…insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and the descending colon is…

…pain and pain in the palliative phase. Severe breathlessness in the palliative phase (at lower doses than for pain). An opioid is rarely the right…

…the highest oxygen demand. The right ventricle and the atria work against much lower resistances and therefore have lower oxygen demands. The wall thickness is…

…which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and the right needle length. Indications Route Typical drugs Absorption :…

…a rising blood pressure with bradycardia. A known or suspected intracranial space occupying lesion with mass effect and midline shift. Ongoing anticoagulant treatment or marked…

…1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites, and hepatic enlargement [8, 10…

…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…

…due to the lower risk of thrombosis and evidence demonstrating long term durability (Filsoufi et al). Percutaneous interventions lack long term safety and efficacy data…

…Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac amyloidosis, BNP…

…the right precordial leads [7]. Septal q waves are usually absent [7]. Stricter Criteria : These require a QRS duration exceeding 140 msec in males and…

…PCI because of endothelial dysfunction, leukocyte and platelet interaction, distal thrombotic debris, cardiomyocyte swelling, interstitial edema, and inflammatory extravascular compression. This impaired tissue perfusion can…

…be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally…

…their capital letters (Q, R, S), and small waves are referred to by their lower case letters (q, r, s). Figure 5 shows examples of…

…ECG as increased amplitudes of the QRS complexes. The explanation is straightforward: myocardial muscle mass is increased and therefore it generates greater electrical potentials. However…

…intrathoracic pressure decreases during inhalation, which lowers pressure in the pulmonary veins and left atrium; this facilitates blood flow from the pulmonary veins to the…

…reflected with a lower frequency than the sound waves emitted from the sound source. The difference in frequency between the emitted and the reflected sound…

…only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac arrest often exhibit favorable neurological outcomes…

…lower than the risk among patients with Brugada syndrome. It follows that Brugada syndrome is a likely diagnosis in patients presenting with these symptoms and…

…ability to relax and stretch out during diastole. During IVRT the pressure in the left ventricle decreases and when it is lower than left atrial…

…activation of the ventricular myocardium. The ventricles should be depolarized (activated) by impulses spreading through the left and right bundle branch, which branches out into…

…unreliable, such that they may cease and thus cause cardiac arrest. Junctional escape rhythm is more reliable (the risk of cardiac arrest is considerably lower)…

…function also lowers pulmonary arterial and pulmonary capillary wedge pressures, thereby reducing the load faced by the failing right ventricle. Clinical presentation and symptoms Clinically…

Right ventricle and pulmonary artery Normal interval Mildly abnormal Moderately abnormal Severely abnormal RV DIMENSIONS Basal RV diameter (RVD 1), cm 2.0–2.8…

…hallmark of both RBBB and LBBB is the QRS duration which is by definition 120 ms or longer. ECG criteria for right bundle branch block…

…V6, I and aVL displays smaller R waves than normal. Along with larger R waves in right sided leads, the R wave progression may be…

…ventricular function affects right ventricular function via afterload. In the case of left ventricular failure, the pressure in the pulmonary vessels rises and the pressure…

…lead to a suspicion of ARVC. The gradual loss of myocardium leads to ventricular dilation and right heart failure. Biventricular heart failure is less common…

Reference values for atrial size and volume Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly abnormal Moderately abnormal Severely abnormal…

…is also referred to as P mitrale , and right atrial enlargement is often referred to as P pulmonale . The reasons for this are explained below…

…shaped appearance in short axis views. The increased pressure may also propagate back to the right atrium and venous system, resulting in dilation of vena…

…multiple leads P pulmonale Figure 1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left…

Cardiology Introduction Since its initial description in 1992 as a syndrome of right bundle branch block, ST segment elevation, and sudden cardiac death (SCD), Brugada…

…in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and makes it visible even…

…medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury…

…clinical implications & Sgarbossa criteria Contrary to right bundle branch block, left bundle branch block is always a pathological finding that affects cardiovascular and total mortality…

…that Figure 1 is a right dominant system (i.e PDA is supplied from RCA). Figure 1. The coronary arteries and their relation to the…

…or surgical embolectomy where available. A vasopressor (noradrenaline) and cautious fluid administration. Large fluid volumes worsen an already strained right ventricle. Clinical probability in the…

…cortisol assay, whether the samples were taken at the right times, and whether you know which decision threshold your own laboratory's method uses. In…

…a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling…

…lesions are: Ventricular septal rupture (VSR), producing an acute left to right shunt. Ventricular free wall rupture, producing haemopericardium and cardiac tamponade. Papillary muscle rupture…

…QTc ≥ 480 ms for females) C: Incomplete Right Bundle Branch Block (rSR' pattern in lead V1 and qRS pattern in V6 with QRS duration <120…

…V5, V6, I and aVL) and deep S waves in right sided leads (V1, V2) indicate that the vector of the left ventricle is amplified…

…right bundle branch block (C). One large box equals 100 ms at paperspeed 25 mm/s. Figure 2 shows 12 lead ECGs demonstrating right and…

…LBBB) nor a right bundle branch block (RBBB). The QRS morphology of nonspecific intraventricular conduction delays may vary substantially. Definition and causes of nonspecific intraventricular…

…in the main pulmonary artery, and thereby increased afterload on the right ventricle. This increases the load on the right ventricle, which therefore requires more…

…artery dilation Pulmonary regurgitation results in right ventricular volume overload, which gradually causes right ventricular failure. The ventricle and RVOT (right ventricular outflow tract) become…

…leads ≥ 1.0 mm V7–V9 (posterior) ≥ 0.5 mm V3R–V4R (right ventricle) ≥ 0.5 mm (≥ 1.0 mm in men < 30 years…

…pharyngeal swelling, obesity N eck mobility Reduced neck mobility, a cervical collar, rheumatoid arthritis, ankylosing spondylitis MACOCHA is validated for the intensive care patient and…

… it does not exclude Diastolic collapse of the right atrium and right ventricle The cardinal echocardiographic finding A dilated inferior vena cava without respiratory variation…

Info Brugada's algorithm is the most used algorithm for distinguishing ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with wide QRS complex. The algorithm entails…

…shunt] Calculating Shunt Fraction (Qp/Qs) Using Echocardiography: A Guide to Methods and Clinical Relevance The shunt fraction (Qp/Qs) is a critical hemodynamic parameter…

…B In patients with inferior myocardial infarction, consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum…

…regurgitation Jet size < 5cm² 5 10 cm² 10 cm² size vena cava inferior < 2,1 cm and compressible in between 2,1 cm…

…in a craniocaudal direction down the right atrial free wall, traverses the cavotricuspid isthmus (CTI) at the inferior boundary, and ascends in a caudocranial direction…

…preserved cardiac output; increased venous and intra abdominal pressures, impaired renal venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the…

…in the pulmonary circulation, which explains why the left ventricle is much larger (ventricular volume and muscle mass) than the right ventricle. Refer to Figure…

…relatively small muscle mass. If the rhythm is sinus rhythm (i.e under normal circumstances) the P wave vector is directed downwards and to the…

…the normal heart axis is between –30° and 90°. If the axis is more positive than 90° it is referred to as right axis deviation…

…the normal heart axis is between –30° and 90°. If the axis is more positive than 90° it is referred to as right axis deviation…

…rate) among persons with heart disease. Alternating block (right and left bundle branch block alternating from one beat to another) is uncommon. Ashman's phenomenon :…