Conduction defects ECG Fascicular block (hemiblock): left anterior fascicular block & left posterior fascicular block Fascicular blocks were previously referred to as hemiblocks, but the latter…

…Note that isolated fascicular blocks are uncommon in acute myocardial infarction. Left bundle branch block (LBBB) Left bundle branch block and ischemia/infarction has been…

…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…

…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…

…heart is rotated 30° to the left in the thorax. This positions the basal portion of the left lateral wall posteriorly in thorax (Figure 1…

…involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction. Its recognition is clinically important because posterior infarction…

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…

…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…

…and left circumflex (LCx) coronary artery territories, resulting in extensive myocardial ischemia or infarction involving the anterior, septal, and lateral walls, and the posterior wall…

…with annulus fibrosus (the fibrous ring). The mitral valve has an anterior leaflet and a posterior leaflet . The anterior leaflet has a semi circular shape…

…the right atrium. It normally consists of three leaflets (anterior, posterior and septal leaflet). The leaflets are attached to the subvalvular apparatus, consisting of the…

…90% of individuals, the right coronary artery gives off the posterior descending artery (PDA) which supplies the inferior wall of the left ventricle. When the…

…54–74% 52–72% Left ventricle, diastolic diameter 3.9–5.3 cm 4.2–5.8 cm Wall thickness (septum, posterior wall) ≤ 0.9…

…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…

…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)…

…Repeat on the left side. A positive test in the posterior canal is characterised by: A latency of 1–5 seconds before the nystagmus begins…

…10) LCX = Left circumflex artery proximal segment (11) obtuse marginal branch (OM) (12) distal segment (13) left posterolateral branch (PL) (14) posterior descending artery…

…heart is rotated 30° to the left in the thorax. This positions the basal portion of the left lateral wall posteriorly in thorax (Figure 1…

…it. A small (under 10 mm), loculated or purely posterior effusion with no safe route for puncture — surgical drainage or pericardiotomy instead. Relative: uncorrected coagulopathy…

…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…

…branches of the facial nerve at the temple, the accessory nerve in the posterior triangle of the neck, and the superficial nerves of the forearm…

…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.

…of bifascicular block) is linked to extensive myocardial necrosis [4]. Clinical Implications and Prognosis Mechanical and Diagnostic Impact LBBB causes extensive reorganization of left ventricular…

…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…

…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…

…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…

…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…

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…

…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…

Echocardiography Cardiac thromboembolism Thromboembolism is a leading cause of death worldwide (1). Emboli originating in the atria, left atrial appendage (LAA), ventricles, valves, and proximal…

…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…

…foundation: an effective digital block and a tourniquet . Without a bloodless field one works by feel, and by feel nail spicules are left behind — which…

…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…

…blood pressure, left ventricular dysfunction, contraindications, or intolerance limit escalation of beta blocker or CCB therapy. Nicorandil and trimetazidine are additional options in selected patients…

…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…