Dr. Zahidul Mostafa

04/10/2025

Coronary Artery Dominance: A Key Concept in Angiography

Dominance is defined by which artery gives rise to the posterior descending artery (PDA):
• Right dominance – PDA from RCA
• Left dominance – PDA from LCx
• Balanced – PDA from both RCA & LCx

Prevalence:
• Right dominant – ~85%
• Left dominant – ~8%
• Balanced – ~7%

Understanding dominance is crucial in assessing myocardial perfusion, planning revascularization, and anticipating outcomes in coronary artery disease.

Image:
Top – Right dominance
Middle – Left dominance
Bottom – Balanced dominance
(Courtesy Dr. Annapoorna Kini, Mount Sinai, NY)

Ref: Braunwald’s Heart Disease, 12th Ed.

29/09/2025

Understanding the Cardiac Cycle: A Diastolic Perspective

This integrated diagram illustrates how echocardiography correlates with the cardiac cycle, especially diastole, using:
✅ Doppler flow
✅ Chamber pressures
✅ Valve timing
✅ Volume curves
✅ ECG

1. Phases of Diastole
Diastole is divided into 4 key phases:
1️⃣ Isovolumic relaxation: Aortic valve closes (AC), mitral valve still closed
2️⃣ Rapid early filling: Mitral valve opens (MO), LV fills passively → E wave on Doppler
3️⃣ Diastasis: Equalized pressures, minimal flow
4️⃣ Atrial contraction: LA contracts, contributes final LV filling → A wave on Doppler

2. Doppler Findings
Using A4C view:
◽E wave = early passive filling
◽A wave = active filling from atrial contraction

E/A ratio helps assess diastolic function and compliance

3. Valve Motion Correlation

🔸MC (Mitral Closure) ends diastole → starts systole
🔸MO (Mitral Opening) begins early diastolic filling

Aortic events:
🔹AO (Aortic Opening) marks start of ejection
🔹AC (Aortic Closure) begins isovolumic relaxation

4. Volume Changes

◾End-Systolic Volume (ESV): lowest LV volume post-ejection

◾End-Diastolic Volume (EDV): peak volume before systole

◾Diastolic filling refills LV from ESV to EDV

5. Mitral Valve Leaflet Behavior (M-mode)

◽Anterior & posterior mitral leaflets (AML/PML) flutter during diastole

◽“E” and “A” waves seen on M-mode match Doppler filling patterns

6. Left Atrium Role
LA acts as reservoir (during systole), conduit (during early diastole), and pump (during atrial contraction)
👉LA size and pressure reflect chronic diastolic dysfunction

16/09/2025

How I treat anemia in heart failure...

https://www.sciencedirect.com/science/article/pii/S0006497120617943

15/09/2025

13/09/2025

Pattern recognition.

Wide complex tachycardia.👇🏼

12/09/2025

Think you can spot all the artifacts in this video? 👀

10/09/2025

Severe tricuspid regurgitation (TR) can cause systolic flow reversal in the hepatic veins, which is detected via pulsed-wave Doppler during an echocardiogram. This flow reversal indicates that blood is flowing backward into the hepatic veins from the heart due to the leaking tricuspid valve and elevated right atrial pressure.

09/09/2025

Fruits and Type 2 Diabetes: What is safe and Healthy?

▶️Many people with type 2 diabetes are unsure about eating fruits. They worry about natural sugars, but the truth is: fruits, eaten whole and in moderation, are not only safe but beneficial, especially when blood sugars are well controlled and body weight is healthy.

✅Healthiest fruit choices
Low to medium glycemic index (GI) fruits are best:
1. Apples, pears
2. Oranges, sweet lime, guava
3. Berries (strawberry, blueberry, blackberry)
4. Papaya, peach, plum
5. Watermelon and muskmelon (in modest amounts)
6. Pomegranate, kiwi
🟠Banana, mango, grapes, chikoo- can also be eaten, but in small portions and not daily, as they raise sugars more quickly.

▶️How much fruit is ideal per day?
✅Generally, 2 servings of whole fruit daily (one serving = a medium apple/pear/orange, or ½ cup of cut fruit) is safe for most people with diabetes.
▶️Spread out the fruit intake across meals or snacks (not all at once) to avoid sugar spikes.
▶️Always pair fruit with other food (nuts, yoghurt, or after a meal) rather than eating on an empty stomach.

What about fruit juices?
1. Fresh or packed fruit juices are not recommended for people with diabetes.
2. Even fresh juice removes fiber, leading to faster sugar absorption and sharp spikes in blood glucose.
3. Packed juices are even worse; they often contain added sugar or concentrates.
4. Whole fruit with its natural fiber is always healthier than juice.

Key take-home points
1. Fruits are part of a healthy diet even with diabetes. Whole fruits, not juices, are the rule.
2. Choose low-GI fruits, limit high-sugar fruits, and aim for 2 servings daily.
3. Portion control and timing matter as much as the type of fruit.

30/07/2025

trtworld Doctors at a hospital in Russia's Kamchatka continued performing surgery even while the building was shaking from a powerful 8.8-magnitude earthquake that struck the region on July 30.

01/07/2025

Like the deep mystery of the sea Like a silent dream,

16/06/2025

Understanding Chest Leads in ECG Interpretation:

ECG chest (precordial) leads show how electrical depolarization spreads across the heart. Here's a breakdown:

1️⃣ Normal R Wave Progression
As you move from V1 → V6, R waves gradually increase in amplitude. This reflects normal ventricular depolarization moving toward the left ventricle.

2️⃣ QRS Transition Zone
This is the point where the QRS complex switches from mostly negative to mostly positive, typically around V3 or V4.

3️⃣ Abnormal Patterns to Know
🔵 Poor R wave progression: Often suggests an old anterior myocardial infarction (scar tissue blocks normal conduction).
🔵 Reverse R wave progression: R wave height decreases across leads, often due to right ventricular hypertrophy (RVH).

4️⃣ QRS Transition Zone Shifts
🔴 Shift to the right (earlier, V1–V2): Can indicate LV myocardial infarction (loss of viable myocardium) or RV hypertrophy (thicker muscle on the right side changes vector orientation).

📚 Based on figures from Osmosis.org