…the right ventricle may appear functionally and morphologically normal on echocardiography and cardiac MRI during the first two decades of life. The most common initial…

…Right ventricular infarction. Ebstein's anomaly (Figure 1). Carcinoid heart disease. Endocarditis (common in intravenous drug addicts). Myxomatous degeneration. Rheumatic heart disease. Dilatation of the…

…right ventricular outflow tract) become dilated, which further agravates the regurgitation. The proximal portion of the pulmonary artery may also be dilated in patients with…

…in increased intramural pressure in the right ventricle, which is counteracted by dilatation of the ventricle. Dilatation of the right ventricle results in reduced intraventricular…

…stenosis results in increased right atrial pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily. Principles of management Medical therapies…

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

…is very common. Figure 2. Two ECGs showing left and right ventricular hypertrophy. Next chapter Biventricular Hypertrophy Related chapters Overview of Hypertrophy and Dilatation Left…

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

…From a hemodynamic standpoint, there are two types of enlargement, namely hypertrophy and dilatation. Both hypertrophy and enlargement may reduce atrial and ventricular function as…

…common and essential terms used in resuscitation science, providing a foundation for understanding subsequent chapters. SCA (Sudden Cardiac Arrest) : Sudden and unexpected cardiac arrest with…

…of two R waves); in that scenario, the R wave peak time should be 0.05 seconds. Figure 3 shows the distinguishing features of right…

…Overview of the normal electrocardiogram (ECG / EKG) Figure 1. The classical ECG curve with its most common waveforms. Important intervals and points of measurement are…

…the vector generated by the right ventricle, the QRS complex is actually a reflection of left ventricular depolarization. QRS duration is the time interval from…

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…

…The most common serious error is dilating a vessel that turns out to be an artery — everything in the technique is designed to make sure…

…waves in right sided chest leads and deeper S waves in left sided leads. Left ventricular hypertrophy (LVH) The most common causes of left ventricular…

…Hemodynamic effects of constrictive pericarditis Diastolic heart failure and right heart failure The rigid pericardium prevents all four heart chambers from dilating adequately during diastole…

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

…with tamponade, and less common causes such as severe pre existing valvular disease or excessive beta blocker or calcium channel blocker exposure. The incidence of…

…Type 1 Brugada syndrome reminds somewhat of right bundle branch block (RBBB) in leads V1–V3, but the QRS duration is not prolonged in leads…

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

…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…

…Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The reference drug, with the greatest experience eGFR 30–60…

…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…

…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…

…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…

…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…

…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…

…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…

…for females) C: Incomplete Right Bundle Branch Block (rSR' pattern in lead V1 and qRS pattern in V6 with QRS duration <120 ms) D: Profound…

…syringes, a three way tap. A Seldinger set with a guidewire, a dilator and a 5–8 F pigtail catheter , plus a drainage bag. Sample…

…Symptoms of systemic venous congestion include: Peripheral edema Rapid weight gain Increasing abdominal girth Early satiety Bendopnea Abdominal ascites Older patients may present atypically, with…

…filling. The impulse then travels through the Bundle of His, which bifurcates into the left bundle branch (LBB) and the right bundle branch (RBB). The…

…the atria activate first, filling the ventricles with adequate volumes of blood before the ventricles begin contracting. To coordinate these two tasks, the heart has…

…by dense collagenous scar, interspersed with surviving bundles of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy…

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

…delay is defined as “a QRS duration greater than 110 ms in adults, greater than 90 ms in children 8 to 16 years of age…

…also be ignored. The atrial lead is therefore set to record signals with an amplitude range of 1.5 to 5 mV, and frequency 80…

…Intermediate–high Stable Yes Raised Admission with monitoring. Be prepared for rescue thrombolysis Intermediate–low Stable One of the two positive Admission Low Stable No…

…water soluble and short acting, not a depot preparation, and gives a shorter duration of effect. Lidocaine 10 mg/mL without adrenaline , 2–5 mL…

…Figure 1. Flowchart of Brugada's algorithm for distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complex. Brugada's algorithm If there…

…QRS duration ≥0.12 s) if there is a left or right bundle branch block. Commonly, the premature atrial impulse arrives before one of the…

…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…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…

…are less common than inherited mutations. Clearly, not all DCM genes have been discovered. Genetic testing for DCM Genetic testing of patients with confirmed or…

…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): [ …

…prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or the connected myocardium may cause mitral prolapse, and thus regurgitation. Ischemia manifests with…

…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…

…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…

…is the most common sustained cardiac arrhythmia and a profound driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke…

…because cardiac output diminishes in parallel with increasing myocardial load (and hence oxygen demand). The most common causes of acute aortic regurgitation are aortic dissection…

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

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

…sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain…

…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…

…a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child…

…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…

…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…