…Figure 1. Anatomy of the mitral valve The leaflets are connected to the papillary muscles via chordae tendineae (Figure 1). The anterolateral papillary muscle receives…

…mitral regurgitation Chronic mitral regurgitation causes a gradual volume and pressure overload, such that LVEDP and LAP rise slowly. This leads to compensatory dilatation of…

…g mitral stenosis) requires intervention. Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of…

…consisting of the chordae tendineae and the papillary muscles . As compared to the mitral valve, the tricuspid valve is located slightly more apically (<0.8…

…help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key Formulas BSA Calculation (Mosteller formula): [ …

…This is called P mitrale, because mitral valve disease is a common cause (Figure 1). The duration of the P wave will exceed 120 milliseconds…

…This reduces the filling of the left atrium and, accordingly, the left ventricle. The reduced flow over the mitral valve results in reduced E wave…

…septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac output…

…does not determine the anticoagulation indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension…

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

…right ventricular hypertrophy. Next chapter Biventricular Hypertrophy Related chapters Overview of Hypertrophy and Dilatation Left Ventricular Hypertrophy Atrial Hypertrophy and Dilatation (P mitrale, P pulmonale…

…during which there is no significant flow across the mitral valve. The duration of diastasis is inversely related to heart rate (diastasis is shorter at…

…pressure Marked respiratory variation in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute…

…in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress and subendocardial ischemia. Neurohormonal activation and vascular and renal…

…displacement, annular dilatation, or both; progressive ventricular remodeling may also occur in primary valvular disease. Increasing severity of mitral regurgitation is associated with worse outcomes…

…in the AV node is high grade. Causes of tachyarrhythmia with narrow QRS complexes (QRS duration < 0.12 s): sinus tachycardia, inappropriate sinus tachycardia…

…Causes of tachycardia (tachyarrhythmia) with wide QRS complexes (QRS duration ≥0,12 s) : ventricular tachycardia is the most common cause and it is potentially life…

…Causes of tachycardia (tachyarrhythmia) with wide QRS complexes (QRS duration ≥0,12 s) : ventricular tachycardia is the most common cause and it is potentially life…

…that the test failed to identify 27.8% of individuals with poor neurological recovery. The specificity of absent pupillary reflex for predicting a poor neurological…

…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…

…patients with pulmonary hypertension. Echocardiography in pulmonary regurgitation Echocardiography is the modality of choice for diagnosing pulmonary regurgitation. Continuous Doppler through the pulmonary valve reveals…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…profound driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke and systemic embolism. The contemporary understanding of AF has…

…Table 1. Causes of aortic regurgitation Bicuspid aortic valve Rheumatic heart disease Calcified aortic valves Idiopathic aortic dilatation (aneurysm) Hypertension Aortic dissection, proximal Marfan syndrome…

…ventricle, which is counteracted by dilatation of the ventricle. Dilatation of the right ventricle results in reduced intraventricular pressure and thereby reduced myoardial load. Pulmonary…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…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…

…the reason for which remains elusive. Gene mutations can be confirmed in roughly 60% of individuals with ARVC. Mutations in the desmosomal gene PKP2 is…

…a precaution. Dosage of vernakalant Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg. Normal dilution: 4 mg/ml. Recommended…

…repeated to a maximum of 3 mg 0.02 mg/kg, minimum 0.1 mg, maximum 0.5 mg For bradycardia with compromise Isoprenaline 0…

…and of ventricular end diastolic and residual volumes. Experimental and clinical observations with a precordial dilution technic. Circulation. Redfield et al: Heart Failure with Preserved…

…reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect, the dosing…

…10 mL with sodium chloride) before intravenous titration. Half of all opioid dosing errors arise at the dilution step, and an undiluted syringe of 10…

ECG Introduction to ECG interpretation The QRS complex (ventricular complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R…

…is increased) and aortic stenosis (in which the narrowing of the opened aortic valve orifice makes it difficult for blood to flow from the ventricle…

…QT dispersion. Increased QT dispersion is associated with increased morbidity and mortality. This is presumably explained by a higher incidence of malignant ventricular arrhythmias. It…

…A duration of 6 months after ACS is generally considered too short for routine use, but it may be considered in selected patients with a…

…with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of the donation…

…Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment…

…interpretation requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation starts with assessment of the P wave…

…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…

…of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with…

…VT]). The VF waveform is initially coarse ( i.e fibrillatory waves have large amplitudes) but as the duration of VF is prolonged, the amplitude gradually…

…of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic considerations, with…

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

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

…requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation traditionally starts with an assessment of the P…

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…

…low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean with a tracheostomy or copious secretions Subclavian vein Most comfortable…

Enalaprilat Enalaprilat is rarely used in hypertensive crisis due to its slow onset, prolonged duration of effect, and significant individual variations in its effect. Drug…

…PR interval <120 ms with a delta wave and wide QRS is indicative of 'Ventricular pre excitation', and QRS duration ≥140 ms is considered 'Profound…

…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…

…Time to onset of action 50 to 10 minutes Duration of action 30 to 60 minutes Delivery IV Dose Initial infusion dose: 0.1 μ…

…Time to onset of action 1 to 2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

…apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well apposed edges, abrasions…

…2 3 LQTS Risk model, a validated tool designed to estimate the 5 year risk of life threatening arrhythmic events in individuals with LQT1, LQT2…

…decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude)…