Quantification of severe MR 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

Treatment of myocardial infarction associated pericarditis

Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let

s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 

Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).

Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 

Acetominophen can be added for pain management.

Dosing of aspirin:

Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 

Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?

Interferes with the antiplatelet aggregation effects of aspirin. 

Interferes with myocardial healing.

PS: Acetominophen does not affect the coagulation system and can be used.

References:

Post-cardiac injury syndrome: aetiology, diagnosis, and treatment https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

Pericardial Disease https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514

-IkaN (Nakeya Dewaswala)

Read EKGs with me #1

Answer below:

Normal P wave ECG notes and mnemonic

Here is the video:

 

Mnemonic:

Notes:
Sinus P waves
Axis: 0 and +75 degrees
Upright: Leads I, II, V5, V6
Inverted: aVR
Duration: <120ms or 3 small squares
Amplitude:
Limb leads: < 2.5 mm (0.25mV)
Precordial leads: < 1.5 mm (0.15mV)

-IkaN

Determining pacemaker type from EKG (RV pacing vs biventricular pacing)

 Hello, cardiowesomites!

Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)

Notes:

Normal cardiac pressures mnemonic (Normal Swan-Ganz pressures)

LV aneurysm: Difference between true LV aneurysm and LV pseudoaneurysm

LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?

Types of pulmonary hypertension mnemonic

Here are my notes and a video on types of pulmonary hypertension - WHO classification! It comes with a mnemonic :)