Cardiology Learner : ECG, Echo & Clinical

Cardiology Learner : ECG, Echo & Clinical National Institute Of Cardiovscular Disease. Dhaka, Bangladesh.

22/02/2025

Moving clip PLAX
- Echofree zone in IVS
- Large VSD which is non-restrictive, malalinged due anterocephalad deviation of conal septum
-Less than 50% overriding of aorta from RV side
-Aorto-mitral continuty

All those features are very characteristic of Tetralogy oF fallots.

Other supportive echo images also given.

HOCM Hypertropic obstructive cardiomyopathy.
20/02/2025

HOCM
Hypertropic obstructive cardiomyopathy.

Global Longitudinal Strain (GLS) is an echocardiographic parameter that measures the deformation of the left ventricle i...
17/02/2025

Global Longitudinal Strain (GLS) is an echocardiographic parameter that measures the deformation of the left ventricle in the longitudinal direction. It's a more sensitive and earlier indicator of left ventricular systolic dysfunction compared to traditional measures like ejection fraction (EF).

Here are some key points about GLS:

1. Measurement: GLS is derived from speckle tracking echocardiography, which analyzes the movement of speckles (natural acoustic markers) in the myocardium during the cardiac cycle.
2. Clinical Importance: GLS can detect subtle changes in left ventricular function, making it useful for early diagnosis and monitoring of conditions like cardiotoxicity from chemotherapy, hypertension, diabetes, and obesity.
3. Normal Value: In adults, a GLS of less than -16% is considered abnormal, while a GLS of more than -18% is considered normal.
4. Applications: GLS is used in various clinical scenarios, including evaluating patients with hypertrophic cardiomyopathy, amyloidosis, aortic stenosis, and mitral regurgitation.

Graft vessel CAG. LIMA to LAD Radial conduit to RCALAD graft usually taken fron LIMA. RCA Graft usually from RIMA or Non...
05/02/2025

Graft vessel CAG.

LIMA to LAD
Radial conduit to RCA

LAD graft usually taken fron LIMA.

RCA Graft usually from RIMA or Nondominant hand Radial artery or SVG.

Side branch of Grafts are occluded by pins.

Radil or SVG graft usually attached to Aorta.

Acute pericarditis. # thing , commonly forgotten.When underlying etiology is there?1. Fever >38 degree.2. Imunocompro...
04/02/2025

Acute pericarditis.

# thing , commonly forgotten.

When underlying etiology is there?
1. Fever >38 degree.
2. Imunocompromised.
3. Non responder to NSAID
4. Related trauma history
5. Use of anticoagulant.

When steroids should be used as furst line drug?
1. CTD- SLE
2. Anticoagulant users
3. TB effusion

# of auscultation

# Finding

Conventional therapy.

Ref- Hursts Cardiology Learner : ECG, Echo & Clinical Text boo..

. Uncommon but recommended fact-1. Genetic factor can aggravate or delay development of ES. (Hyper reactor / Hypo react...
03/02/2025

.

Uncommon but recommended fact-

1. Genetic factor can aggravate or delay development of ES. (Hyper reactor / Hypo reactor)

2. Lung biopsy - less popular but recommended investigation can be done.

3. NSAID should be avoided in any situation, it will aggravate bleeding.

4. GTN should be avoided even in angina like chest pain.

5. Gene therapy - less practiced, less available but o promising treatment options.

6. Phlebotomy is partially benifcial. Repeated steps can precipitate anaemic HF. So give Fe supplement when IDA.

7. Have to differentiated from IPAH. Primary PAH.

8. Combination of Bosentan & Sildinafil not recommended.

9. Riociguat is teratogenic.

10. Combination of Bosentan & Tadalafil from fisrt is benificial.

Degenerative severe aortic stenosis.
02/02/2025

Degenerative severe aortic stenosis.

Transposition of Great Arteries (TGA)
29/12/2024

Transposition of Great Arteries (TGA)

60-Year Old male patient, Diagnosed case of RHD, Severe MS, Mild MR, Severe AS, Mild AR, Severe TR, PASP:70 mm(Hg).1.A4C...
16/11/2024

60-Year Old male patient, Diagnosed case of RHD, Severe MS, Mild MR, Severe AS, Mild AR, Severe TR, PASP:70 mm(Hg).

1.A4CV- LA Dilated contain an irregular shaped thrombus of mixer echogenicity. AML, PML tips are thicked & Calcified. Aortic leaflets are also tickended & calcified.

2. PLAX view- A linear structure seen in LA, which is thrombus. Diastolic doming of AML.

80 year old male. Fever 5 days & cough.Chest tightness for last 30 days. Examination-----Emaciated -Anemic -Pulse 110/ m...
16/10/2024

80 year old male.
Fever 5 days & cough.
Chest tightness for last 30 days.

Examination----
-Emaciated
-Anemic
-Pulse 110/ min
- BP 90/60 mm
- Muffled heart sound
-JVP raised on inspiration.
- So Becks triad was there.

ECG
Chest Xray
Echo -2D, M-mode & PWD images are given here. Before & after pericardiocentesis.

Cardiac temponade- Medical emergency of low cardiac output due to impaired ventricular filling from raised intrapericardial pressure.

Avoid Diuretics & Vasodilator in such patient. Give I.V Fluid & Ionotrops (If required) during pericardiocentesis.

After pericardiocentesis look at JVP. It is expected to found JVP has fallen. But if JVP still raised probably it is effusive-constrictive pericarditis. Now - search for constrictive features on Echo ( Septal bounce, Ventricular interdependence, Anulus reversus, Expiratory hepatic venous diastolic flow reversal).

20-25% patient of Cardiac temponade will develop constrictive pericarditis. So 1 month (NSAID & COLCHICINE) can be used adjunct to pericardiocentesis.

Common cause of Cardiac temponade-
Tuberculosis
Neoplastic
CTD
Idiopathic rarely.

When pericardial temponade is there, There must be underlying aetiology. Viral or idiopathic PE rarely exceed 10mm in diastolic M-mode measurement.

This patient has hemorrhagic effusion.

So does recent RTI causes Pericardial effusion? or any underlying neoplastic condition leads to develop RTI due to immunesuppression?

What was paradox in this patient?

Precordial/Cardiac Palpation- # Locate apex with Finger, place parallal to intercostal space , if don't found then roll ...
09/10/2024

Precordial/Cardiac Palpation-

# Locate apex with Finger, place parallal to intercostal space , if don't found then roll the patient left lateral & try to research!

# Examine thril in apex & both side of sternum with base of your finger.

# Examine Left parasternal heave with heel of your hand.

# LVH- Commonly occur in HTN, AS. Apex is heaving without dislacement.

# RV heave commonly found in Pulmonary hypertension & RV voloume overload.

# Tapping apex beat found in mitral stenosis, which is palpable first heart sound without apical displacement.

# Double apex impulse found in HCM.

# Most common cause of thrill is AS which is found in right upper sternal border.

# Thrill caused by VAD felt in left & right sternal edges.

# Diastolic thrill is very rare.

36-year-old lady presented with palpitation & SOB on exertion (NYHA-Class 2) for 10 year.Precordial auscultation - Pansy...
10/09/2024

36-year-old lady presented with palpitation & SOB on exertion (NYHA-Class 2) for 10 year.

Precordial auscultation - Pansystolic murmur heard all over the precordium but best heard at left lower sternal area.

Echocardiography Image-
1. PLAX
2. PSAX Color flow interrogation
3.Left to right shunt-PG 179
3.Qp/Qs 2.5
5.MPAP- 26 mm(Hg)

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