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In decompensated heart failure, gut edema can impair warfarin absorption leading to low INR, which may rise after diuresis as intestinal absorption improves. ⬇️ • Congestive hepatopathy → reduced clotting factor synthesis → ↑ INR • Poor oral intake → ↓ vitamin K → ↑ INR • Antibiotics → ↑ INR • Renal dysfunction → altered protein binding #cardiology #pharmacology

1. Mitral opens → Filling (diastole) • LV relaxed • Volume rises from ESV to EDV • Pressure rises slightly (depends on compliance) 2. Mitral closes → Isovolumetric contraction • Both valves closed • Volume constant (at EDV) • Pressure rises fast until LV pressure > aortic diastolic pressure 3. Aortic opens → Ejection • Blood leaves LV • Volume falls from EDV to ESV • Pressure rises then falls (depends on contractility + afterload) 4. Aortic closes → Isovolumetric relaxation • Both valves closed • Volume constant (at ESV) • Pressure falls fast until LV pressure < LA pressure 5. Mitral opens again • Cycle repeats at low pressure, starting filling again #cardiology

In HFrEF, peak VO₂ ≤ 12 mL/kg/min (on β-blockers) supports heart transplant listing. ⬇️ NOT on β-blockers: Peak VO₂ ≤ 14 mL/kg/min → Consider transplant #cardiology #Heart_failure

Sodium nitroprusside decreases blood pressure by increasing cGMP-mediated vasodilation of both arteries and veins, leading to reduced preload/after-load and decreased LV end-diastolic volume. ⬇️ • ↓ Afterload → ↓ regurgitant fraction • ↓ LVEDP → ↓ LA pressure • Improves forward flow ⬇️ • Preload reduction → ↓ pulmonary congestion #cardiology

• ESPVR slope = contractility • Loop width = stroke volume • Right border = EDV • Left border = ESV ⬇️ Preload → EDV Afterload → Aortic pressure / SVR Contractility → ESPVR slope ⬇️ A PV loop describes: ⬇️ Left ventricular pressure changes as volume changes during one cardiac cycle ⬇️ It reflects the interaction between: • Preload • Afterload • Contractility • Ventricular compliance ⬇️ The PV loop is a graphical representation of how preload, afterload, contractility, and compliance determine stroke volume and cardiac performance. #cardiology

Carpal tunnel syndrome is distal median nerve compression at the wrist presenting primarily with nocturnal sensory symptoms, whereas lacertus syndrome is proximal median nerve compression at the elbow presenting predominantly with motor weakness and forearm pain. #neurology

• A pathologic Q wave is ≥40 ms wide or ≥25% of R-wave amplitude in ≥2 contiguous leads. • Q waves represent electrically silent myocardium from transmural infarction. • Normal septal Q waves are small and limited to lateral leads. ⬇️ Pathologic Q waves are wide and/or deep Q waves present in contiguous leads, indicating prior transmural myocardial infarction, whereas small septal Q waves in lateral leads are physiologic. #cardiology #ECG

• M1 marks the onset of ventricular systole. • A2 marks the end of ventricular systole. • The interval between M1 and A2 corresponds to isovolumetric contraction + ejection. • All systolic murmurs occur between M1 and A2. ⬇️ The interval from M1 to A2 represents ventricular systole, encompassing isovolumetric contraction and ventricular ejection, and defines the timing of all systolic cardiac murmurs. #cardiology

A coronary cameral fistula causes continuous runoff of contrast into a cardiac chamber, whereas coronary dissection shows contrast staining within the vessel wall due to an intimal tear with potential luminal compromise. ⬇️ Chamber filling = fistula Wall staining / flap = dissection #cardiology

In elderly patients or CKD: ⬇️ • ↓ GFR → drug accumulation • ↑ β-blockade effect → bradycardia, hypotension, AV block ⬇️ This is a key reason atenolol is risky for CHB in elderly. ⬇️ Water-soluble β-blockers (atenolol, nadolol, sotalol) accumulate in renal failure → bradycardia and AV block. #cardiology #Electrophysiology

