…and pregnancy related history. Female specific or female predominant factors associated with later cardiovascular risk include: Premature menopause Premature ovarian insufficiency Hypertensive disorders of pregnancy…

…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.

…1–2 <1 1–1.5 (not reversed with Valsalva maneuver) 1.5 1.5–2.0 (not reversed with Valsalva maneuver) Deceleration time (DT)…

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…

…conduction delay within the left bundle system in the case of incomplete LBBB [7]. In more severe forms, LBBB is associated with the following: Myocardial…

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

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…

…could expect, low sensitivity but high specificity with respect to detecting atrial enlargement. Left atrial enlargement is also referred to as P mitrale , and right…

…Implications of left bundle branch block in myocardial ischemia and infarction A summary of the issues that arise when facing a patient with left bundle…

…atrioventricular (AV) node, Bundle of His, bundle branches (left and right bundle branch), and Purkinje fibers. The conduction system allows for rapid spread of the…

…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…

…ejection fraction has become virtually synonymous with left ventricular function. An obvious drawback with the use of the ejection fraction is that it only assesses…

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…

…heart using the long axis of the left ventricle and selected planes oriented at 90° angles relative to the long axis. With regards to echocardiography…

…with left ventricular systolic function. EAT = v max /time Fractional shortening (FS) Fractional shortening (FS) is calculated by measuring the change (% reduction) in left…

…LCx supplies the posterior descending artery (PDA) in a left dominant circulation (i.e. 10 15% of cases). Clinically, patients present with severe chest pain…

…lower oxygen demands. The wall thickness is considerably thinner in the atria and right ventricle, as compared with the left ventricle. Indeed, the atrial myocardium…

…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…

…rS complexes. Causes of left anterior fascicular block (LAFB) LAFB may occur in persons who are otherwise healthy. The majority of those with LAFB, however…

…Also, the load on individual fibers is positively correlated with left ventricular volume, meaning that load on the muscle fibers increases as ventricular volume increases…

…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) …

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

…rises rapidly with further volume increases. This is explained by the existence of an upper limit for ventricular compliance. The greater the left ventricular compliance…

…dilatation Biventricular hypertrophy Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to detecting biventricular hypertrophy…

…mitral valve separates the left atrium and the left ventricle. The valve is attached to the mitral annulus , which is continuous with annulus fibrosus (the…

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…

…are organized into several sheets wrapping around the ventricle with varying orientation. This organization allows the left ventricle to contract in a highly sophisticated 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…

…and left ventricular function. The HCM Risk SCD score aims to identify individuals with a high risk of SCD and determine whether an implantable cardioverter…

…is that the patient actually has NSTE ACS (NSTEMI) since they present with ST segment depressions on the 12 lead ECG (recall that ST segment…

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…

… Is the left ventricle dilated? Is the left ventricle hypertrophic? Is left ventricular ejection fraction (LVEF) normal? A normal sized ventricle with hyperdynamic contractility suggests…

…heart disease (including complications) can cause embolisms. Left ventricular aneurysm with thrombus Cardiomyopathies Valve prosthesis Devices (pacemaker, ICD CRT) Endocarditis Cardiac tumors Atherosclerosis of the…

…cardiomyopathy (DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family…

…is also affected by left ventricular volume (size). For example, athletes have large ventricular dimensions and often lower ejection fraction, as compared with non athletes…

…must be normal. For example, in the setting of left bundle branch block (LBBB), fractional shortening is not representative of ventricular function, since the activation…

…is a genetic disorder that causes left ventricular hypertrophy under normal loading conditions. Hypertrophic cardiomyopathy should not be confused with hypertrophy caused by increased loading…

…I and aVL displays smaller R waves than normal. Along with larger R waves in right sided leads, the R wave progression may be opposite…

…by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision…

…Scan the left lower quadrant. Confirm at least 2–3 cm of free fluid depth with no bowel in the path of the needle and…

…Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular failure. Mechanism of action Enalaprilat is the active metabolite (ester)…

…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…

…CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II…

…in patients with reduced left ventricular ejection fraction (LVEF). They are also recommended in patients within one year of MI and in those with LVEF…

…65 years presenting with heart failure and increased left ventricular (LV) wall thickness [3, 5]. Unexplained LV hypertrophy (LVH) or heart failure with preserved ejection…

…occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling, reduced stroke volume…

…not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without…

…of heart failure and a left ventricular ejection fraction (LVEF) of 41–49%. It occupies an intermediate position between heart failure with reduced ejection fraction …

…factors influencing treatment selection The following characteristics favour CABG when clinically and anatomically appropriate: Diabetes mellitus, particularly with multivessel disease involving the LAD Left v

…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 classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH, including acute responders and non responders. Left heart disease is the most common risk…

…modest left sided congestion—is an important clinical clue. Haemodynamic severity The presentation may range from mild right ventricular impairment to cardiogenic shock. Patients with…

…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…

…prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or…

…Left posterior fascicular block is diagnosed when the axis is between 90° and 180° with rS complex in I and aVL as well as qR…

…Left posterior fascicular block is diagnosed when the axis is between 90° and 180° with rS complex in I and aVL as well as qR…

…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…

…aortic valve with three cusps (RCC, NCC and LCC). The right coronary artery (RCA) departs from the right coronary cusp (RCC), and the left main…

…may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of…

Cardiology Definition and terminology Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by the cardinal symptoms and signs of heart…