…common agent. These streptococci most often originate from the oral cavity and affect heart valves that have some kind of damage, change or degeneration. Endocarditis…

…death. Important clinical features suggesting UA include a prolonged episode at rest, newly developed severe angina, or a clear deterioration in a previously stable pattern…

…in acute STEMI have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction), a rehearsal is provided below. Management of acute STEMI is…

…the characteristic clinical syndrome of breathlessness, fatigue and oedema. The underlying mechanisms are not uniform across the HFmrEF population. Some patients have a pathophysiological profile…

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…and arrhythmology ECG Diagnosis and management of narrow and wide complex tachycardia All clinically significant supraventricular and ventricular tachyarrhythmias have been reviewed in previous sections…

…course have been meticulously crafted. ECGwaves.com welcomes readers regardless of their previous training and profession. Read Dr Rawshani's book Below follows a review…

…a clinically unstable acute coronary syndrome, but the examination does not reliably establish or exclude the diagnosis. The ECG and serial assessment remain central. Diagnostic…

…If pathological Q waves occur as a result of myocardial infarction, the infarction may be classified as Q wave infarction (this has negligible clinical implication)…

…establish a working diagnosis of STEMI rapidly, identify haemodynamic or electrical instability and determine the appropriate reperfusion pathway. Important early clinical priorities include: Recognition of…

…recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD Characteristics suggesting that good…

…the patient is clinically unstable, identify life threatening diagnoses rapidly, and select a safe disposition and diagnostic strategy. Only a minority of patients presenting with…

…clinical diagnosis, often described as acute brain failure. It is precipitated by somatic illness, drugs, poisoning, withdrawal, surgery or several concurrent factors. A diagnosis of…

…against previous ECGs and with the clinical context. 1. Rhythm Check Is the ventricular rate regular at 50–100 beats/min? Is there a P…

…rhythm. Recognizing these arrhythmias on the electrocardiogram (ECG) is of clinical importance. Diagnosis and management of ventricular tachycardia will be addressed in a separate chapter…

…be maximal, which means that the clinician must set a lower goal regarding workload (e.g. reaching 70% of maximal pulse instead of 85%). Many…

…once the exercise is stopped. Some experts believe that these ST segment depressions represent a benign form of subendocardial ischemia. Refer to Exercise Stress Testing…

…or additional risk factors 55 mm (ascending aorta, aortic arch) All individuals 60 mm (descending aorta) All individuals Risk factors : previous dissection, family history of…

…Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in…

…management of sinus tachycardia is aimed at finding secondary causes that can be treated or, when no cause can be found, establishing a diagnosis of…

…a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or reduced exercise capacity. Suspected asthma or COPD — diagnosis and follow up. Risk groups: current or…

…fascicle. Approximately 5–10% of all individuals have a third fascicle – the median or centroseptal fascicle – which gives off Purkinje fibers to the interventricular septum…

…leads, as the diagnosis can often be established by examining fewer leads. On the other hand, for the purpose of diagnosing morphological changes (e.g…

…to a wax plug. The tympanic membrane cannot be inspected and the examination is needed for the diagnosis. Before audiometry or the fitting of a…

…be altered. In each of these blocks, the QRS morphology will have a characteristic appearance which makes it fairly easy to diagnose them. Altered electrical…

…diagnostic criteria According to the international consensus report of 2024, the diagnosis of DKA requires three components: diabetes or hyperglycaemia, ketosis and metabolic acidosis. A…

…Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min 1.5 Immobilisation ≥ 3 days or…

…on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and…

…the diagnosis alone. Indications Hypoxaemia: a saturation below the target range, or a PaO2 below 8 kPa on an arterial blood gas. Acute critical illness…

…Unna boot), or a class 2–3 compression stocking. Tape measure for ankle circumference — this governs the choice of material and bandaging technique. Procedure Assessment…

…A very simple rule of thumb can be applied to do this: whenever there are varying PR intervals, the diagnosis is Mobitz type 1 (Wenckebach…

