…account for a substantial proportion of sudden cardiac death in young athletes. Clinically, they may be categorized according to whether they are: Not associated with…

…For obvious reasons, more complex defects are typically diagnosed earlier. Defects resulting in reduced oxygen saturation are generally detected with neonatal pulse oximetry (POX) screening…

…segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment…

…should lead to suspicion of ischemia (if the patient has symptoms consistent with ischemia). The same is true for artificial pacemakers (virtually all pacemakers stimula

…guideline criteria for ischemic ST segment elevation: New ST segment elevations in at least two anatomically contiguous leads: • Men age ≥40 years: ≥2 mm in…

…to such ECG changes. It must also be noted that the J point is occasionally suboptimal for measuring ST segment deviation. This is explained by…

…as compared with other segmentation models. Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left ventricle is divided into 17 segments for 2D…

…an accessory pathway). This is associated with a delta wave. For further details on the PR interval and the PR segment, refer to The normal…

ECG Video lecture: The ST segment: J point, J 60 point, ST depression & ST elevation

…of the P wave, PR interval and PR segment The P wave ECG interpretation usually starts with assessment of the P wave. The P wave…

…wave The transition from the ST segment to the T wave is smooth, as is the transition between phases 2 and 3 of the action…

…Sinus rhythm. Relatively large T waves in V2 V3, with ST segment elevations. Relative to the R waves, T waves are too large and pointed…

…segment elevation myocardial infarction (NSTEMI) is considered within the spectrum of non ST elevation acute coronary syndrome (NSTE ACS). The clinical spectrum includes patients with…

…present for more than 2–3 hours. Patients with a working diagnosis of STEMI should, whenever possible, be transported directly to a hospital with 24…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

…on ST segment elevation as the key trigger for emergent reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary…

…Transmural ischemia yields ST segment elevations on ECG. ST elevations are the hallmark of STEMI. However, there are situations with transmural ischemia that do not…

…the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction…

…The P wave, PR interval and PR segment ECG interpretation starts with assessment of the P wave and PR interval. The P wave is generated…

…ST segment elevation in the right precordial leads—and a propensity for life threatening polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with…

…blockers: withheld 2–3 days before the test only when the question is purely diagnostic and the target heart rate is needed for the test…

…conditions can produce ST segment elevations that mimic acute myocardial infarction. Acute pericarditis is a primary differential diagnosis and presents with distinct characteristics compared to…

…LV endocardium, typically overlying an akinetic or dyskinetic myocardial segment after myocardial infarction (MI). It is particularly associated with extensive anterior or transmural infarction, apical…

…specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow may also occur in association with other procedural complications…

…patients with suspected ST segment elevation myocardial infarction to a percutaneous coronary intervention capable hospital. The initial ECG should be interpreted in conjunction with the…

…the overlapping of vulnerable plaque and thrombogenic blood, which are critical determinants for infarction occurrence and extension. Plaque rupture or erosion leads to thrombus formation…

…a more distinct transition from ST segment to T wave and lower T wave amplitude. The T wave should be concordant with the QRS complex…

…with NSTE ACS undergoing angiography, approximately 10% have no critical epicardial stenosis. In some of these patients, microvascular obstruction or epicardial spasm may account for…

…be obtained immediately after ROSC in order to identify cases with ST segment elevations, which demand urgent coronary angiography with the intent to perform PCI…

…correlate well with the severity and extent of ischemia. In the setting of moderate ischemia, the myocardium becomes hypokinetic, meaning that the ischemic segments contract…

…sinoatrial pause (sinus pause/arrest): ECG characteristics & clinical implications A sinoatrial arrest occurs when the sinoatrial node does not discharge an impulse for ≥2 seconds…

…ST segment The T wave The U wave The QT interval (QTc) Neonatal reference values Davignon et al. The ranges are 98 % confidence intervals, with…

…segment 40 mm in diameter. Thresholds for surgery Threshold for surgery Relevant patient category 27.5 mm/m 2 Turner syndrome 40 mm • Patients with…

…cardiac abnormalities, nor coronary artery disease. Another male patient, with similar ST segment changes, experienced syncopal episodes, ventricular tachycardia (including torsades des pointes), ventricular fibrillation…

…elevated cardiac troponin concentration and new ST segment depression in new onset AF should not automatically be labelled type 2 myocardial infarction without further assessment…

…likely to develop in the arterial segment proximal to the bridge, particularly in older adults. Consequently, an adult with bridging and a substantial proximal atherosclerotic…

…to invasive coronary angiography (ICA) for excluding non ST segment elevation acute coronary syndrome (NSTE ACS) in patients with a low to intermediate likelihood of…

…with increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and…

…amenable to PCI. Stent selection must nevertheless be integrated with lesion anatomy, clinical presentation, bleeding risk, the anticipated need for non cardiac surgery, procedural complexity…

…exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD…

…Incomplete lesion preparation Persistent stenosis within the treated segment Mechanical factors are particularly important because correction of the underlying problem is necessary for durable treatment…

…approximately 5–20 µm depending on the system, compared with roughly 70–200 µm for gray scale IVUS. This allows detailed visualization of the lumen…

…therefore heterogeneous. Irreversibly scarred regions may alternate with viable segments that are dysfunctional because of repeated ischemic episodes or chronic reductions in perfusion. The amount…

…coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18…

…although the SYNTAX score is more widely used. Anatomical assessment should be integrated with clinical variables rather than applied in isolation. A multidisciplinary heart team…

…acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R waves ( Figure 2 shows right ventricular hypertrophy). The following…

…capacity, low affinity transporter situated in the S1 and S2 segments of the renal proximal tubule. It accounts for approximately 90% of renal glucose reabsorption…

…Acute native vessel thrombosis Stent thrombosis Mechanical complications of myocardial infarction Pericarditis Dynamic recurrence of ST segment elevation is particularly concerning for a new infarction…

…the Romhilt Estes point score system for diagnosing LVH assigns 2 points for left axis deviation that is greater than or equal to 30 degrees…

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

…patients with NSTE ACS, the condition is classified as unstable angina (UA) . Please refer to Diagnostic Criteria for Myocardial Infarction for further details. Figure 2…

…segment depressions with curved ST segment (generalized implies that the depressions may occur in most ECG leads). Refer to Figure 1 . Figure 1. ST segment…

…heart rhythm and conduction Effect on sinoatrial (SA) node SA node function may become worse in patients with established SA node disease (sinus node dysfunction…

…nor cardiac rhythm, or impulse conduction. 2. Calcium Hypercalcemia Causes of hypercalcaemia Primary hyperparathyroidism and malignancies cause 90% of all cases of hypercalcemia. Less common…

…management strategies. For instance, administering nitroglycerin to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing…

…least two anatomically contiguous leads. In patients with STEMI, ST segment elevations and pathological Q waves occur in the same leads, which is why pathological…

…of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1. Etiologies in acute endocarditis. Table 2…

…coronary angiography with the intent of performing PCI. The COACT, PEARL and TOMAHAWK trials studied patients with ROSC who did not display ST segment elevations…

…Rest Imaging : Conducted after a predefined interval to allow for radiotracer clearance or with a different radiotracer to capture myocardial blood flow under baseline conditions…

…in chronological order: Heart rate Rhythm P wave PR interval QRS complex ST segment T wave U wave QT (QTc) interval Pediatric and neonatal electrocardiograms…