…could enhance the score's predictive accuracy. The SYNTAX Score remains a cornerstone in the management of complex CAD, providing a structured approach to revascularization…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…particularly in complex multivessel or left main disease. Clinical presentation and symptoms The clinical presentation of multivessel CAD varies from stable angina or exertional limitation…

…dedicated multidisciplinary Shock Team. Evaluation and physical examination Assessment should establish: The ACS presentation and its urgency. The presence or absence of haemodynamic instability or…

…7 ). The explanation for this is as follows: The vector resulting from activation of the right ventricle does not come to expression , because it is…

ECG Video lecture: The QRS complex: Q wave, R wave & S wave

…The QRS complex appears if the atrial impulse is conducted to the ventricles. Because the impulse enters the ventricles through the bundle of His (which…

…the ventricles it will spread partly or entirely outside of the conduction system and thus produce a wide QRS complex (QRS duration ≥0.12 s)…

Arrhythmias and arrhythmology ECG Diagnosis and management of narrow and wide complex tachycardia All clinically significant supraventricular and ventricular tachyarrhythmias have been reviewed in previous…

…left ventricle is many times larger than the vector generated by the right ventricle, the QRS complex is actually a reflection of left ventricular depolarization…

ECG Troponin is a protein complex expressed in cardiac and skeletal muscle. The complex consists of troponin I (TnI) , troponin C (TnC) and troponin T…

…bundles of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy (NICM), hypertrophic cardiomyopathy (HCM), and arrhythmogenic right…

…Consequently, current guidelines recommend a 3 generation family history and consideration of genetic testing for all patients with non ischemic HFrEF. Toxic and infiltrative causes…

…progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental pathophysiological substrate for acute coronary syndromes (ACS), including…

Arrhythmias and arrhythmology Pharmacology & dosing Pharmacokinetic Considerations Relevant to Dosing Amiodarone exhibits highly variable and complex pharmacokinetics that profoundly influence its dosing strategies. The drug…

…a chronic, relapsing and biologically complex disease characterized by excessive accumulation of adipose tissue. It is an important cause of cardiovascular disease (CVD), cardiovascular risk…

…complex clinical syndrome characterized by the cardinal symptoms and signs of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of…

…SVT) with wide QRS complex. The algorithm entails 5 criteria, which are tested sequentially (Figure 1). Figure 1. Flowchart of Brugada's algorithm for distinguishing…

…injury, accelerates atherosclerosis, increases myocardial oxygen demand, and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of…

…complex as a QR complex. Because the left ventricle is usually considerably larger than the right ventricle, the QRS complex is actually a reflection of…

…it is asked of a patient who is haemodynamically stable enough for there to be time to ask it. Indications Wide complex tachycardia where ventricular…

…complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia…

…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…

…a widened QRS complex and secondary ST T wave abnormalities [7]. Diagnostic Criteria The diagnostic requirements for LBBB vary by the stringency of the criteria…

…for depolarization and repolarization. It is measured from the beginning of the QRS complex to the end of the T wave. Prolonged QT duration predisposes…

…and use of biphasic defibrillators , which are standard due to superior efficacy over monophasic devices. Electrode position (anterior posterior vs. antero lateral) does not affect…

…to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma. Irregular wide complex tachycardia (absolute…

…The contemporary understanding of AF has evolved significantly; it is no longer viewed merely as an electrical anomaly but as a progressive, complex atrial myopathy…

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

…to prolonged QT interval The QT interval is the time interval from the beginning of the QRS complex to the end of the T wave…

…waves with constant morphology preceding every QRS complex. P wave is positive in limb lead II. Normal (physiological) causes of sinus bradycardia Sinus bradycardia (SB…

…220 msec. The PR segment is the flat line between the end of the P wave and the start of the QRS complex. The PR…

…P wave precedes every QRS complex; the PR interval is constant and the P wave is positive in lead II. Causes of bradyarrhythmia: sinus bradycardia…

…Method of interpretation Heart rate Heart rhythm The P wave The PR interval The QRS complex The ST segment The T wave The U wave…

…platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation…

…180°) : Net negative QRS complex in leads I and II. Figure 2. The direction of the QRS complex. Axis deviation: right axis deviation (RAD) and…

…of right axis deviation Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale (COPD, pulmonary hypertension, pulmonary valve stenosis). Lateral…

…positive QRS complex should be followed by a positive T wave, and vice versa ( Figure 17 ). Otherwise there is discordance (opposite directions of QRS and…

…and sudden cardiac death. The relationship between glycaemia and cardiovascular disease is complex. Glycaemic control is important for prevention of microvascular complications, but intensive glucose…

…QRS complex), which has much stronger electrical potentials. Cell types in electrocardiology For the purpose of this discussion it is important to distinguish between two…

…cases of congenital heart disease reach adulthood ( Mandalenakis et al ). The largest leap in survival has been observed among cases with the most complex malformations…

…become worse. Particularly, the degree of AV block may increase. QRS complex QRS duration becomes prolonged. ST segment ST segment depression may develop. T wave…

…QRS complex First degree AV block with normal QRS complex (QRS duration <0.12 s) is localized in the AV node in 90% of the…

…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…

…a multifactorial disease caused by a complex interplay between genes and environment. Industrialization and a Western lifestyle are strongly related to the development of hypertension…

…P wave PR interval QRS complex ST segment T wave U wave QT (QTc) interval Pediatric and neonatal electrocardiograms differ markedly – in terms of rhythm…

…The appearance of the P wave depends on where the atrial lead is fixed. Typically, the atrial lead is fixed next to the right atrial…

…amplitude of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex…

…set to be triggered by the atrial impulse. Another cause of pacemaker mediated tachycardia is endless loop tachycardia, which also depends on the ventricular stimulation…

…QRS complex as an R’ wave (pronounced "R prime"), which is directed anteriorly and rightward. Due to the abnormal depolarization sequence of the right ventricle…

…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…

…as a gradual prolongation of the PR interval with each successive beat until a P wave fails to conduct, resulting in a dropped QRS complex…

…QRS complex. This rhythm is referred to as a junctional rhythm . The His Purkinje network : All these fibers possess automaticity with an intrinsic rate of…

…every QRS complex. The P wave is positive in lead II. Figure 1 (below) shows normal sinus rhythm at a paper speed of 25 mm…

…a complex interaction between the muscle fibers in these layers, which collectively produces a highly efficient pumping mechanism. Figure 1A 2C. The orientation of myocardial…

…concordance between QRS complex and ST T segment. The transition from ST segment to T wave should be smooth. The amplitude of the T wave…

…High aortic pressure and low right atrial pressure favor coronary blood flow. A CPP of approximately ≥ 15 mmHg is required to induce spontaneous electrical activity…

…Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular…

…seconds). The QRS complex is wide simply because the ectopic impulses that cause these rhythms spread partially or entirely outside of the ventricular conduction system…

…rivaroxaban, edoxaban Prothrombin complex concentrate, consider within 15 hours of the last dose. Andexanet alfa where available Low molecular weight heparin Protamine has only a…