…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…invasive physiological indices, led by fractional flow reserve (FFR), have been validated against outcomes and shown to outperform visual angiographic guidance in selecting lesions for…

…to aVR upside down. It turns out that the use of lead –aVR is meaningful, as it facilitates ECG interpretation (e.g. interpretation of myocardial…

…segment elevations on ECG There are two situations in which transmural ischemia does not present with ST segment elevations on the conventional 12 lead ECG…

…from different angles. This means that ECG leads with similar angles must display similar ECG curves (diagrams). For some purposes (e.g. diagnosis of some…

…the chapter ST elevations in ischemia and differential diagnoses. In cardiac arrest caused by acute total occlusion of an epicardial coronary artery (i.e. STEMI)…

…chest (precordial) electrodes are not changed but additional leads may be attached in children under the age of 5 years. These additional leads are V3R…

…Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is working…

…not exclude dangerous hyperkalaemia. Record a 12 lead ECG and start cardiac monitoring at a plasma potassium above 6.0 mmol/L, and at lower…

…I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST…

…depolarization (e.g sinus tachycardia with simultaneous left bundle branch block). P wave and PR interval Checklist P wave is always positive in lead II…

…death: what the new Nature study shows Low risk (blue) versus high risk (red) ECG morphs in lead aVL (adapted from Obermeyer et al 1 )…

…positive hyperacute T waves [15]. Profound ST elevation across multiple leads generally indicates very severe ischemia [15]. A key distinguishing feature of ischemic ST elevation…

…usually on a treadmill, while symptoms, a 12 lead ECG, heart rate and blood pressure are monitored. The test is generally symptom limited and is…

…the surface ECG as ST segment displacement. When the ischaemic vector is directed away from the standard anterior leads, posterior infarction may manifest as reciprocal…

…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…

…spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left ventricular function may lead to myocardial infarction, ventricular tachycardia…

…are therefore based on observational data, expert opinion, or extrapolation from other fields (e.g. sepsis research) or physiological reasoning. Cardiac arrest care is advanced…

…It should be noted that several types of cardiomyopathies ( e.g ischemic cardiomyopathy, tachycardia induced cardiomyopathy, diabetic cardiomyopathy, etc. ) may ultimately lead to ventricular dilation…

…therefore critical. The 12 lead electrocardiogram (ECG) is an immediately available diagnostic tool that can provide essential clues to LMCA occlusion or critical stenosis. This…

…voltage in limb leads. Click to zoom. Figure 4. Sinus bradycardia. Click to zoom. Treatment of sinus bradycardia Benign causes of sinus bradycardia (e.g…

…concomitant tachyarrhythmia, the pacemaker allows for adequate (high) dosing of rate controlling drugs (e.g beta blockers) without the risk of worsening the bradycardia. Persons…

…evident, ventricular tachycardia may appear more polymorphic in one lead (the upper lead). ECG 2 . Although the signal in the upper lead appears very disorganized…

…pulseless electrical activity (PEA). These are highly lethal arrhythmias that lead to death if cardiopulmonary resuscitation is not started immediately. Ventricular fibrillation is the result…

…P wave precedes every QRS complex; the PR interval is constant and the P wave is positive in lead II. Causes of bradyarrhythmia: sinus bradycardia…

…9 mmol/L, and consider telemetry. The QT interval is measured in the lead in which it is longest, usually II or V5, and the…

…complex. Brugada's algorithm If there is no RS complex in any chest lead (V1–V6) a diagnosis of ventricular tachycardia can be made. Otherwise…

…PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and give by slow injection over…

…administration of ticagrelor with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir) can lead to a significant increase in exposure to ticagrelor…

…male patient (Figure 1) presented at age 36 years with an ECG showing deep and persistent, concave upward ST segment depression in leads I, II…

…withdrawal of treatment with an ACE inhibitor may lead to clinical deterioration and should be avoided in the absence of life threatening complications (e.g.…

