…technically more difficult with ultrasound Femoral vein Fastest, and does not interfere with ongoing CPR or airway management, no risk of pneumothorax Highest risk of…

…lead to ventricular dilation. However, the term dilated cardiomyopathy (DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop…

…with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy , can be caused by any tachyarrhythmia leading to prolonged periods of…

…muscle rupture. The risk of rupture is greater for the posteromedial papillary muscle, which only receives blood supply from one coronary artery (Coronary arteries). Chronic…

…either LCX or the right coronary artery (RCA). For details, refer to chapter The Coronary Arteries. Mitral valve disease A wide range of conditions may…

…prevent, or alleviate, the pressure increase in the left ventricle and left atrium. Chronic aortic regurgitation leads to dilatation and hypertrophy of the left ventricle…

…with more severe neurological deficits, and carry higher rates of mortality and long term disability compared to non cardioembolic ischemic strokes. Consequently, the cornerstone of…

…Rheumatic heart disease. Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension. Left to right shunt. Right ventricular dysfunction due to pressure…

…size and form of the thrombus, it will occlude the main pulmonary artery or its branches. The larger the thrombus, the more proximal the occlusion…

…al). ARVC is more malignant in men, the reason for which remains elusive. Gene mutations can be confirmed in roughly 60% of individuals with ARVC…

…prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left…

…prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…for assessing ventricular function. For better or worse, ejection fraction has become virtually synonymous with left ventricular function. An obvious drawback with the use of…

…or treatment with sodium nitroprusside. In most hypertensive emergencies the following is aimed for: 1. Lower the mean arterial pressure by no more than about…

…vectors resulting from activation of the ventricular free walls is directed to the left and downwards ( Figure 7 ). The explanation for this is as follows…

…a patient on digoxin treatment 1 ECG signs of left atrial enlargement 3 Left axis deviation 2 QRS duration ≥90 milliseconds 1 Prolonged R wave…

…and 240 ms. The deceleration time indicates the duration for equalizing the pressure difference between the left atrium and the left ventricle. The deceleration time…

…The duration of the P wave will exceed 120 milliseconds in lead II. Biatrial abnormality/enlargement Biatrial abnormality implies that the ECG indicates both left…

…dilatation. The most common cause is valvular regurgitation (insufficiency). For example, aortic regurgitation causes the flow of blood from the aorta back into the left…

…duration of 120 ms (0.12 s) or more is required to diagnose a complete left bundle branch block . In addition to prolonged QRS duration…

…duration exceeding 140 msec in males and 130 msec in females , along with slurring or notching of the mid QRS in at least two left…

…who are otherwise healthy. The majority of those with LAFB, however, have significant heart disease. Myocardial infarction, coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy…

…system (His Purkinje network), which results in rapid impulse transmission and thus shorter QRS duration (as compared with apical pacing). Because ventricular pacing results in…

…aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation Left bundle…

…aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation Left bundle…

…of increasing coronary blood flow. In circumstances with non shockable rhythm or with prolonged periods of VF (fine VF resistant to defibrillations), the purpose of…

…reflection of the electrical potentials generated by the left ventricle. QRS duration QRS duration is the time duration from the start to the end of…

…complex is actually a reflection of left ventricular depolarization. QRS duration is the time interval from the onset to the end of the QRS complex…

ECG Hypertrophy and dilatation Biventricular hypertrophy Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to…

…ECGs showing left and right ventricular hypertrophy. Next chapter Biventricular Hypertrophy Related chapters Overview of Hypertrophy and Dilatation Left Ventricular Hypertrophy Atrial Hypertrophy and Dilatation …

…prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left…

…heal with good function or cosmesis without apposition. A wound that bleeds because the edges are held apart. A wound through the full thickness of…

…lead V1 and qRS pattern in V6 with QRS duration <120 ms) D: Profound sinus bradycardia (<30 beats/min or sinus pauses ≥3 s) Explanation…

…therapies have failed. Patients with structural heart disease or reduced left ventricular function are not eligible. Effects of propafenone and flecainide on ECG, heart rhythm…

…and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction…

…treated initially with diuretics, whereas norepinephrine and/or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion…

…patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for EMS or bystanders…

…Since the left ventricle is not filled normally, there is more room for the right ventricle, the filling of which increases and the septum bulges…

…abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood…

…rate (for example atrial fibrillation) if the block in the AV node is high grade. Causes of tachyarrhythmia with narrow QRS complexes (QRS duration <…

…tap. A Seldinger set with a guidewire, a dilator and a 5–8 F pigtail catheter , plus a drainage bag. Sample tubes for cell count…

…remain consistent with those used for non pregnant adults. The fetus is not harmed by defibrillation, amiodarone, or adrenaline (epinephrine). In the event of a…

…collectively dictate the urgency and modality of intervention [3] . By Duration: Non sustained VT (NSVT): Defined as three or more consecutive ventricular beats at a…

…safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen consumption. Time to onset of action: 5…

…in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological…

…clinical patterns of AF—paroxysmal, persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes…

…16 years of age, and greater than 80 ms in children less than 8 years of age without meeting the criteria for RBBB or LBBB…

…or combinations of these mechanisms. Drug selection can therefore be tailored to the suspected mechanism. No antianginal class has demonstrated consistent superiority for symptom relief…

…the stroke risk is high or the time of onset uncertain, choose the more cautious course. Anticoagulation Assess the risk with CHA₂DS₂ VA (the sex…

…then reserved for patients with a CHA₂DS₂ VA score of 0–1. Check what applies in your own region. Duration above the threshold or unknown…

…The hallmark of both RBBB and LBBB is the QRS duration which is by definition 120 ms or longer. ECG criteria for right bundle branch…

…vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left ventricular…

…branches of the same coronary artery or another coronary artery, will alleviate the ischemia, improve myocardial function and increase resistance to episodes of more severe…

…left ventricular hypertrophy, or echocardiographic evidence of impaired filling, make the diagnosis more likely. HFpEF and HFmrEF together account for approximately half of patients with…

…primarily for instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary…

…or more frequently, as individually appropriate. 3 Important study: Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock (N Engl J Med 2021…

…is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to…

…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…

…Note that narrow complex tachyarrhythmia rarely causes circulatory compromise or collapse. Causes of tachycardia (tachyarrhythmia) with wide QRS complexes (QRS duration ≥0,12 s) : ventricular…