…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.

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…

…notched R waves in leads I, aVL, and the left precordial leads, and narrow r waves followed by broad, deep S waves in the right…

…stenosis Distal bifurcation involvement Coexisting multivessel disease The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of…

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…

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…

…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…

…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…

…the left ventricular myocardium begins to relax and ventricular pressure drops rapidly (Figure 2). The initial relaxation is isovolumetric , meaning that relaxation occurs without changes…

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…

…orient and display the heart using the long axis of the left ventricle and selected planes oriented at 90° angles relative to the long axis…

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…

…and lateral walls, and the posterior wall if the LCx supplies the posterior descending artery (PDA) in a left dominant circulation (i.e. 10 15…

…affected, then the left ventricle is virtually always affected due to the coronary anatomy (refer to the chapter Coronary Arteries and Localization of Infarction & Ischemia)…

…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…

…the myocardium without fascicular supply will depend on impulses spreading from other parts of the ventricle (where the fascicle is intact). Figure 1. Left anterior…

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…

…defined as left ventricular volume at the closure of the aortic valve. Upon aortic valve closure, the ventricle relaxes and pressure drops rapidly, without any…

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…

…a significantly increased risk of atrial fibrillation. The increase in left atrial pressure may also propagate backward to the pulmonary circulation, causing pulmonary hypertension (PH)…

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…

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…

…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…

…of the aorta LOW EMBOLIC POTENTIAL SEP (Spontaneous Echocardiographic Potential) Left ventricular aneurysm without thrombus Prolapse of mitral valve Aortic stenosis with calcification Mitral disease…

…However, the term dilated cardiomyopathy (DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in…

…fraction <55%. This implies that left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection…

…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…

Echocardiography Hypertrophic cardiomyopathy (HCM): from pathophysiology to echocardiography Hypertrophic cardiomyopathy is a genetic disorder that causes left ventricular hypertrophy under normal loading conditions. Hypertrophic cardiomyopathy…

…1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left ventricle is enhanced in LVH…

…left behind — which is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision and drainage Acute paronychia without…

…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…

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

…renal function, left ventricular ejection fraction) to provide a more personalized risk assessment. Key Variables in SYNTAX Score II Anatomical SYNTAX Score : Derived from the…

…conversion of angiotensin I to angiotensin II. By abrogating the effects of angiotensin II, ACE inhibitors stabilize left ventricular remodeling, improve patient symptoms, prevent hospitalization…

…symptoms, while maintaining tolerability and adherence. Selection should be individualized according to blood pressure, heart rate, left ventricular function, comorbidities, concomitant medications, potential drug interactions…

…Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left ventricular (LV) wall thickness [3…

…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…

…depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical…

…a clinical syndrome defined by the combination of symptoms and/or signs of heart failure and a left ventricular ejection fraction (LVEF) of 41–49%…

…and treatment goals Diabetes, left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator…

…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…

…by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease, left sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction…

…is myocardial necrosis involving the right ventricle, most often occurring in association with an inferior left ventricular infarction. At least minor right ventricular necrosis is…

…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…

…coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological stress. The physiological basis is an…

…contraction. The direction of the depolarization (and thus the electrical axis) is generally alongside the heart's longitudinal axis (to the left and downwards). Figure…

…ventricular contraction. The direction of the depolarization (and thus the electrical axis) is generally alongside the hearts longitudinal axis (to the left and downwards). Figure…

…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…

…As the area is reduced, transvalvular flow resistance increases. This results in increased left ventricular load, while simultaneously affecting systemic perfusion. Aortic stenosis is a…

…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…

…clinical syndrome characterized by the cardinal symptoms and signs of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of ≥50%…