…pivotal in diagnosing and managing congenital or acquired cardiac shunts, such as atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA)…

…of the great arteries, pulmonary valve stenosis, atrial septal defect, ventricular septal defect), tricuspid valve regurgitation are the most common causes. ECG changes in right…

…anterior , lateral and septal wall ( Figure 2 below). An inferior myocardial infarction refers to an infarction located in the inferior wall of the left ventricle…

Conduction defects ECG Right bundle branch block (RBBB) Right bundle branch block (RBBB) is due to an anatomical or functional dysfunction in the right bundle…

…the right atrium. It normally consists of three leaflets (anterior, posterior and septal leaflet). The leaflets are attached to the subvalvular apparatus, consisting of the…

…through the heart and vessels. The velocity of erythrocytes ( i.e blood) can be used to estimate pressure gradients (pressure differences) between the atria, ventricles…

…Agent Standard dose in atrial fibrillation Criteria for dose reduction according to FASS : : : Apixaban 5 mg × 2 2.5 mg × 2 if at least two…

Arrhythmias and arrhythmology Critical care Definition and pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and…

…and travels in a counterclockwise direction. The activation wavefront propagates in a craniocaudal direction down the right atrial free wall, traverses the cavotricuspid isthmus (CTI…

…atrial enlargement predisposes to atrial fibrillation/flutter and ventricular enlargement predisposes to ventricular tachycardia. The ECG is a useful tool for detecting hypertrophy/dilatation but…

…prevalence figures are scarce). Indeed, the strongest risk factor for developing atrial fibrillation is age. Other significant risk factors are as follows: male sex, hypertension…

…on the ECG. The flutter waves (on the contrary to f waves in atrial fibrillation) have identical morphology (in each ECG lead). Flutter waves are…

…evolved significantly; it is no longer viewed merely as an electrical anomaly but as a progressive, complex atrial myopathy. For the practicing cardiologist, mastering the…

…may precede the full tachycardia. It is characterized by short, rapid bursts of atrial activity. In the majority of cases, the arrhythmia is self limiting…

…Atrial enlargement/abnormality often accompanies ventricular enlargement. The ECG has, as one could expect, low sensitivity but high specificity with respect to detecting atrial enlargement…

…The P wave of a premature atrial contraction has the following characteristics ( Figure 1 ): A premature P wave occurs earlier than the sinus P wave…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and pathophysiology Atrial fibrillation (AF) is a major independent risk factor for thromboembolism, including ischaemic stroke. This risk applies…

…of bleeding Low risk 0 3 0.8% Intermediate risk 4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score…

…m2 22 ± 6 29–33 34–39 40 22 ± 6 29–33 34–39 40 ​BSA, Body surface area; LA, left atrial; RA, right atrial.

…Note that 10% of wide complex tachycardias actually originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g…

CPR ECG 1 . The initial rhythm is atrial fibrillation. The fifth beat is a ventricular premature beat. A ventricular tachycardia (VT) emerges. As evident, ventricular…

CPR ECG 1 . The underlying rhythm is atrial fibrillation, which is interrupted by polymorphic ventricular tachycardia (VT). ECG 2 . Polymorphic ventricular tachycardia. ECG 3 . Spontaneous…

…atrial fibrillation. Three QRS T complexes are seen, with the latter two having similar QRS morphology. These beats may originate from the ventricles or atria…

…Set the filter: a frequency range of about 15–40 Hz , and adjust the gain so that the atrial deflections are clear without clipping. 4…

…HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy…

…conversion to sinus rhythm occurs) unless contraindications occur. If hemodynamically stable atrial flutter occurs after the first dose, the second dose can still be given…

…Left ventricular aneurysm without thrombus Prolapse of mitral valve Aortic stenosis with calcification Mitral disease with calcification Fibrin strands Giant Lambls excrescences Septum Defects — PFO…

…ECG changes: arrhythmias, conduction defects and waveform changes Digoxin may be used in patients with heart failure, atrial fibrillation, atrial flutter, and in selected cases…

Echocardiography Left ventricular function and its echocardiographic assessment Cardiac function depends on a large number of parameters, including atrial function, valvular function, and ventricular function…

Arrhythmias and arrhythmology ECG Pacemaker mediated tachycardia (PMT) Pacemaker mediated tachycardia may arise if the pacemaker records a rapid atrial rate (e.g. during a…

