…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)…

…further volume increases. This is explained by the existence of an upper limit for ventricular compliance. The greater the left ventricular compliance, the less steep…

…Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An ECG recording…

…arms, neck, jaw, upper back, and abdomen, as well as dyspnea and nausea (anginal equivalents) [7]. Clinicians must consider both cardiac and non cardiac etiologies…

…pulmonary venous hypertension caused by left heart disease from pulmonary vascular disease. Although a PAWP of 12 mmHg represents the upper limit of normal in…

…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…

…anatomical development during infancy & childhood In adults, the left ventricle is considerably larger than the right ventricle. This is the result of ventricular adaptation to…

…a reflection of right atrial depolarization and the second half is a reflection of left atrial depolarization. This is shown in Figure 3 (upper panel)…

…anatomical development during infancy & childhood In adults, the left ventricle is considerably larger than the right ventricle. This is the result of ventricular adaptation to…

…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…

…jaw, back, upper abdomen, and left or right arm. Onset and evolution How do symptoms start (suddenly or gradually)? When did the patient first note…

…Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers…

…raised — the two decisions must never be conflated. There is no absolute upper age limit. Suitability is determined organ by organ in consultation between the…

…lid margin upwards and backwards towards the forehead. Double eversion is achieved by advancing the bud further downwards until the upper fornix is visible. 6…

…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…

…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…

…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…

…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…

…01 to 0.04 seconds). ECG criteria for left anterior fascicular block (LAFB) Electrical axis between 45° to 90°. If the electrical axis is 30°…

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…

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…

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…

…a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : …

…the left flank. Have the patient empty the bladder first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal…

…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…

…fatigue and oedema. This definition does not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the…

…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…