Lead impedance change threshold and cause

Low lead impedance 

< 200 ohms

Indicate insulation breach

Usually inner insulation in a bipolar coaxial lead

High lead impedance 

> 2000 ohms

Indicate open circuit

Lead fracture or loose set screw

Threshold for surgical repair of thoracic aortic aneurysm in patients with Marfan syndrome mnemonic

What is the threshold for surgical repair of thoracic aortic aneurysm in patients with Marfan syndrome? 

5 cm

Marfan, MarFIVE

The threshold for surgical repair in patients with Marfan syndrome is an external diameter of 5 cm. Factors that will prompt repair at a diameter <5 cm include rapid growth of >0.5 cm in 1 year, family history of aortic dissection at a diameter <5 cm, or the presence of significant aortic regurgitation.

Cardiology board prep study groups

Creating echo boards prep Whatsapp group and general cardiology boards prep Whatsapp group. Please email medicowesome@gmail.com for details :)

Transposition of the Great Arteries: D-TGA & L-TGA (congenitally corrected TGA) mnemonic

Here's a mnemonic I made:

D the arteries. 

And L flipped 45 degrees counter clock wise looks like a V for ventricles so ventricles are transpositioned. Ventricles also have C that reminds me it's congenitally corrected. 

That's all! 

Read more: Transpositioned of great arteries by Medha

-IkaN (Nakeya Dewaswala) 

Hysteresis

In single chamber devices, for ventricular pacing, hysteresis allows a longer cycle length after a sensed event than after a paced beat. 

It helps maintain intrinsic rhythm and preserves battery. 

In summary: Hysteresis is a programmable feature that allows the pacemaker to begin ventricular pacing only if the spontaneous rate falls below a set rate (eg, 50 bpm); then pacing continues at the programmed base rate (60 bpm) unless intrinsic ventricular activity is sensed.

Soluble Guanylate Cyclase Stimulators notes and mnemonic

Low voltage criteria on ECG mnemonic

Entire amplitude of the QRS (R + S wave) must be < 5mm in all limb leads or < 10mm in all precordial leads. How do I remember this? Mnemonic!​

- IkaN (Nakeya Dewaswala)

Quantification of severe mitral regurgitation (MR) mnemonic

Quantification of severe chronic mitral regurgitation mnemonic. 

Courtesy Dr. Mikel Smith

-IkaN (Nakeya Dewaswala Bhopalwala) 

Mitral stenosis gradient and heart rate

Why is the pressure gradient in mitral stenosis heart rate dependent? Why is the pressure gradient in aortic stenosis heart rate dependent?

Clinical pearl: Retroperitoneal hematoma

 Hello

Vascular access during cardiac catheterization (in cases of myocardial infarction, for example) obtained through femoral artery above the level of inguinal ligament may lead to retroperitoneal hematoma due to arterial puncture.

Acute rheumatic fever and RHD - diagnostic criteria

Hello

Diagnosis of ARF and RHD based on modified Jones' criteria - let's review:

Introducing Cardiowesome

Hi everyone, 

As you already know I have started my Cardiology Fellowship this year. I'm going to post a lot of blogs on cardiovascular diseases that might of not be palatable for medical students. Only some of these posts maybe helpful (pharmacology related, EKG ones, and basic pathophysiology of cardiovascular diseases). 

I understand that the majority of my posts will be limited to a specialized group of cardiologists, echocardiographers, emergency medicine physicians, critical care professionals, POCUS users, electrophysiologists, heart failure specialists, and interventional cardiologists.

This is why, I'm introducing a new label on the medicowesome blog called cardiowesome. These are advanced posts targeted for cardiology fellows and trainees.

I hope you enjoy reading them and learning with me. 

-IkaN (Nakeya Dewaswala Bhopalwala) 

S' Tissue Doppler Imaging - Derived Tricuspid Lateral Annular Systolic Velocity mnemonic

S’ Wave: Tissue doppler imaging-Derived Tricuspid Lateral Annular Systolic Velocity

S’ value less than 9.5 cm/sec indicating RV dysfunction. Mnemonic... If you stare at the number long enough you'll see 9.5 in it lol. 

The first peak above baseline that is timed with the QRS represents isovolumetric contraction and not the tricuspid annular velocity.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Relative wall thickness 0.42 mnemonic

The RWT reports the relationship between the wall thickness and cavity size. It is an index of LV concentricity. 

The golden number to remember for RWT is 0.42 as it allows further classification of LV mass increase as either concentric hypertrophy (RWT >0.42) or eccentric hypertrophy (RWT ≤0.42). 

Since there are so many numbers to remember in echocardiography, I made a mnemonic for RWT. 

Relative = 0 (Relative zero)

Wall = 4 (4 letters in the word wall)

Thickness = 2 (2 strokes in the letter T) 

Hope this helps! 

-IkaN (Nakeya Dewaswala Bhopalwala) 

Rheumatic chorea - variable clinical presentation timelines

 Hello

Variations in clinical presentation of rheumatic/ sydenham's chorea -

Relative wall thickness on echocardiography

Relative wall thickness (RWT) is calculated as two times posterior wall thickness (PWT) divided by the left ventricular internal diastolic diameter (LVIDd). 

RWT allows further classification of LV mass increase as either concentric hypertrophy (RWT >0.42) or eccentric hypertrophy (RWT ≤0.42).

-IkaN (Nakeya Dewaswala Bhopalwala) 

Infective endocarditis vegetations - which side do they develop?

Infective endocarditis vegetations tend to develop on the upstream side of the valve (flow side) which is typically tend to be the lower pressure side. These are the ventricular side of the aortic valve and the atrial side of the mitral or tricuspid valve. 

Image shows parasternal long axis view on echocardiography showing vegetations on the mitral and aortic valve (green vegetations because vegetables are green lol!)

-IkaN 

Mitral valve anatomy and types of mitral regurgitation mnemonic

Mnemonic:

Prolapse tip points towards LV

Flail tip flips away from LV

Secondary stay away from each other (dilation) 

Metoprolol tartrate vs succinate dosing mnemonic

Metoprolol tartrate is short acting. 

Metoprolol succinate is long acting. 

Mnemonic succinate single dose, tartrate two doses.

-IkaN (Nakeya Dewaswala Bhopalwala) 

EKG quiz #1

What does this EKG show? 

Answer will be posted soon.

-IkaN