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…

…LBBB and a left ventricular ejection fraction (LVEF) $< 35%$, the implantation of a defibrillator or a CRT D is indicated to prevent SCD…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…His, bundle branches (left and right bundle branch), and Purkinje fibers. The conduction system allows for rapid spread of the depolarization to the contractile cells…

…produce ST segment elevations that mimic acute myocardial infarction. Acute pericarditis is a primary differential diagnosis and presents with distinct characteristics compared to transmural ischemia…

…septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac output…

…left bundle branch block, Wolff–Parkinson–White patterns or ventricular pacing STEMI and non ST segment elevation myocardial infarction (NSTEMI) are contemporary clinical and electrocardiographic…

…to Approach to Patients with Chest Pain). As in patients with STEMI, those with NSTEMI and unstable angina are at considerable risk of developing life…

…left lateral wall posteriorly in thorax (Figure 1). This area is most frequently designated as the posterolateral wall, but it may also be referred to…

…Example 10 STEMI Example 11 STEMI Example 12 ECG examples of acute STEMI (ST elevation myocardial infarction). Overview of management Click the diagram to enlarge…

…haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial…

…leads aVL and I may show changes similar to those in V5 and V6. Figure 1. ECG changes in left ventricular hypertrophy (LVH) and right…

…life threatening complication of coronary atherosclerosis. The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary mechanisms: Plaque Rupture: Accounting…

…fundamental pathophysiological substrate for acute coronary syndromes (ACS), including ST Elevation Myocardial Infarction (STEMI) [1] . Historically viewed as a simple plumbing problem characterized by the…

…instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest after presentation are markers of very high risk. They…

DICTrank: The Largest Reference List of 1318 Human Drugs Ranked by Risk of Drug Induced Cardiotoxicity Using FDA Labeling . Drug Discovery Today. 2023. DICT =…

…elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow to…

…ischaemic symptoms, haemodynamic instability or life threatening arrhythmias. Twelve to 48 hours after onset: routine primary PCI should be considered in otherwise stable patients. More…

…of right and left sided filling, reduced stroke volume, diminished cardiac output, falling arterial pressure, and, if untreated, death. The volume required to produce tamponade…

…PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease, left sided cardiac disease…

…do not meet the established ECG criteria for STEMI, leading to delays in potentially life saving interventions. This limitation has been acknowledged in contemporary clinical…

…during the first days after ST elevation myocardial infarction (STEMI). The principal lesions are: Ventricular septal rupture (VSR), producing an acute left to right shunt…

…acquisition can shorten the time to diagnosis and facilitate triage of patients with suspected ST segment elevation myocardial infarction to a percutaneous coronary intervention capable…

…for life threatening polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with structurally normal hearts [2] . Epidemiologically, BrS is responsible for up to…

…Hyperkalaemia may cause ST segment elevations in V1–V3 that resemble those in Brugada syndrome. This disorder is easy to diagnose with a simple blood…

…NSTEMI (Non ST Elevation Myocardial Infarction). Orientation of myocardial fibers The orientation of myocardial fibers varies, and this allows the left ventricle to contract in…

…V2 through V6; and ST segment elevation in lead aVR (which corresponds to an identical ST segment depression in the inverted lead aVR). A notch…

…causes reciprocal ST segment depressions in V1–V3 (occasionally V4). Leads V7–V9 must be placed to reveal the ST segment elevations. North American (AHA…

…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…

…narrow at the top. Refer to Figure 1 . Patients with left ventricular hypertrophy may instead display normalization of secondary T wave inversions (lead V5, V6…

…block −90° to ±180° Extreme axis deviation Amplitude criteria Criterion Threshold Suggests : : : Sokolow–Lyon S in V1 + R in V5/V6 35 mm Left ventricular…

…an acute coronary process. Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce…

…characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and a consequent excess risk of premature atherosclerotic cardiovascular disease (ASCVD)…

…PDEI) activity, which may contribute to its inotropic profile. The drug possesses an active, acetylated metabolite with a half life exceeding 80 hours, allowing for…

…hypotension, or evidence of low output despite relatively limited elevation of left sided filling pressure. Evaluation and physical examination Initial assessment should establish whether the…

…to identify inducible myocardial ischaemia and to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left…

…Japanese word for a kind of octopus trap (the left ventricle takes the shape of that octopus trap). Refer to Figure 1 and Figure 2…

…the chest leads (V1 through V6) are displayed on the ECG paper in their anatomically contiguous order from right anterior (V1) to left lateral (V6)…

…The ventricular rate and its relationship to symptoms and haemodynamic status Whether heart failure is present and whether left ventricular systolic function is depressed or…

…exclusively at the infarct related artery (IRA), or it may extend to additional non infarct related lesions. Culprit only revascularization treats the artery responsible for…

…a detailed list of physical examination findings or a specific examination sequence. It does, however, emphasize that symptoms and vital signs contribute to initial triage…

…solely as an isolated coronary event. SCAD predominantly affects the left sided coronary circulation and may involve multiple vessels. Pregnancy associated SCAD can occur at…

…elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). The traditional term “vulnerable plaque” describes an atherosclerotic lesion thought to be susceptible to…

…a patient with chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic heart disease…

…into the left ventricle during diastole. The flow of blood into the ventricle causes volume overload, which exhausts the ventricle and ultimately leads to dilatation…

…L per hour for a total of 4 6 mEq/L in 24 hours may be targeted. Chronic Hyponatremia ( 48 hours duration): Due to cellular…

…complex is actually a reflection of left ventricular depolarization. QRS duration is the time interval from the onset to the end of the QRS complex…

…the electrical potentials generated by the left ventricle. QRS duration QRS duration is the time duration from the start to the end of the QRS…

ECG Introduction to ECG interpretation 1. Which of the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family…

…crucial to distinguish Type 2 MI from acute and chronic myocardial injury. Myocardial injury is characterised by myocyte necrosis and troponin elevation due to mechanisms…

…available. Recall that ST segment elevations also become normalized as a part of the natural course of myocardial infarction (refer to Figure 2 below). However…

…these elevations and depressions with those caused by STEMI (STE ACS). Indeed, several studies have shown that the majority of patients inappropriately referred to the…

…Ventricular rupture : A transmural infarction can cause a rupture in the left ventricular free wall. Mediastinal trauma : Penetrating injuries to the mediastinum can cause tamponade…

…attention due to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm…

…de Winter's sign, widespread ST segment depressions) that point to the left anterior descending artery (LAD) as the culprit. The coronary arteries: a brief…

…with ST segment elevations not seen previously. ECG Case 2: Ventricular tachycardia progressing to ventricular fibrillation Below are sequential ECG recordings during a sudden cardiac…

…chest leads may indicate an acute occlusion in the LAD (left anterior descending artery). This ECG pattern is referred to as de Winter's ECG …

…applying a 5 minute occlusion reflow cycle repeatedly to the circumflex artery before a 60 minute occlusion of the left anterior descending coronary artery (LAD)…

…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 : …

…to negative chronotropic effect. • In patients with pheochromocytoma, cocaine or methamphetamine overdose, prior treatment with alpha blockade is necessary before administering labetalol (risk of elevating…