…the early warning sign. Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The reference drug, with the greatest…

…impaired renal venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of congestion by producing a negative sodium…

…alternative in cancer associated thrombosis. Warfarin in antiphospholipid syndrome and in marked renal failure. Duration of treatment: at least 3 months. Extended treatment in unprovoked…

…other ECG changes (see below) should lead to a suspicion of ARVC. The gradual loss of myocardium leads to ventricular dilation and right heart failure…

…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…

…of catheterization) Congenital dysplasia/aplasia of the pulmonary valve Idiopathic pulmonary artery dilation Pulmonary regurgitation results in right ventricular volume overload, which gradually causes right…

…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…

…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…

…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…

…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…

…of increased resistance to empty blood into the right ventricle. This may be due to pulmonary valve stenosis, increased pulmonary artery pressure etc . The right…

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

…left ventricular enlargement, right ventricular enlargement and atrial enlargement. Below follows a discussion on the principles and differences of dilatation and hypertrophy, as well as…

…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…

…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…

…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…

…is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of the donation — may continue for at m

…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…

…than the right ventricle, the QRS complex is actually a reflection of the electrical potentials generated by the left ventricle. QRS duration QRS duration is…

…circulatory flow arrest. No flow time : The duration (minutes) from circulatory collapse to initiation of CPR. During no flow there is no cerebral perfusion and…

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

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

…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…

…in V6 with QRS duration <120 ms) D: Profound sinus bradycardia (<30 beats/min or sinus pauses ≥3 s) Explanation: Incomplete Right Bundle Branch Block…

…ECG signs of left atrial enlargement 3 Left axis deviation 2 QRS duration ≥90 milliseconds 1 Prolonged R wave peak time: V1 V2 (right ventricle…

…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…

…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…

…of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the right atrium and right…

…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…

…activated (depolarized) simultaneously. The rapid activation of the ventricles yields a narrow QRS complex (defined as QRS duration <120 ms). The cardiac action potential The…

…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…

…These require a QRS duration exceeding 140 msec in males and 130 msec in females , along with slurring or notching of the mid QRS in…

…zone. Coronary Occlusion and Myocardial Injury STEMI generally results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery…

…be −30° to 90°. Normal values and differential diagnoses Prolonged QRS duration: left bundle branch block. Right bundle branch block. Non specific intraventricular conduction delay…

…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…

…and duration of the pulse must be optimized to ensure depolarization while minimizing battery consumption. Amplitudes are normally below 1.5 V and pulse duration…

…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…

…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…

…The initial portion of the QRS complex is smooth in ventricular tachycardia. SVT has a sharp start of the QRS complex. R wave duration ≥40…

…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…

…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…

…may understate the possibility of ischaemia. A focused history should establish: Quality of the discomfort. Location and radiation. Onset and temporal pattern. Duration and recurrence…

…light causes rapid bilateral pupillary constriction (a brisk reflex), whereas low light causes dilation. This reflex is highly sensitive to brainstem integrity and cerebral perfusion…

…obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries (Felker et al). Left ventricular dilation entails a markedly elevated risk of…

…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): [ …

…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…

…ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia) can also cause this cardiomyopathy. The duration of the tachyarrhythmia appears to be a stronger risk factor…

…Time to onset of action 5 to 15 minutes Duration of action 1.5 to 5 hours Delivery IV Dose 5–15 mg/hour IV…

…Abnormal renal/liver function, Stroke history, Bleeding history, Labile INRs, Elderly age ( 65), and Drugs/alcohol. A crucial clinical pitfall is the misapplication of this…

…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…

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

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

…although the exact exposure threshold and duration required are not established. The source material identifies chronic intake of approximately 60 g daily in males and…

…days duration. Vernakalant does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting appropriate for cardioversion. Administration of…

…the dilution step, not in the choice of dose. Paediatric doses are calculated on actual body weight unless otherwise stated. When the weight of a…

…and prognosis of most cardiac diseases, including coronary artery disease, heart failure, arrhythmias, structural heart disease, etc. Over the years, a large number of parameters…

…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…

…to measure the QT interval Measurement of the QT interval may be difficult due to T wave changes. Causes of prolonged QTc duration Antiarrhythmics (procainamide…