…of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and the descending colon…

…of the left anterior descending artery was associated with lower five year survival than a more distal lesion. Revascularisation improves myocardial blood flow and angina…

…to relax and stretch out during diastole. During IVRT the pressure in the left ventricle decreases and when it is lower than left atrial pressure…

…risk factor for death [15]. For patients with LBBB and a left ventricular ejection fraction (LVEF) $< 35%$, the implantation of a defibrillator or…

…the left ventricle has the highest oxygen demand. The right ventricle and the atria work against much lower resistances and therefore have lower oxygen demands…

…activation of the ventricular myocardium. The ventricles should be depolarized (activated) by impulses spreading through the left and right bundle branch, which branches out into…

…the ability of the left ventricle to relax during diastole. Compliance is fundamental to diastolic function. High compliance is desirable and means that the ventricle…

…left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection fraction 63% to 69% Lower…

…stroke volume, and subsequently lower blood pressure and reduced organ perfusion. Left ventricular dilation occurs with ensuing decline inleft ventricular ejection fraction (LVEF). This is…

…function increases risk. Left Ventricular Ejection Fraction (LVEF) : Lower LVEF is associated with worse outcomes. Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular…

…Cardiac Amyloidosis Demographic and Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left ventricular …

…preload and afterload Lower left ventricular wall stress Reduced sympathetic nervous system activity Improvement in cardiac metabolic efficiency, including increased oxygen delivery and beta hydroxybutyrate…

…coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood…

…angiotensin II. By abrogating the effects of angiotensin II, ACE inhibitors stabilize left ventricular remodeling, improve patient symptoms, prevent hospitalization, and prolong life. Furthermore, because…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…influences are particularly important because women have historically been perceived as being at lower cardiovascular risk, including after menopause, contributing to delayed assessment and undertreatment…

…with lower stroke rates, but it is associated with less complete revascularization, less durable relief of angina in some patients and a greater likelihood of…

…reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary…

…is explained by formation of thrombi in the left atrial appendage . Such thrombi may leave the appendage and enter the systemic circulation which causes thromboembolic…

…radiotracers emit gamma photons directly. These gamma rays are detected by gamma cameras to create tomographic images of the left ventricle. In PET (Positron Emission…

…back or abdominal pain. Pain may be described as ripping, tearing, sharp or stabbing. Its location and radiation may reflect the segment of aorta involved…

…both reduced clearance and the high prevalence of structural heart disease in this population. Obesity is associated with lower than expected BNP and NT proBNP…

…monophosphate (cAMP) and calcium, as well as through the direct activation of voltage sensitive calcium channels. At lower doses, dobutamine stimulates beta2 and alpha receptors…

…be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally…

…third vector: the ventricular free wall The vectors resulting from activation of the ventricular free walls is directed to the left and downwards ( Figure 7 )…

…ECG as increased amplitudes of the QRS complexes. The explanation is straightforward: myocardial muscle mass is increased and therefore it generates greater electrical potentials. However…

…effect on the activity in the SA node. Propafenone may decrease automaticity in the SA node and thereby lower heart rate. P wave No effect…

…during inhalation, which lowers pressure in the pulmonary veins and left atrium; this facilitates blood flow from the pulmonary veins to the left atrium. In…

…increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use…

…Acute left ventricular failure. Mechanism of action Enalaprilat is the active metabolite (ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure…

…left ventricular function also lowers pulmonary arterial and pulmonary capillary wedge pressures, thereby reducing the load faced by the failing right ventricle. Clinical presentation and…

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…and reduces myocardial oxygen consumption. Time to onset of action: 5 minutes. Effects Lowers blood pressure, reduces heart rate, myocardial oxygen consumption and myocardial contractility…

…moment the spray starts. Let the tissue thaw completely between cycles — it is the freeze–thaw–freeze cycle that causes cell death, not the cold…

…Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab. Let the skin dry completely before…

CPR This chapter discusses interventions and evaluations performed during advanced cardiovascular life support (ACLS). While basic life support (BLS) can be delivered by virtually anyone…

…raises the potassium, LDH and AST and lowers the haptoglobin. A tourniquet left on during sampling raises the potassium, calcium and proteins. Fasting is required…

Procedurer The single most important step in any eye injury is to measure and document the visual acuity before anything else is done. The second…

…the tourniquet 10–15 cm proximal to the intended puncture site, let the arm hang, ask the patient to pump with the hand, and pa

…Acute left ventricular failure. Mechanism of action Enalaprilat is the active metabolite (ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure…

…Acute left ventricular failure. Mechanism of action Enalaprilat is the active metabolite (ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure…

Reference values for atrial size and volume Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly abnormal Moderately abnormal Severely abnormal…

…Left ventricular mass and geometry Women Men Reference Mildy abnormal Moderately abnormal Severely abnormal Reference Mildly abnormal Moderately abnormal Severely abnormal LINEAR METHOD LV mass…

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…

…P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) Abnormal P waves: atrial enlargement If an atrium becomes enlarged (typically as a compensatory…

…by a left bundle branch block are more pronounced than those caused by ischemia. As a result, the ischemic changes are obscured and do not…

…bundle branch block (RBBB) and left bundle branch block (LBBB). The cardiac conduction system The cardiac conduction system ensures rapid and synchronized spread of depolarization…

…left ventricular function is actually a stronger predictor of death than the atherosclerotic burden. Assessment of the size, mass, geometry, and function of the left…

…to approximate ventricular mass. Most formulas are simple mathematical equations, included in all ultrasound systems, and assume that the geometry of the left ventricle is…

…Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left ventricle is divided into 17 segments for 2D echocardiography. One can identify these segments…

…echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects of systolic function and their combined use allows for…

…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…

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

…instead of qR complex. The electrical axis will be shifted to the left (left axis deviation), ranging between 45° and 90°. The QRS duration will…

…Estimating left ventricular filling pressure via e' . Measurement of deceleration time (DT) . Diastolic function can be estimated from E/A ratio, e' and deceleration time…

…7. When the tip reaches the pharynx: let the patient take a mouthful of water and hold it. Advance the electrode at the very moment…

…sided chest leads (V1, V2). Right ventricular hypertrophy causes large R waves in right sided chest leads and deeper S waves in left sided leads.

Echocardiography The mitral valve The mitral valve separates the left atrium and the left ventricle. The valve is attached to the mitral annulus , which is…

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…