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…

…had higher crude in hospital and 6 month mortality (up to 18% at 6 months for 1 mm elevation, vs 7.6% with no elevation)…

…A), left bundle branch block (B) and right bundle branch block (C). One large box equals 100 ms at paperspeed 25 mm/s. Figure 2…

…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…

…of activity, unlike typical exertional angina. A precipitating factor is identifiable in up to one half of cases. Reported precipitants include vigorous physical activity, emotional…

…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…

…at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias…

…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…

…is hereditary with an autosomal dominant inheritance pattern, meaning that only one mutated gene is necessary to develop the disorder. Till now (2016) more than…

…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…

…approximately one third of patients with inferior infarction. Extensive involvement is less common in patients with inferoposterior left ventricular infarction, while infarction confined predominantly to…

…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…

…ventricle. Studies from the US and Japan has estimated that up to 2% of patients referred to PCI with a suspicion of STE ACS/STEMI…

…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…

…STEMI is more frequent than NSTEMI, and up to two thirds of infarctions are anterior. The risk of ACS is greatest during the third trimester…

…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…

ECG Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms…

…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…

…particularly before laboratory results are available. Notably: Both hyperkalemia and hypokalemia can induce life threatening arrhythmias and cardiac arrest, with hyperkalemia being the most prevalent…

ECG Introduction to ECG interpretation ECG Interpretation: definitions, criteria, and characteristics of the normal ECG waves, intervals, durations and rhythm This is arguably one of…

…to as a QRS complex . However, one may also be more explicit and refer to such a complex as a QR complex. Because the left…

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…

…and marked normalization (return) of ST segment elevations. If the reperfusion is complete (after a total occlusion) the ST segment is normalized within one hour…

…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…

…with factors striving to lysate the thrombus (pro thrombolytic factors). The balance between pro thrombogenic and pro thrombolytic factors varies from one minute to another…

…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…

…are actually reciprocal (mirror images) to ST segment elevations. ST segment depressions with upsloping ST segment are rarely caused by ischemia, with one notable exception…

…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)…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…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…