…01 to 0.04 seconds). ECG criteria for left anterior fascicular block (LAFB) Electrical axis between 45° to 90°. If the electrical axis is 30°…

Conduction defects ECG Intraventricular conduction delay (defect): constellations of bundle branch blocks and fascicular blocks (hemiblocks) This chapter discusses intraventricular conduction delays (defects), which are…

…bifascicular block. The anterior fascicle is most likely to be defect because it is most sensitive to myocardial ischemia. Note that isolated fascicular blocks are…

…Left axis deviation — left anterior fascicular block, inferior infarction, hypertrophy +90° to +180° Right axis deviation — right ventricular strain, lateral infarction, left posterior fascicular block…

…Causes of left axis deviation Left bundle branch block. Left ventricular hypertrophy. Inferior infarction. Pre excitation. Left anterior fascicular block is diagnosed if the axis…

…Causes of left axis deviation Left bundle branch block. Left ventricular hypertrophy. Inferior infarction. Pre excitation. Left anterior fascicular block is diagnosed if the axis…

…a lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than a more distal…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction…

…more frequently associated with anterior infarction than with inferoposterior infarction [4]. Myocardial Necrosis : The occurrence of LBBB (as a form of bifascicular block) is linked…

…To address these challenges, researchers have developed ECG criteria designed to identify ischemia in the presence of left bundle branch block. The most widely recognized…

…QRS duration. A QRS duration of 120 ms (0.12 s) or more is required to diagnose a complete left bundle branch block . In addition…

…segments ( apical anterior , apical septal , apical inferior , and apical lateral ) and the apex (Table 2). Table 2. The 17 segments of the left ventricle Basal…

…anterior , lateral and septal wall ( Figure 2 below). An inferior myocardial infarction refers to an infarction located in the inferior wall of the left ventricle…

…left ventricle. The valve is attached to the mitral annulus , which is continuous with annulus fibrosus (the fibrous ring). The mitral valve has an anterior…

…aspect of the aortic bulb. The left main coronary artery ( LMCA ) originates from the left anterior aspect of the aortic bulb. The LMCA is short…

ECG Myocardial ischemia and infarction Definition and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part…

Echocardiography Tricuspid regurgitation The tricuspid valve separates the right ventricle and the right atrium. It normally consists of three leaflets (anterior, posterior and septal leaflet)…

…infarction (STEMI). The principal lesions are: Ventricular septal rupture (VSR), producing an acute left to right shunt. Ventricular free wall rupture, producing haemopericardium and cardiac…

…the chest leads (V1 through V6) are displayed on the ECG paper in their anatomically contiguous order from right anterior (V1) to left lateral (V6)…

…The intramyocardial segment is termed the tunnelled artery. The left anterior descending artery (LAD) is most commonly involved. The reported prevalence depends substantially on the…

…2], [5]. Localization: While often retrosternal, the pain may be localized to the left anterior chest and can radiate to the neck, shoulders, and arms…

…tissues and organs. A few decades later Cohnheim demonstrated that ligation of the left anterior descending artery in dogs resulted in myoardial infarction. An important…

…de Winter's sign, widespread ST segment depressions) that point to the left anterior descending artery (LAD) as the culprit. The coronary arteries: a brief…

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

…septum. The left atrium is activated passively. The upper boundary of this circuit may be located either anterior or posterior to the superior vena cava…

…In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases…

…involvement The anatomical territory, including anterior, inferoposterolateral or right ventricular involvement Pre existing abnormalities such as prior infarction, left bundle branch block, Wolff–Parkinson–White…

…dominated by electrical vectors from the left ventricle due to its significantly larger mass compared to the right ventricle. In right bundle branch block (RBBB)…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…solely as an isolated coronary event. SCAD predominantly affects the left sided coronary circulation and may involve multiple vessels. Pregnancy associated SCAD can occur at…

…Lesion location also matters: stenoses in the left main stem or proximal left anterior descending artery are more likely to affect flow because they supply…

…cycle repeatedly to the circumflex artery before a 60 minute occlusion of the left anterior descending coronary artery (LAD) would reduce the infarct size by…

…segment depressions with prominent T waves in the majority of the chest leads may indicate an acute occlusion in the LAD (left anterior descending artery)…

…V2 and V4. V4: placed on the left medioclavicular line between rib 5 and 6. V5: placed on the anterior axillary line, on level with…

…An alcohol or chlorhexidine swab. Let the skin dry completely before inserting the needle — alcohol carried in with the needle stings. Needles of the correct…

…5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of minutes before the needle is inserted…

…2. Inspect the eyelids, conjunctiva, cornea and anterior chamber. Note the pupil size, shape and reaction to light. A teardrop shaped or peaked pupil suggests…

…ventricle in the thorax. It is localized immediately behind the sternum and thus is the most anteriorly located part of the heart. The right ventricle…

…prepared. The patient is positioned semi recumbent, at 30–45 degrees — the fluid then collects anteriorly and inferiorly, which makes it easier to reach subxiphoid…

…m2 22 ± 6 29–33 34–39 40 22 ± 6 29–33 34–39 40 ​BSA, Body surface area; LA, left atrial; RA, right atrial.

Visual assessment of regional wall motion (left ventricle) TYPE OF MOTION DEFINITION WALL MOTION SCORE Normal Normal thickening (typically 30% thickening from end diastole to…

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

…an intuitive basis. Consider the fact that the left ventricle contracts and ejects blood into the aorta roughly 100,000 times daily, each time overcoming…

Echocardiography Left ventricular function and its echocardiographic assessment Cardiac function depends on a large number of parameters, including atrial function, valvular function, and ventricular function…

Echocardiography Size and mass of the left ventricle Left ventricular mass is a flawed proxy for ventricular systolic function and load. The mass is, however…

Echocardiography Methods for assessing systolic function (contractile function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects…

…2) in these leads. These ECG changes were previously referred to as strain pattern because it was believed that they indicated left ventricular exhaustion. However…

Echocardiography Myocardial relaxation and left ventricular diastolic function Diastolic function is determined by the efficiency of myocardial relaxation. The degree and velocity of relaxation are…

…is derived by measuring flow velocities across the mitral valve using pulsed Doppler. Estimating left ventricular filling pressure via e' . Measurement of deceleration time (DT) …

Procedurer The oesophagus runs directly behind the left atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an…

…be moved along the black lines called EDPVR and ESPVR. EDPVR (End Diastolic Pressure Volume Relationship) shows the relationship between ESV and left ventricular volume…

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…

Echocardiography Structure and contractile function of myocardial fibers The left ventricular wall can be subdivided into several layers. These layers are similar to those seen…

…speckle tracking As previously discussed, the left ventricular wall can be subdivided into three layers: the inner lining ( endocardium ), a thick muscle layer ( myocardium ) and…

Echocardiography Cardiomyopathy caused by tachycardia A prolonged tachycardia can cause cardiomyopathy with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy…

[calc_hcmrisk] Predicting Sudden Cardiac Death in Hypertrophic Cardiomyopathy (HCM) Hypertrophic Cardiomyopathy (HCM) is a genetic cardiomyopathy characterized by left ventricular hypertrophy. It is the…

…The heart is rotated 30° to the left in the thorax. This positions the basal portion of the left lateral wall posteriorly in thorax (Figure…

…volume overload. Unfortunately, adaptation implies that the left ventricle dilates, which induces irreversible cellular and extracellular processes that ultimately lead to heart failure. This initially…