…et al have presumably identified a novel familial (autosomal dominant) cardiac syndrome. The underlying genetic abnormality is yet to be discovered. Diagnosis of this syndrome…

…angina have been discussed previously (refer to Classification of Acute Coronary Syndromes, and Ischemia and the ST Segment and ST segment depressions), a rehearsal of…

…programming. The simplest pacemaker systems consist of a pulse generator and one lead, which is located either in the right atrium or the right ventricle…

…it is still used in clinical practice. M mode provides a one dimensional view of all reflectors (i.e structures reflecting ultrasound waves) along one…

…layer results in a twisting (rotating) motion of the entire left ventricle. Basal segments rotate clockwise, and the apex rotates counterclockwise. This rotating, or twisting…

…or the tricuspid valve. This is explained by the principle of continuity (the continuity equation) , which states that the volume of blood flowing into a…

…infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form of arterial hyperplastic…

ECG Myocardial ischemia and infarction T wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided…

…can present postpartum. Known hypertension and current antihypertensive treatment. Missed doses or abrupt withdrawal of a beta blocker, clonidine or another sympatholytic drug. Cocaine, amfetamine…

…the QRS complex will have a left bundle branch block morphology. However, left bundle branch block morphology is more common (regardless of heart rate) among…

…confusing ECG changes. ECG changes and arrhythmias caused by digoxin were discussed previously. Below follows a rather detailed declaration of ECG changes, arrhythmias and conduction…

…echocardiography. A common question is the presence of right ventricular load. This condition implies that the right ventricle is pressure and/or volume loaded. The…

…Myocardial Infarction) in terms of treatment and interventions. As discussed previously, STEMI is the result of a complete and proximal occlusion in a coronary artery…

…an arteriovenous fistula, previous axillary clearance or lymphoedema. A limb with paresis or marked swelling. A vein suspected of thrombosis or previously thrombophlebitic. Intraosseous access…

…study, PET, SPECT, genetic profiling — add information but are too costly or invasive to screen a population. The surface ECG is the obvious cheap, standardized…

…clinical problem. It can manifest as an increase in the frequency of a pre existing arrhythmia, the sustenance of a previously non sustained arrhythmia, or…

…specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics Non invasive assessment of ischaemia and viability Objective evidence of ischaemia is important…

…abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood…

…renal insufficiency, therapeutic interventions with tamoxifen or lithium, thiazide administration, and over supplementation of calcium and vitamin D. ECG in hypercalcemia Typical ECG changes: Shortened…

…Doppler effect, which was discussed previously (see Doppler Effect and Doppler Echocardiography). Only a brief summary of the Doppler effect is provided here. The Doppler…

…Hg systolic or 10 mm Hg diastolic leads to a doubling of the risk of stroke and acute myocardial infarction. • The threshold for diagnosing hypertension…

…physiology of the SA node and pacemaker cells in the heart have been discussed previously. Definition (criteria) for sinus rhythm Regular rhythm with a ventricular…

…Technical aspects of optimization of image quality have been discussed previously (refer to Optimization of the Ultrasound Image). Additionally, a number of transducer movements can…

…Relapse of VF and new shock. ECG 12 . Sinus rhythm. ECG 13 . Recurring VT. ECG 14 . Sinus rhythm, with ST segment elevations not seen previously…

…lines to create a 90° wide and 15 cm deep image requires approximately 40 milliseconds (ms). Increasing the number of ultrasound lines or image depth…

…bleeding, or a smaller measured blood loss if there is physiological compromise. Do not wait for hypotension in young, pregnant or previously athletic patients. Beta…

…effect of a coronary lesion depends on more than its visual diameter reduction. Relevant determinants include: Lesion eccentricity Vessel tortuosity Calcification Plaque rupture or asymmetric…

…including walking, household tasks, active commuting and recreational activities. Exercise is a more structured form of physical activity undertaken to maintain or improve physical fitness…

…begins with the clinical presentation, including the character and stability of chest discomfort, associated dyspnoea, and the presence of risk factors or previously identified coronary…