• Q-wave MI = transmural infarction • Myocardium is necrotic, friable, non-viable • Free wall rupture typically occurs 3–7 days post-MI • Reperfusion at this stage: • Does not salvage myocardium • Increases intramyocardial hemorrhage • Worsens rupture / tamponade ⬇️ Revascularization offers no benefit and real harm. ⬇️ Clinical priorities in LV free wall rupture ⬇️ Management focus: • Immediate hemodynamic stabilization • Pericardiocentesis (if tamponade) • Avoid anticoagulation / thrombolysis • Urgent surgical repair (patch repair ± cardiopulmonary bypass) ⬇️ PCI delays life-saving surgery and may worsen bleeding. ⬇️ Why Q-wave matters • Q-wave = completed infarction • No myocardium left to rescue • Contrast this with early non-Q-wave MI, where PCI helps ⬇️ Q-wave MI + sudden shock + electromechanical dissociation = think rupture, not re-occlusion ⬇️ In LV free wall rupture following Q-wave MI, revascularization is contraindicated; urgent surgical repair is required. #cardiology #Electrophysiology

RS3PE is an inflammatory syndrome in elderly patients characterized by symmetrical synovitis with pitting edema, seronegativity, and dramatic response to steroids, often linked to VEGF-mediated capillary leak and possible malignancy. ⬇️ Remitting seronegative symmetrical synovitis with pitting edema #Rheumatology

Blood pressure is not a single number. ⬇️ It is a composite physiological signal where each component reflects a different domain: ⬇️ MAP = perfusion, DAP = vascular tone, SAP = afterload, PP = stroke volume ⬇️ Look at BP → Split into components ↓ MAP → perfusion SAP → LV work (afterload) DAP → vascular tone + coronary perfusion PP → stroke volume / compliance ↓ Integrate all together ↓ Identify physiology (shock / valve / sepsis / HF) #cardiology #ICU #physiology

LVEDP ↑ ↓ Resistance to atrial contraction ↑ ↓ Backward flow → Ar ↑ ↓ Delayed pressure equalization → Ar duration ↑ #Cardiology

Atrial flutter = macroreentrant atrial tachycardia, classically seen as sawtooth flutter waves on ECG (best in inferior leads). It’s driven by large circuits, often in the RA, but LA circuits are also common post-surgery or ablation. ⬇️ Types of atrial flutter in the image: ⬇️ A. Typical RA flutter: Circuit loops counterclockwise around the tricuspid annulus, dependent on the cavo-tricuspid isthmus. B. Lower loop reentry: Involves the IVC and crosses the posterior RA, forming an atypical RA flutter. C. Peri-mitral flutter: Circuit around the mitral valve annulus, often involving posterior LA scar. D. LA flutter circuits: Reentry around pulmonary veins and scar tissue, can result from remodeling or prior ablation. E. Post-surgical flutter: Circuits form around atrial scars or patches (e.g., after ASD repair). ⬇️ Accurate mapping is essential for targeted ablation and restoring sinus rhythm. #Cardiology #Electrophysiology

Atrial MR ⬇️ ✔ Large LA ✔ Normal LV size ✔ Normal EF ✔ Dilated annulus ✔ Small tethering angle ✔ Central MR jet ✔ AF frequently present Ventricular MR ⬇️ ✔ Dilated LV ✔ Reduced EF ✔ Increased tenting height ✔ Increased tenting area ✔ Posterior leaflet tethering ✔ Papillary displacement ✔ Often eccentric jet #Cardiology #Echocardiogram

“A new continuous murmur in acute chest pain is a hemodynamic lesion until proven otherwise.” ⬇️ Ruptured sinus of Valsalva aneurysm must be excluded urgently. ⬇️ Sinus of Valsalva aneurysm ↓ Rupture ↓ Aorta → RA/RV shunt ↓ Continuous murmur ↓ Acute HF / shock #Cardiology #CVICU

SESAME (Septal Scoring Along the Midline Endocardium) is a minimally invasive electrosurgical catheter procedure that creates a slice in a thickened heart septum to improve blood flow. ⬇️ It is specifically used as an adjunct to Transcatheter Mitral Valve Replacement (TMVR) to prevent the replacement valve from blocking the heart's main exit pathway (LVOT). #Cardiology #Interventional_cardiology

Pressure Half-Time is: The time required for the transmitral pressure gradient to fall by 50%. Since pressure and velocity are related by the Bernoulli equation: ⬇️ P = 4V^2 ⬇️ A 50% pressure reduction corresponds to velocity decreasing to: ⬇️ 0.707 * Peak Velocity. ⬇️ Pressure Half-Time is excellent for native rheumatic mitral stenosis. #Cardiology #Echocardiogram