…Nevertheless, I recently read Recommendations for interpretation of 12 lead electrocardiogram in the athlete , which is a great paper written by a dozen of merited…

…resistance (e.g due to mitral valve stenosis) it becomes enlarged (hypertrophy) which amplifies its contribution to the P wave. The second hump in lead…

…causes reciprocal ST segment depressions in V1–V3 (occasionally V4). Leads V7–V9 must be placed to reveal the ST segment elevations. North American (AHA…

…To compute the mean QRS axis, the area under the QRS waveform is measured in at least two leads. Areas above the baseline (typically the…

…Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior fascicular block is diagnosed when…

…Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior fascicular block is diagnosed when…

…but fundamental part of ECG interpretation. The normal T wave in adults is positive in most precordial and limb leads. The T wave amplitude is…

…output is insufficient. Aortic regurgitation may cause myocardial ischemia because cardiac output diminishes in parallel with increasing myocardial load (and hence oxygen demand). The most…

…patients with chest pain. A 12 lead ECG recording must be registered and interpreted within 10 minutes of arrival at the hospital. The ECG differentiates…

…etc. Most cases of malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less…

…However, the term PSVT does not have any clinical relevance and it may lead to misunderstanding. Use of the term PSVT is therefore not recommended…

…and programming. The simplest pacemaker systems consist of a pulse generator and one lead, which is located either in the right atrium or the right…

…are based on conventional 12 lead ECG. Established ECG criteria do not apply to mathematicallyderived 12 lead ECGs (e.g EASI, Frank's leads etc)…

…main principle behind artificial pacemakers; i.e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an…

…early repolarization have varied over the years and across studies. This has lead to much confusion. In 2015 MacFarlane et al issued a consensus statement…

…ECG syndromes (e.g. Wellen's syndrome, de Winter's sign, widespread ST segment depressions) that point to the left anterior descending artery (LAD) as…

…be present in at least two anatomically contiguous leads. In patients with STEMI, ST segment elevations and pathological Q waves occur in the same leads…

…valvular disease or congenital heart disease. Cardiomyopathy leads to impaired cardiac function and heart failure. There are six main types of cardiomyopathy: Hypertrophic cardiomyopathy (HCM…

…may even lead to compression of the ventricles during diastole; cardiac tamponade occurs if excess pericardial fluid causes hemodynamic effects. Electrical alternans – i.e the…

…for the immune system to reach the bacteria. Endocarditis can lead to the destruction of the valvular apparatus, as well as to embolization in the…

…are as follows: The size of the thrombus (i.e the degree of artery obstruction): The greater the obstruction the more extensive the ischemia/infarction…

…Note that 10% of wide complex tachycardias actually originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g…

…stress images to accurately compare corresponding myocardial regions, as misalignment can lead to incorrect interpretation of perfusion differences. Perfusion assessment The assessment of myocardial regions…

…120 milliseconds in lead II. Biatrial abnormality/enlargement Biatrial abnormality implies that the ECG indicates both left and right atrial enlargement; i.e a large…

…large box equals 100 ms at paperspeed 25 mm/s. Figure 2 shows 12 lead ECGs demonstrating right and left bundle branch blocks. Figure 2…

…of ventricular function. Impaired diastolic function (i.e diastolic dysfunction ) may lead to diastolic heart failure (i.e heart failure with preserved ejection fraction, HFPEF …

…Ventricular dilation leads to dilation of the mitral annulus and papillary muscle displacement (i.e the distance between the papillary muscle and the mitral annulus…

Arrhythmias and arrhythmology ECG Pacemaker mediated tachycardia (PMT) Pacemaker mediated tachycardia may arise if the pacemaker records a rapid atrial rate (e.g. during a…

…reduction in pulmonary perfusion and the subsequent reduction in left ventricular preload lead to a cascade of hemodynamic alterations which may culminate in cardiac arrest…