…disease causing variants have been described [12]. Wild type ATTR (ATTRwt): A sporadic, age related disease characterized by a normal TTR genetic sequence [9, 19]…

…block: ECG criteria, clinical characteristics & management In this chapter, the focus will be on second degree atrioventricular (AV) block. Before proceeding, it is advised to…

…be carried out by anyone. The reader will gradually notice that ECG interpretation is markedly facilitated by using an algorithm, as it minimizes the risk…

…to the fact that the left ventricle pumps against greater resistance and any disturbance in ventricular activation will reduce the efficiency of the pumping function…

…Because the impulse originates in the atria it will pass through the bundle of His and therefore produce a normal QRS complex (provided that intraventricular…

…arrest will ensue. Progression from first degree AV block to third degree AV block is rare. Progression from second degree AV block Mobitz type 1…

…electrocardiogram (ECG) is of clinical importance. Diagnosis and management of ventricular tachycardia will be addressed in a separate chapter. The following arrhythmias are discussed in…

…high value As required, in addition to the mealtime dose Never stop basal insulin in a person with type 1 diabetes , not even before fasting…

…or as a substitute for mobilisation and bladder training. Contraindications Type Condition : : Absolute Suspected urethral injury — blood at the meatus, a perineal or scrotal haematoma…

…patient's dependence on pacing, the presence of CRT, the type and location of surgery, and the anticipated current pathway. In a pacing dependent patient…

…treatment. It is associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of hypertension, type 2 diabetes, coronary disease, stroke…

…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…

…appearance of the flutter waves will depend on the location and direction of the re entry circuit. In the most common type of atrial flutter…

…be considered a basic clinical skill. Pacing activity may be visible or invisible, depending on e.g the type of pacemaker, intrinsic cardiac activity, etc…

…artery. Depending on the size and form of the thrombus, it will occlude the main pulmonary artery or its branches. The larger the thrombus, the…

…that type of normalization is much slower and it is explained by the gradual death (and thus the disappearance of membrane potential) in the ischemic…

…myocardium , myocardium, or simply myocardial cell, refer to this cell type, and these terms are used interchangeably. Cardiac cell architecture In contrast to skeletal muscle…

…pause. Refer to Figure 2 (below). This type of block, where there is a gradual exhausting of the conduction before it is completely blocked, is…

…virtually always accompanied by impaired left ventricular systolic function. It should be noted that several types of cardiomyopathies ( e.g ischemic cardiomyopathy, tachycardia induced cardiomyopathy…

…atrial enlargement and ventricular enlargement . From a hemodynamic standpoint, there are two types of enlargement, namely hypertrophy and dilatation. Both hypertrophy and enlargement may reduce…

…abnormalities. Assessment of wall motion abnormalities is particularly important in the setting of chronic or acute coronary artery disease. All types of ischemia– chronic, acute…

…Hence, the ventricles will be activated normally via the His Purkinje system and therefore the QRS complexes are normal (QRS duration < 0.12 s)…

CPR This chapter will introduce the most common and essential terms used in resuscitation science, providing a foundation for understanding subsequent chapters. SCA (Sudden Cardiac…

…procedure must be explained carefully to the patient, who must also be informed that his/her performance will affect the validity of the test. Hence…

…Rhythms arising near the atrioventricular node: junctional rhythm (escape rhythm) and junctional tachycardia In this article, you will learn about rhythms arising in, or near…

…ECG Ventricular fibrillation, pulseless electrical activity (PEA) and sudden cardiac arrest This chapter will focus on ventricular fibrillation and pulseless electrical activity (PEA). These are…

…the patient has not kept a diary. The set up and the instructions decide whether the investigation will be usable. Ambulatory blood pressure monitoring (ABPM…

…outside them . Order twelve tests in a healthy person and the probability is around 46 % that at least one will fall outside. The ranges below…

…of a fine needle, and collapsed veins mean that the fine needle is in addition the only one that will go in. The rule that…

…to its depth, and has not been assessed for tendon and nerve injury will heal badly however neatly the suture is placed. The commonest cause…

…from trivial and the stakes are high; mastering ECG interpretation will frequently be a matter of life and death. ECG interpretation is a sophisticated art…

…the intensity of reflected sound waves. Structures with high echogenicity will reflect more ultrasound and appear brighter on the image. Structures with low echogenicity reflect…

…cells in contact with the lead tip, and thus generate an action potential that will spread through the myocardium. Components of an artificial pacemaker Pacemakers…

…of congenital heart disease in the general population, such that most clinicians will regularly encounter patients with CHD. Approximately 95% of all incident cases of…

…waves) is stationary, then the reflected sound waves will have the same frequency as the sound waves emitted by the sound source. If the reflector…

…acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (Non STEMI, NSTEMI) in…

…determine whether the ECG waves and intervals are normal. This chapter will focus on the ECG waves in terms of morphology (appearance), durations and intervals…

…from the right ventricle. The electrical impulse will propagate through the left ventricle partially or entirely outside the specialized conduction system. This slower conduction results…

…ventricular contractions or just ventricular beats/contractions/complexes . These terms will be used interchangeably in this discussion. A premature ventricular complex is recognized on the…

…when liquid flows through a circular orifice. The flow will converge and accelerate just proximal to the orifice. The change in flow profile results in…

…the physiology of the T wavewas previously provided. Only aspects relevant to ischemia will be discussed here. The T wave is notoriously difficult to judge…

… plan as though cardioversion will occur Target rate in the acute phase: a resting ventricular rate < 110/min is a sufficient initial target in…

…any decision to limit treatment when time allows. There is complete upper airway obstruction where laryngoscopy will not succeed; plan for a surgical airway or…

…with a grinder, a drill, a lawnmower, or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute…

…this post I would like to discuss hot topics related to coronary artery disease and I will emphasize on issues that are typically raised by…

…the ECG course in order to obtain your certificate. New ECG test will be added in February. Continue to log in if you are already…

…may be accompanied by inferior infarction if the occlusion affects both vascular territories. This will result in ST segment elevations in II, aVF and III…

…Thus, an individual plaque’s morphology does not reliably establish that it will cause an acute event. A more clinically useful model considers both the…

…stroke volumes. Failure to increase cardiac output sufficiently will result in the following compilations: Pulmonary edema develops due to rising LAP and LVEDP. Cardiogenic shock…

…as well as several supplementary methods, will now be discussed in detail. E/A ratio: Blood flow across the mitral valve Flow velocity across the…

…the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are…

…managed as a distinct clinical entity. The hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during…

…wide complex tachycardia (WCT) . This initial distinction will guide the rest of the thinking needed to arrive at a final diagnosis. Narrow (normal) QRS complexes…

…channel blockers (inhibitors). The reader will notice that most of these drugs are contraindicated in patients with structural heart disease, as well as patients with…

…arrhythmias, conduction defects Cause of termination This article will discuss each of these six parameters in detail. Symptom during exercise stress testing Perceived exertion The…

…This article will deal with the physiology of exercise and emphasis will be placed on myocardial oxygen consumption and the development of myocardial ischemia during…

…If the achieved workload is not sufficient, the reliability and thus usefulness of the test will be inadequate. The whole purpose of the exercise ECG…

…the ischemia/infarction. The location of the thrombus in the artery: a proximally located thrombus will cut off blood flow to more branches, and thus…

…fascicular block, the myocardium without fascicular supply will depend on impulses spreading from other parts of the ventricle (where the fascicle is intact). Figure 1…

…moving towards the sound source, will be reflected with higher frequency than the sound waves emitted from the sound source. Sound waves that hit an…