…etc. Right ventricular load is thus an issue that is raised both in outpatient and emergency care. To evaluate the presence of right ventricular load…

…components of the ventricular conduction system, including the right bundle branch (RBBB). In the presence of right bundle branch block, depolarization of the right ventricle…

…I C If time from symptom onset is 12 h, a primary PCI strategy is indicated in the presence of ongoing ischemic symptoms, haemodynamic instability…

…manifestations of severe right ventricular failure. Typical findings include: Jugular venous distension Kussmaul’s sign Hepatomegaly Hypotension, which may or may not be present Markedly…

…be ignored. The most common situation is when assessing aortic stenosis in the presence of a narrowing of the LVOT (left ventricular outflow tract). Such…

…either RV dysfunction or elevated biomarkers, or neither of these abnormalities in the presence of abnormal clinical risk assessment. Low risk PE is characterized by…

…right ventricular free wall is being compressed by the fluid. Video source.gif). ECG changes caused by pericardial effusion and cardiac tamponade Small amounts of…

…progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant…

…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…

…R wave in V5 and V6. Secondary ST T changes occur invariably in the presence of LBBB. The following ECG criteria and characteristics are used…

…and V6; occasional RS pattern in V5 and V6 [3] Presence of LVH pattern; slurring and notching of the tall R wave upstroke [3, 7…

…former). Even small pressure elevations on the right side can compromise venous return to the right ventricle. Therefore, in the presence of a tamponade, chest…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…severe pulmonary stenosis, alongside right ventricular hypertrophy (RVH) and right atrial enlargement [8]. RAD is present in most cases of significant RVH, although it is…

…supply of the conduction system Figure 1 presents the components of the conduction system and the arterial blood supply. The first third of the right…

…The inhibition of pacing is appropriate when there is intrinsic cardiac activity; the presence of spontaneous atrial or ventricular activity should inhibit pacing in the…

…in the left atrium (most of them originate from the atrial septum). In 15 20% of cases, the tumor is localized in the right atrium…

…It was believed that the mere presence of physicians and nurses caused harmful stress. Approximately 30% of patients died in the hospital and fatal tachyarrhythmias…

…cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with…

…important to note that a traditional 12 lead ECG only presents a few seconds of myocardial electrical activity and there is a chance that ischemic…

…supplies the posterior descending artery (PDA) in a left dominant circulation (i.e. 10 15% of cases). Clinically, patients present with severe chest pain, diaphoresis…

…paper. It would be more efficient to present the limb leads in their anatomically contiguous manner; that is, from left superior basal to right inferior…

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…

…right side of the corresponding image marker in the ultrasound image. Similarly, structures located on the left hand side of the index marker are presented…

…setting of rheumatic valvular disease. The regurgitation is considered severe if the tricuspid annulus diameter is 4 cm. Severe tricuspid regurgitation results in right ventricular…

…interpretation of the Doppler signals. Figure 1. The image on the left shows many sample volumes within a Doppler sector. The picture on the right…

…into the right ventricle during diastole. The most common cause of abnormal pulmonary regurgitation is pulmonary hypertension. Table 1 presents the causes of pulmonary regurgitation…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…

…gradient across the valve (ΔP) from right intraventricular pressure. The systolic PA pressure is an indicator of cardiac hemodynamic status and may be estimated…

…filled normally, there is more room for the right ventricle, the filling of which increases and the septum bulges into the left ventricle. During exhalation…

…impaired renal venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of congestion by producing a negative sodium…

…observational databases report approximately 5–10%. Only about 10% of patients who develop shock present with it at hospital admission; approximately 90% deteriorate during hospitalization…

…may be present despite a high atrial rate (for example atrial fibrillation) if the block in the AV node is high grade. Causes of tachyarrhythmia…

…of ultrasound image. This view is called parasternal long axis view. The ultrasound image contains several important parameters (Figure 4). The ECG signal is presented…

…It generally results from accumulation of pericardial fluid, blood, or, less commonly, a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure…

…not present with ST segment elevations on the conventional 12 lead ECG. These situations are as follows: Transmural ischemia located in the posterolateral portion of…

…reentry. In the common form of typical atrial flutter, the reentrant circuit is confined to the right atrium and travels in a counterclockwise direction. The…

…the pacemaker electrode is placed and stimulates the right ventricle. Hence, whenever a patient with a pacemaker presents with tachyarrhythmia and the QRS complexes appear…

…Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular…

…Please refer to these articles. ECG examples of each condition are presented below. The ECG in Brugada syndrome Brugada syndrome is a rare channelopathy (an…

…NSTEMI) since they present with ST segment depressions on the 12 lead ECG (recall that ST segment depression is the hallmark of NSTE ACS/NSTEMI…

…first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and…

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

…In the vast majority of cases, the re entry circuit in atrial flutter is located in the right atrium and it typically loops around the…

…4). Figure 1 . 12 lead ECG (presented according to Cabrera), recorded at 63 years of age, demonstrates concave upward ST segment depression in leads I…

…elevations resolve after normalization of potassium levels. Brugada like ECG changes may occur transiently after electrical cardioversion . Early repolarization also presents with J point elevation…

…be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome…

…3 years. Long term prognosis in aortiv stenosis is presented in Figure 3. Figure 3. Prognosis in aortic stenosis according to type of stenosis. The…

…dilated, light unresponsive pupils are indicative of cerebral anoxia or brain death and constitute an adverse prognostic sign. Notably, the presence of dilated, nonreactive pupils…

…of an epicardial coronary artery (i.e. STEMI), pathological Q waves can develop already within 2 hours after the onset of infarction. The presence of…

…The absence of symptoms indicates that the bradycardia is compensated by an increase in stroke volume. Symptomatic bradycardia may present with chronic or acute symptoms…

…the presence of CRT, the type and location of surgery, and the anticipated current pathway. In a pacing dependent patient, inhibition of pacemaker output may…

…heart failure or after myocardial infarction). Ventricular arrhythmias are easier to induce in the presence of arrhythmogenic substrates. A substrate is defined as a physiological…

…is caused by partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions…

…without the presence of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG…

… Is the clinical likelihood of true NSTE ACS low enough that non invasive evaluation is more appropriate? The presence of extensive comorbidity may alter the…

…dyspnoea, and the presence of risk factors or previously identified coronary calcification. Age and sex remain important determinants of the expected prevalence of obstructive CAD…

…factors. Plaque erosion Plaque erosion is increasingly recognized and is present in at least one third of acute coronary syndromes in the cited material. Eroded…

CPR Pneumothorax Pneumothorax is characterized by the presence of free air in the thoracic cavity. While this can occasionally be benign and manifest even in…

…Occlusion Myocardial Infarction (OMI) versus Non Occlusion Myocardial Infarction (NOMI). This method focuses on the presence or absence of ACO, rather than rigid ECG thresholds…