U Waves

The U wave is a smaller structure after the T wave that resembles a second T wave, kind of like Baby Mario, M&M’s Minis or Pichu. It’s best seen in V2 and V3.

Prominent U waves are most commonly found in:

  • Bradycardia
  • Hypokalaemia

Inverted U waves are abnormal and point to cardiac disease.

References

  1. Burns, E. (2019). U Wave. [online] Life in the Fast Lane. Available at: https://litfl.com/u-wave-ecg-library/ [Accessed 29 Jan. 2020].

Pulsus Paradoxus

It’s normal for blood pressure to drop when breathing in.

When you breathe in, the negative intrathoracic pressure increases. That basically means the extra force of all the air you’re leeching from the atmosphere pushes on the insides of the body, squishing the important bits of the cardiovascular system. So, the blood flow gushing out to the rest of the body is reduced a bit, referring to the cardiac output emitting from the left side of the heart. Note that venous return to the right side of the heart increases with inspiration.

A drop in SBP<10 is normal during inspiration. When it’s greater than this, it’s pulsus paradoxus. That can happen in things like:

  • croup
    • inflammatory reaction to parainfluenza virus
    • results in airway obstruction, mainly in children because they have smaller airways
    • airway obstruction means even bigger negative intrathoracic pressures
    • this increases left ventricular afterload, which is the force the heart has to push blood against
  • cardiac tamponade
    • heart is compressed
    • leads to reduced cardiac output

References

  1. Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul, Pulsus paradoxus
  2. Van Dam MN, Fitzgerald BM. Pulsus Paradoxus. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482292/

The Sad Evils Of Smoked Salmon

Smoked seafood has, unfortunately, been cast into the same category as preserved meats. These traitors have been linked with an increased risk of malignancy. Shun them all!

On the plus side, chicken is still in season(ing). As long as you’re not a greedy pig about it. Moderation, which basically means not over-gorging, is the key to success. That is, health.

References

  1. Egan, S. (2019). Do Lox and Other Smoked Fish Increase Cancer Risk?. Retrieved 29 August 2019, from https://www.nytimes.com/2019/07/26/well/eat/does-lox-and-other-smoked-fish-increase-cancer-risk.html
  2. Meat, Poultry, and Fish: Picking Healthy Proteins. (2017). Retrieved 29 August 2019, from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/meat-poultry-and-fish-picking-healthy-proteins

Cardiac Valves

Which side of the heart does each atrioventricular valve correspond to? Memory aids enlighten us all!

Atrioventricular Valves

  • Tricuspid is in the right heart
  • Mitral is in the left heart

What about the semilunar valves? They must not be forgotten! And so they shan’t be!

Semilunar Valves

  • Pulmonary goes to the lungs and is on the right
  • Aortical goes to the rest of the body and is on the left

Hypokalaemia ECG Changes

There are three major ones, plus more!

  1. ST depression
  2. Flattened T waves
  3. Abnormally prominent U waves

The way to remember this is that, in line with the subpar nature of hypokalaemia, everything is weak and low!

ST depression is a depression, so it is low.

The T waves have low amplitude, so they too are low.

The dip of the letter U, as in U waves, looks like the minimum point of a parabola, so it’s also low.

Conveniently, it all follows an alphabetical pattern: ST, T, U.

References

  1. ECG Learning Center. (n.d.). 12. Nice Seeing “U” Again. [online] Available at: https://ecg.utah.edu/lesson/12 [Accessed 4 Jul. 2018].
  2. Burns, E. (n.d.). Hypokalaemia. [online] LITFL. Available at: https://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/ [Accessed 4 Jul. 2018].

Podcast 015: Cardiology With Dr Chris Semsarian

Without the heart, there is no mindless muscle bag to pump blood all around the body. That would, unfortunately, lead to death.

Fortunately, cardiology exists to cure, palliate and address issues of this important organ!

In this episode, Professor Chris talks about his work as a specialist cardiologist, why he campaigned for public defibrillators and the crucial contribution of being passionate about your work.

Podcast

About the guest speaker

Dr Chris Semsarian is a cardiologist and professor with a specific research focus in the genetic basis of cardiovascular disease. He trained at the University of Sydney, Royal Prince Alfred Hospital and Harvard Medical School.

Professor Chris was awarded a Member in the General Division of the Order of Australia (AM) on January 26, 2017 for significant service to medicine in the field of cardiology as a clinician, administrator and educator and to the community. He has a large number of other letters behind his name too: MBBS PhD MPH FAHMS FRACP FRCPA FCSANZ FAHA FHRS.

Professor Chris has published over 200 peer-reviewed scientific publications, in the highest-ranking cardiovascular and general medical journals. A focus area of his research is in the investigation and prevention of sudden cardiac death in the young, particularly amongst children and young adults. He has been the primary supervisor of over 30 PhD, honours and medical honours students since 2003 and led major community programs in the area of prevention of sudden death.

Music credits

Opening and closing themes by Lily Chen.

Heart Failure Treatment Acronyms

Medications don’t cure people. Acronyms do.

Well, maybe medications do a little bit.

Maybe.

Anyway, here’s how to remember how to treat acute heart failure in an examination setting.

LMNOP

  • Lasix
  • Morphine
  • Nitrates
  • Oxygen
  • Position

POND

  • Position and positive pressure ventilation
  • Oxygen
  • Nitrates
  • Diuretics

References

  1. SOCMOB Blog. (2017). Evidence Based Management of Acute Heart Failure: Forget LMNOP, think POND! – SOCMOB Blog. [online] Available at: http://socmob.org/2013/04/evidence-based-management-of-acute-heart-failure-forget-lmnop-think-pond/ [Accessed 24 Dec. 2017].
  2. Time of Care. (2017). LMNOP – For Congestion in Acute Decompensated Hear Failure. [online] Available at: https://www.timeofcare.com/lmnop-for-congestion-in-acute-decompensated-hear-failure/ [Accessed 24 Dec. 2017].