…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…

…or end stage renal failure Consider renal replacement therapy Hypoperfusion with persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative care Right…

…syndrome and in marked renal failure. Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence…

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

…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…

…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…

…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…

…Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and evidence demonstrating long…

…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…

…Hypertrophy and dilatation Atrial enlargement: left atrial enlargement (P mitrale) and right atrial enlargement (P pulmonale) The atria may become dilated and/or hypertrophic during…

…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…

…of the P wave depends on where the atrial lead is fixed. Typically, the atrial lead is fixed next to the right atrial appendage, or…

…deceased — in the donation register, on a donor card, or through statements made to the next of kin. Active malignancy with a risk of transmission …

…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…

…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…

…occurs in diastole or the decompression phase during CPR). High aortic pressure and low right atrial pressure favor coronary blood flow. A CPP of approximately …

…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…

…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…

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

…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…

…not interfere with ongoing CPR or airway management, no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal jugular…

…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…

…or the needle from a pericardiocentesis set), 10 mL and 20 mL syringes, a three way tap. A Seldinger set with a guidewire, a dilator…

…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…

…the more efficient the pumping mechanism. Sequential activation means that the atria activate first, filling the ventricles with adequate volumes of blood before the ventricles…

…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…

…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…

…to right shunt, tamponade, or sudden loss of effective cardiac output. Their recognition is essential because treatment often requires urgent surgical or transcatheter intervention, with…

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

…cardiomyopathy or hypertrophy. Prognosis of nonspecific intraventricular conduction delay Patients with nonspecific intraventricular conduction delays are at twice as great a risk of all cause…

…chapter, the delivery of pacing pulses can be bipolar or unipolar. Sensing can also be bi or unipolar. Generally, sensing is more accurate with bipolar

…and trigger finger. Syringes of 3, 5 and 10 mL, artery forceps, gauze, a dressing, gloves. A cold spray or a lidocaine weal. Site Triamcinolone…

…for decades, and it has been regarded as a benign form of ST segment elevation with slurring or notching at the J point. A notch…

…duration ≥40 ms suggest ventricular tachycardia. Duration from start of QRS complex to nadir of S wave ≥60 ms suggests ventricular tachycardia. V6 : QR or…

…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…

…of the discomfort. Location and radiation. Onset and temporal pattern. Duration and recurrence. Provoking and relieving factors. Associated symptoms. Similarity to previous documented angina or…

…the vast majority of cardiac arrest patients—can induce such pupillary responses. In a comprehensive study by Javaudin et al., involving more than 11,000…

…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…

…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): [ …

…with connective tissue disorders (Marfan syndrome, Ehlers Danlos syndrome), osteogenesis imperfecta typically causes prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or…

…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…

…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…

…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…

…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…

…if hypotension or bradycardia occurs. A defibrillator should be immediately available as a precaution. Dosage of vernakalant Vernakalant is dosed by body weight, with the…

…thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in cardiac arrest. High quality compressions with minimal interruptions…

…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…

…cerebral, coronary or renal ischaemia. Neurological status, urine output, creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]…

…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…