…Doses in atrial fibrillation Drug Standard dose Reduced dose and criterion : : : Apixaban 5 mg twice daily 2.5 mg twice daily if at least two…

…As of 2025, it is recommended to use the CHA₂DS₂ VA score for stroke risk assessment in atrial fibrillation patients. By excluding the sex parameter…

…widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants…

…or < 20% of atrial size 4 10 cm² or 20 40% of atrial size 10 cm² or 40% of atrial size Jet orientation central…

…to acetylcholine. The resulting increase in K+ conductance shortens the atrial action potential duration (APD), hyperpolarizes the membrane potential, and decreases atrial contractility. Analogous electrophysiological…

…a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling…

…systolic dysfunction. Levels may also rise with: Left ventricular diastolic dysfunction Valvular heart disease Pulmonary hypertension Ischaemic heart disease Atrial arrhythmias Pericardial disease, including constriction…

…atherosclerosis, heart failure (HF), atrial fibrillation and cardiovascular events. In clinical practice, obesity is conventionally defined by a body mass index (BMI) of ≥30 kg…

…myocardial infarction, stroke, heart failure (HF), atrial fibrillation (AF), aortic disease, and peripheral artery disease (PAD). Diabetes also substantially increases the risk of chronic kidney…

…for evaluating left ventricular diastolic function have evolved considerably in the past two decades. Currently recommended methods evaluate left atrial and left ventricular function, geometry…

…than stenotic arteries, which are already dilated. This results in flow heterogeneity and perfusion defects in areas supplied by the disease artery. Thus, vasodilators replicate…

…node and bundle of His are normally the only communication between the atria and the ventricles. The atrial impulse must pass through the atrioventricular node…

Conduction defects ECG Second degree AV block: ECG criteria, clinical characteristics & management In this chapter, the focus will be on second degree atrioventricular (AV) block…

…surface). This is because the electrical potentials generated by the sinoatrial node are much too small to be detected on the surface ECG. Intracardiac electrodes…

Conduction defects ECG Third degree (complete) AV block: ECG criteria, clinical characteristics and management This chapter discusses third degree AV block, which is synonymous with…

…the investigation will be usable. Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended before treatment is started . Suspected white coat hypertension…

…posterior wall) ≤ 0.9 cm ≤ 1.0 cm Left atrial volume index ≤ 34 mL/m² ≤ 34 mL/m² TAPSE 17 mm 17 mm E/e…

…that any arrhythmia arising in the atria may have wide QRS complexes if the ventricles cannot be depolarised normally (example: sinus tachycardia together with left…

…2.5 mm tall Right atrial enlargement P wave in V1 Terminal negative component 1 mm × 40 ms Left atrial enlargement Low voltage QRS <…

…when the shock is delivered, and that the thromboembolic risk has been dealt with before the atria begin to contract again. An unsynchronised shock that…

…event, where DOACs have proved inferior. Atrial fibrillation with marked renal failure or on dialysis, where DOACs lack documentation or have only weak evidence. Venous…

…total cholesterol and triglycerides) Atrial fibrillation BMI categories The World Health Organization defines BMI categories as follows: Underweight : Less than 18.5 Normal weight : 18…

…Adverse effects Headache. Nausea. Fever. Atrial fibrillation. Worsening of heart failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia…

…risk. Left Atrial Diameter (LA) : Enlargement of the left atrium is a marker of elevated left ventricular filling pressures and is linked to adverse outcomes…

…myocardial infarction may coexist with adverse effects on stroke, heart failure, cardiovascular mortality and atrial fibrillation. Consequently, alcohol should not be initiated as a cardiovascular…

…Atrial arrhythmias, particularly atrial fibrillation and flutter, are common and may precipitate heart failure [8, 10]. Refractory atrial arrhythmias resistant to antiarrhythmic drugs or repeated…

…cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms linking…

…pathways. The source material also describes possible antiarrhythmic effects, associated with reductions in sudden cardiac death and atrial fibrillation. Dietary quality also affects energy balance…

…BNP ≥35 pg/mL or NT proBNP ≥125 pg/mL supports the diagnosis Structural or functional cardiac abnormality Evidence such as increased left atrial size…

…41–49%. In this group, structural abnormalities such as left atrial enlargement or left ventricular hypertrophy, or echocardiographic evidence of impaired filling, make the diagnosis…