is Echocardiography and Why It Matters Echocardiography uses cardiac ultrasound to create deta...

Wandering Baseline Artifact Baseline Wander (BW) Artifact on ECG  One of the other major/common noise type on surface ecg is the baseline wander (BW). BW recorded on ECG is mainly caused by the movement and respiration of the patient hence they appears as low-frequency artifacts!!!! Generally these fluctuations on ECG are not of cardiac origin. And are typically in range below 0.5 Hz  Issues with Baseline wander  1. They can distort the ECG shape esp whenever there is body movement inc even deep rapid breathing !!! ( Some data even suggest that BW can even be caused by loose or dry electrodes)  (To mitigate this issue remember Some techs may be used to ask patients to hold their breath during a 12-lead ECG. Be aware of this as this can also alter the patient’s heart rate)  2. BW is especially important when subtle changes in the “low-frequency” ST–T segment are analyzed for the diagnosis of ischemia, for which ETT is performed .  Though The frequency conte...

  Bicuspid Aortic Valve (BAV) can cause severe aortic regurgitation (AR) through several mechanisms: Congenital Abnormalities 1. Abnormal valve morphology: BAVs often have an abnormal valve morphology, which can lead to incomplete closure of the valve leaflets, resulting in AR. 2. Fusion of valve leaflets: In BAV, the valve leaflets may be fused together, creating a single, abnormal leaflet that cannot close properly, leading to AR. Acquired Changes 1. Valve calcification: Over time, BAVs can become calcified, leading to stiffening of the valve leaflets and incomplete closure, resulting in AR. 2. Valve prolapse: BAVs can also prolapse, causing the valve leaflets to bulge backward into the left ventricle, leading to AR. Aortic Root Changes 1. Aortic root dilation: BAVs are often associated with aortic root dilation, which can lead to AR by causing the valve leaflets to become misaligned. 2. Aortic aneurysm formation: In some cases, BAVs can lead [3/4, 1:39 PM] Meta AI: Bicuspid Aort...

ECG artefacts!!! a relatively common happening in every day clinical life can have a wide range of presentations and can create varying clinical relevance !!!!!!  ECG artifacts are distortions/ changes in the ECG that are not caused by the heart electrically activity by itself !!!!!   Commonly used terms in this regard are  1. Motion artifacts! irregular ECG baseline changes caused by movement or shaking of body.  2. ECG artefacts! on the other hand “signals that are not related to cardiac electrical activity” A. Artefacts due to technical problems with recording sys  (nuisance artefact’s)  1. malfunctioning equipment  inc loose or fractured leads 2. accumulation of static energy 3. electromagnetic interference(EMI). caused by power lines and electrical equipment.  “It can be recognized as high frequency sharp signals at 60 Hz” 4. patient-related artifact such as body movement,  5. poor electrode contact because of hairy skin or w...