…a reflection of right atrial activation and the second half is a reflection of left atrial activation. This is shown in Figure 1 (upper panel)…

…of an upper limit for ventricular compliance. The greater the left ventricular compliance, the less steep the slope of the EDPVR curve, and vice versa…

…to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may…

…and tends to worsen when the patient lies flat or moves [2], [5]. Localization: While often retrosternal, the pain may be localized to the left…

…left sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and…

…and ascends in a caudocranial direction along the interatrial septum. The left atrium is activated passively. The upper boundary of this circuit may be located…

…in the pulmonary circulation, which explains why the left ventricle is much larger (ventricular volume and muscle mass) than the right ventricle. Refer to Figure…

…muscle mass. If the rhythm is sinus rhythm (i.e under normal circumstances) the P wave vector is directed downwards and to the left in…

…in the pulmonary circulation, which explains why the left ventricle is much larger (ventricular volume and muscle mass) than the right ventricle. Refer to Figure…

…electrodes more proximally (closer to the trunk): leg electrodes are placed proximally on the thighs and arm electrodes are placed proximally on the upper arm…

…sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, and left or right arm. Onset and evolution How do…

…alae nasi, upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers, tendon sheaths Deep compartments and tendon sheaths, loss…

…conflated. There is no absolute upper age limit. Suitability is determined organ by organ in consultation between the intensive care physician and the transplant service…

…Vertical, linear scratch marks suggest a foreign body under the upper eyelid. 7. Seidel's sign: apply fluorescein generously and look under blue light. A…

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…

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

…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…

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…

…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…

…emptying (contraction) of the left atrium Figure 2, a modified Wiggers diagram, provides a comprehensive view of the phases and events during the cardiac cycle…

…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…

…the atrial cavity. The left ventricle is considerably thicker and – except the endocardium – it cannot utilize the oxygen from within the ventricular cavity. The location…

…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…

…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…

…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…

…discussed, the left ventricular wall can be subdivided into three layers: the inner lining ( endocardium ), a thick muscle layer ( myocardium ) and an outer lining ( epicardium )…

…Yokokawa et al). Tachycardia induced cardiomyopathy is presumably the main cause of left ventricular dysfunction among patients with atrial fibrillation and other supraventricular tachyarrhythmias. Moreover…

…American College of Cardiology (ACC) and American Heart Association (AHA). The formula takes into account the following variables: Maximum Left Ventricular Wall Thickness (MaxLVWT) : Hypertrophy…

Myocardial ischemia and infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the…

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…

…and trauma . Chronic aortic regurgitation If aortic regurgitation develops gradually, then the ventricle will adapt to the volume overload. Unfortunately, adaptation implies that the left…

…blood flow from the right to the left atrium. Echocardiography is of importance for cardioembolic stroke, cryptogenic stroke, and for emboli arising in the proximal…

…idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family history of heart failure…

…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…

…in left ventricular diameter during systole. It is measured in parasternal long axis view (PLAX) using M mode. The end systolic and end diastolic left…

…Both aortic stenosis and hypertension result in increased ventricular load, which the ventricle counteracts by developing hypertrophy. Hypertrophic cardiomyopathy implies left ventricular hypertrophy under normal…

…II and III ( S I S II S III pattern ). P pulmonale is very common. Figure 2. Two ECGs showing left and right ventricular hypertrophy…

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

…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…

…effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular failure. Mechanism…

…both anatomical (from the original SYNTAX Score) and clinical variables (e.g., age, sex, renal function, left ventricular ejection fraction) to provide a more personalized…

…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…

…heart rate, left ventricular function, comorbidities, concomitant medications, potential drug interactions, the presumed mechanism of ischaemia, patient preferences, local availability, and cost. The pathophysiological substrate…

…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 …

…a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling…

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

…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…

…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