…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…

…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 :…

…which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the time to antibiotics that saves…

…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…

…and calcium, as well as through the direct activation of voltage sensitive calcium channels. At lower doses, dobutamine stimulates beta2 and alpha receptors, inducing vasodilation…

…stenosis results in increased right atrial pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily. Principles of management Medical therapies…

…markers of myocardial wall stress. They are released principally by ventricular cardiomyocytes in response to increased transmural stress and ventricular stretch. Atrial natriuretic peptide is…

…leads, and narrow r waves followed by broad, deep S waves in the right precordial leads [7]. Septal q waves are usually absent [7]. Stricter…

…may occur. Pain usually involves the central chest or epigastrium, may radiate to the arms, and less often to the abdomen, back, lower jaw, neck…

…inferoposterolateral or right ventricular involvement Pre existing abnormalities such as prior infarction, left bundle branch block, Wolff–Parkinson–White patterns or ventricular pacing STEMI and…

…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…

…left ventricular enlargement, right ventricular enlargement and atrial enlargement. Below follows a discussion on the principles and differences of dilatation and hypertrophy, as well as…

…right atrium leads to a decrease in atrial filling. Respiratory variations in E wave velocity Under normal circumstances, intrathoracic pressure decreases during inhalation, which lowers…

…exceptions. Prior to the Doppler era, hemodynamic assessments were performed by means of right heart catheterization (with Swan Ganz catheter [ pulmonary artery catheter ]). However, hemodynamic…

…cardiac arrest is 2.5%. As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest…

…chest pain (30%) and dyspnea (10%). The major ECG findings in ARVC are T wave inversion in V1–V3 (in the absence of right bundle…

…stretch out during diastole. During IVRT the pressure in the left ventricle decreases and when it is lower than left atrial pressure, the mitral valve…

…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…

…complexes. P waves may occur on the ST T segment ( Figure 1 , upper panel). The atrial rate is typically faster than the ventricular rate. It…

…management principle is preservation of adequate right ventricular preload while supporting left ventricular performance and systemic circulation. Improvement in left ventricular function also lowers pulmonary…

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…

…is by definition 120 ms or longer. ECG criteria for right bundle branch block (RBBB) QRS duration ≥0,12 seconds. Leads V1 V2: The QRS…

…the most common causes. ECG changes in right ventricular hypertrophy V1 and V2 shows larger R waves and smaller S waves. The R wave may…

Echocardiography Right ventricular strain When assessing the right half of the heart, it is important to familiarize yourself with the principles of hemodynamics and conditions…

…Likewise, the right ventricle may appear functionally and morphologically normal on echocardiography and cardiac MRI during the first two decades of life. The most common…

…m2 22 ± 6 29–33 34–39 40 22 ± 6 29–33 34–39 40 ​BSA, Body surface area; LA, left atrial; RA, right atrial.

…a reflection of right atrial activation and the second half is a reflection of left atrial activation. This is shown in Figure 1 (upper panel)…

…BSA. Basal segments of the right ventricle (i.e parts on the atrial side of the tricuspid annulus) function as atrium and becomes dilated. The…

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…

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…

…atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and…

…right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the intensity of monitoring, supportive treatment, anticoagulation, and possible reperfusion. The principal…

…ECG Myocardial ischemia and infarction Left bundle branch block (LBBB) in acute myocardial infarction (AMI): clinical implications & Sgarbossa criteria Contrary to right bundle branch block…

…and their relation to the ECG leads. Note that Figure 1 is a right dominant system (i.e PDA is supplied from RCA). Figure 1…

…Large fluid volumes worsen an already strained right ventricle. Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs…

…steroid that cross reacts in the cortisol assay, whether the samples were taken at the right times, and whether you know which decision threshold your…

…death. The volume required to produce tamponade depends principally on the rate of accumulation and the compliance of the pericardium. Rapid accumulation may cause tamponade…

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

…B: Prolonged QT interval (QTc ≥ 480 ms for females) C: Incomplete Right Bundle Branch Block (rSR' pattern in lead V1 and qRS pattern in V6…

…and clinical characteristics in left ventricular hypertrophy (LVH) The following figure shows characteristic ECG changes in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH)…

…Consequently, depolarization of the left ventricle is achieved by impulses spreading from the right ventricle. The electrical impulse will propagate through the left ventricle partially…

…exists if the ECG displays a widened QRS appearance that is neither a left bundle branch block (LBBB) nor a right bundle branch block (RBBB)…

…flow via inferior vena cava to the right atrium and ventricle. The thrombus is pumped from the right ventricle through the pulmonary valve into the…

…considered a normal finding. The regurgitation results in blood flowing back from the pulmonary artery into the right ventricle during diastole. The most common cause…

…emphysema, amyloidosis ST elevation criteria in suspected infarction New ST elevation at the J point in two contiguous leads: Leads Threshold : : V2–V3, men ≥ 40…

…fibreoptic intubation. A difficult airway is anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI…

…With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the needle is followed all the way in, which has…

…4 in Brugada's algorithm) If the QRS complex in V1–V2 resembles a right bundle branch block (i.e positive QRS) V1 : Monophasic R…

…travels during systole. 3. Right Ventricular Outflow Tract (RVOT) Diameter Optimal View : Right ventricular inflow outflow (RVIO) view. Method : Under zoomed conditions, measure the RVOT…

…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…

…ZTime velocity integral of the tricuspid inflow (cm) 60 cm Pressure half time (T ½,ms) ≥ 190 ms Right atrium Pressure half time (T ½…

…superior vena cava. A critical area of slow conduction is consistently located in the posterolateral to posteromedial inferior region of the right atrium. This circuit…

…increased venous and intra abdominal pressures, impaired renal venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of…

…anatomical development during infancy & childhood In adults, the left ventricle is considerably larger than the right ventricle. This is the result of ventricular adaptation to…

…a reflection of right atrial depolarization and the second half is a reflection of left atrial depolarization. This is shown in Figure 3 (upper panel)…

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

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

…by the time the next impulse reaches the ventricles, the impulse will be blocked at that point. The length of the refractory period (see Basic…