…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)…

…the fact that the Purkinje fibers run through the endocardium. It is likely that conduction defects would have been more common in myocardial ischemia otherwise.

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…

…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…

…Ebstein's anomaly is characterized by the following malformations: The septal and posterior leaflets of the tricuspid valve adhere to the ventricular myocardium (failure of…

…gradients using Doppler measurements Continuous wave Doppler and pulsed wave Doppler can measure the velocity of erythrocytes as they travel through the heart and vessels…

…of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary…

…transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure…

…population. AF can act as a trigger for atrial flutter, and the development of AF is common following the successful ablation of typical flutter. Furthermore…

…however, reach 0.12 s (such significant prolongation is due to intraventricular conduction defects). Hypertrophy may also shift the electrical axis (to the right in…

…syndrome) being the most common. Atrial fibrillation with onset during hyperthyroidism (thyrotoxicosis), alcohol overdose, thoracic surgery, acute myocardial infarction, pericarditis/myocarditis or pulmonary embolism is…

…of atrial fibrillation. Acute and paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial…

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

…atrial activity. In the majority of cases, the arrhythmia is self limiting; however, it may recur and, in some instances, persist for extended durations. As…

…ventricle. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P wave. The…

…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…

…Thrombus formation is most commonly related to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also…

…Go AS, Chang Y, et al. A new risk scheme to predict warfarin associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study…

…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.

…in lead II. Common findings Sinus rhythm (which is the normal rhythm) has the following characteristics: (1) heart rate 50–100 beats per minute; (2…

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

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…

…morphology. These beats may originate from the ventricles or atria. ECG 2. The initial part shows QRS complexes with similar morphology as ECG 1, likely…

…atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and…

…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…

…hours prior to, as well as in the first 4 hours after, vernakalant administration. Acute coronary syndrome (including myocardial infarction) within the last 30 days.

…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…

…atrial function, valvular function, and ventricular function. A large body of science has demonstrated that these parameters are highly interdependent and rather complex. Indeed, myocardial…

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…

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

…oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such as HEMORR2HAGES, ATRIA, ORBIT, and GARFIELD…

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

…adenosine produces a transient, rate dependent prolongation of the A H interval, frequently manifesting as transient first , second , or third degree AV nodal block lasting…

…and other iatrogenic cardiovascular procedures Acute aortic disease, particularly ascending or type A aortic dissection Myocardial free wall rupture after infarction Anticoagulant associated bleeding Renal…

…circulating markers of myocardial wall stress. They are released principally by ventricular cardiomyocytes in response to increased transmural stress and ventricular stretch. Atrial natriuretic peptide…

…diabetes mellitus Atherosclerotic cardiovascular events HF and atrial fibrillation Obesity therefore acts both as an independent cardiovascular risk factor and as a driver of hypertension…

…include atherosclerotic cardiovascular disease (ASCVD), coronary artery disease (CAD), myocardial infarction, stroke, heart failure (HF), atrial fibrillation (AF), aortic disease, and peripheral artery disease (PAD…

…is reduced, or if left atrial pressure is increased. Figure 2. Deceleration time (DT). Diastasis The phase following the E wave is the diastasis , during…

…Atrial fibrillation or atrial flutter Patients on medications such as nitrates, beta blockers, or calcium channel blockers Recent acute myocardial infarction (AMI) Pharmacologic agents in…

…Can you spot them? Note that negative delta waves may simulate pathological Q waves (and thus be confused with previous myocardial infarction). ECG examples of…

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…

…Causes of sinoatrial (SA) block The following conditions cause sinoatrial block: Sinus node dysfunction (SND) Perimyocarditis Acute myocardial infarction (or ischemia) Drug side effects (procainamide…

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…

Procedurer Two recordings that are performed in primary care but interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the…

…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…

…emphysema, amyloidosis ST elevation criteria in suspected infarction New ST elevation at the J point in two contiguous leads: Leads Threshold : : V2–V3, men ≥ 40…

…myocardial ischaemia or a falling level of consciousness. Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid ventricular rate…

…the weekly dose is adjusted in small steps, that every new prescription is assessed as a potential interaction, and that there is a ready made…

…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…

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

…the following variables: Maximum Left Ventricular Wall Thickness (MaxLVWT) : Hypertrophy is a hallmark of HCM and is associated with increased arrhythmic risk. Left Atrial Diameter…

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

…worldwide [15]. Clinical Presentation and Course Both AL and ATTR CA typically present as heart failure with preserved ejection fraction (HFpEF), and a multitude of…

…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…

…dietary interventions than with low fat control diets. In one trial of patients with previous myocardial infarction, the Mediterranean intervention involved greater consumption of fruits…

…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…