…bundle branch blocks are treated sub optimally (in terms of evidence based medications and use of PCI), as compared with individuals without bundle branch blocks…

…fibrosis of the conduction system and acute myocardial infarction (particularly anterior STEMI). Hence, an acute myocardial infarction may actually result in LBBB which then masks…

…against greater resistance and any disturbance in ventricular activation will reduce the efficiency of the pumping function. The primary ECG manifestations of conduction defects are…

…bundle branch blocks and alter their appearance. Some patients develop nonspecific intraventricular conduction defects without any change in their QRS appearance. Such conduction delays may…

…immediately treatable threats without delay: hypoxia, hypoglycaemia, circulatory failure, sepsis, stroke, intracranial haemorrhage, seizure, poisoning and severe withdrawal. 4. Establish whether the condition is new…

…ischemic injury can disrupt the conduction system at any level, producing atrioventricular (AV) or intraventricular blocks. Isolated sinus bradycardia in the early hours following infarction…

…digoxin. Increased Vagus activity diminishes the automaticity in the sinoatrial node (which lowers heart rate) and also slows conduction over the atrioventricular (AV) node. The…

…and short RR intervals have shorter refractory periods. Aberrant conduction occurs when the length of the cardiac cycle is changed without a compensatory change in…

…Proposed explanations in the source material include cardiac memory after abnormal ventricular activation, transient rate related conduction abnormalities, pacing related repolarization changes, and inadequate coronary…

…In either scenario, there is sustained muscle activation, leading to marked heat generation, acidosis, and the subsequent development of hyperkalemia. This condition is potentially fatal…

…pathological condition. Explanation: In the absence of symptoms, heart rates ≥30 beats/min are considered normal in highly trained athletes. Sinus rhythm should resume and…

…one in five strokes. Thrombus formation is most commonly related to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small…

…the elderly also tend to have more atherosclerosis (both in frequency and severity) which may compensate for the inability to reach their maximal heart rate…

…R wave progression Normal R wave progression implies that the R wave amplitude increases gradually from V1 to V5 and then diminishes again in V6…

…individuals at risk in an autosomal dominant family, whereas heterozygous carriers of an X linked condition may develop a phenotype later and require delayed or…

…depression. Sinus tachycardia. Refer to Figure 1 . Figure 1. Electrical alternans in patient with cardiac tamponade. The ECG shows varying QRS and T wave amplitudes.

…ventricle contracts against much greater resistance (i.e. the pressure in the systemic circulation), and therefore it faces the highest workload; for the same reason…

…block Mobitz type I exhibits the Wenckebach phenomenon , which is characterized by a progressive delay in impulse conduction, eventually leading to a blocked atrial impulse…

…Figure 1. The sinoatrial (SA) node and atrioventricular (AV) node are located in the atria and are not part of the ventricular conduction system. The…

…as lower ejection fractions and higher peak biomarker levels, compared to those without such conduction defects [12]. Sudden Cardiac Death (SCD) : In patients with a…

…AV block is rarely of clinical significance and typically does not require intervention. In most cases, the conduction delay is localized to the atrioventricular node…

…be normal or wide. P waves have constant PP interval and ride straight through the strip, without any relation to QRS complexes. P waves may…

…slower conduction results in a prolonged QRS duration. The defining features of LBBB include a QRS duration of ≥0.12 seconds, a deep and broad…

…by both sympathetic and parasympathetic nerve fibers. Sympathetic stimulation enhances impulse conduction through the AV node, a phenomenon known as the bathmotropic effect . In contrast…

…may imitate anteroseptal infarction. rS complexes in leads II, III and aVF may mask Q waves from a prior inferior infarction. Left posterior fascicular block…

…Treatment in the acute setting is directed at managing bradycardia and reduced cardiac output. Bradycardia causing hemodynamic instability is a potentially life threatening condition and…

…constant PR interval. Third degree AV block: all atrial impulses are blocked in the AV conduction system and therefore cannot activate the ventricles. An escape…

…Without a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition…

…in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and…

…workload is heavy, or as a substitute for mobilisation and bladder training. Contraindications Type Condition : : Absolute Suspected urethral injury — blood at the meatus, a perineal…

…in the thorax, the atrial situs viscerum, the vein atrial and the atrio ventricular connections, the relationship between the ventricles, the ventriculo arterial connection and…

…Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in hypertensive emergencies. Time to onset…

…cardiac deaths in patients without structural heart disease and is the leading cause of SCD in men under the age of 40 in endemic regions…

…induced cardiac arrest Sepsis is a life threatening condition characterized by systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), and hypoperfusion manifesting as hypotension…

…Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in hypertensive emergencies. Time to onset…

…condition that may be caused by rheumatic valvular disease, congenital heart disease, Whipple’s disease, or tumors. Rheumatic disease is the most common cause, in…

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…Relative: Condition Comment : : Left main stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without…

…and risks (e.g., device related complications). Monitoring disease progression By periodically recalculating the SCD risk, clinicians can monitor changes in a patient's condition…

…as well as possibly ventilation and automatic external defibrillator (AED). Return of Spontaneous Circulation (ROSC) : Return of mechanical cardiac function resulting in circulation with pulse…

…should be maintained, particularly in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular conduction defect. In severe cases, bradycardia may…

…or cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked…

…immediately and aim for administration within one hour in septic shock, or when sepsis is judged certain or highly likely. With possible sepsis without shock…

…of symptoms, with or without physical signs, and an LVEF below 40%. Signs may be absent in early disease or after effective treatment. HFrEF is…

…Conduction disease and the need for pacemaker therapy may be more frequent in T2DM, although management follows the same principles as in patients without diabetes…

…exhibit ST segment elevations, but the condition should be managed as STEMI (ST Elevation Myocardial Infarction) in terms of treatment and interventions. As discussed previously…

…syndrome (DI LQTS) [1]. The condition arises in the setting of both modifiable and nonmodifiable risk factors. Modifiable risk factors include electrolyte abnormalities such as…

…Venous thromboembolism is a chronic and serious condition. Mortality in pulmonary embolism is up to 20%, and roughly 30% of patients with pulmonary embolism or…

…aggravating the condition. Perimyocarditis (myocarditis) in acute phase – due to risk of arrhythmias Severe aortic stenosis – due to risk of syncope, ischemia, and arrhythmias Endocarditis…

…principle, not a universal target. Chronic hypertension shifts autoregulation in the brain and kidneys towards higher pressures. Too rapid a normalisation can therefore cause cerebral…

…not an alternative to it. See the separate guide to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The…

…This condition is primarily attributed to specific genetic mutations: loss of function mutations in KCNQ1 (LQT1) and KCNH2 (LQT2), and gain of function mutations in…

…This condition is primarily attributed to specific genetic mutations: loss of function mutations in KCNQ1 (LQT1) and KCNH2 (LQT2), and gain of function mutations in…

…condition may occur especially in young women. Non coronary mechanisms that reduce oxygen supply include severe bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and…

…parameters. Diameter of the regurgitant jet The diameter of the regurgitant jet is measured in PLAX, and then compared with the diameter of the LVOT…

…Natural course and prognosis in aortic stenosis Aortic stenosis is generally asymptomatic until the valve area is <1 cm². This condition causes hemodynamic changes that…

…of overall and cardiovascular mortality. The condition is very common among individuals with heart failure. Notably, beta blockers actually increase chronotropic competency in patients with…

…is important to detect the disease early in the course. Hemodynamic effects of constrictive pericarditis Diastolic heart failure and right heart failure The rigid pericardium…

…heart rhythm and conduction Effect on sinoatrial (SA) node SA node function may become worse in patients with established SA node disease (sinus node dysfunction…

Echocardiography Endocarditis Endocarditis implies that a bacterial infection engages the heart valves and this is a serious condition. The focus of infection on the flap…