but I don't see any signs of left atrial enlargement on this EKG. We hope you enjoy the summaries. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. Support stockings may be beneficial. Echocardiogram This imaging technique uses sound waves to project a. In association with left ventricular hypertrophy: Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. normal sinus rhythm In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. [7] However, if atrial fibrillation is present, a P wave would not be present. Conditions affecting the left side of the heart. Electrocardiogram (ECG or EKG). Increased vagal tone (e.g., sinus bradycardia, first degree atrioventricular block [AVB]) and increased chamber size due to physiologic remodeling (e.g., left ventricular hypertrophy [LVH], bi-atrial enlargement) account for normal ECG patterns seen in highly trained athletes. Read More Created for people with ongoing healthcare needs but benefits everyone. This condition is usually harmless and does not shorten life expectancy. Surgical Fellow Doctoral Degree 997 satisfied customers EKG said sinus tachycardia, left atrial enlargement, EKG said sinus tachycardia, left atrial enlargement, borderline report. All patients had normal coronary arteriography, sinus rhythm, normal left ventricular volumes and function, no valvular disease, and no echocardiographic or ECG left ventricular hypertrophy. Research suggests that left atrium size as measured by an echo-cardiograph may be linked to cardiovascular disease. In most cases, limiting stimulants, such as caffeine and cigarettes, is all that is needed to control symptoms. Terminate or adjust any medications that cause or aggravate the bradycardia. LAE is often a precursor to atrial fibrillation. Learn more about conduction defects caused byischemia and infarction. [4], Obstructive sleep apnea (OSA) may be a cause of LAE in some cases. J Electrocardiol. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Simple guide to reading and reporting an EKG step by step. Healthy lifestyle behaviors and regular exercise are encouraged. Learn how we can help 290 views Answered >2 years ago Thank A 36-year-old female asked: It's located in the upper half of the heart and on the left side of your body. In fact, it has been considered that the bimodal P wave is better explained because of underlying interatrial block than the longer distance that the impulse has to go across6. poss left atrial enlargement Palpitations (sensation of fast or irregular heart beat) are the most common complaint among patients with Mitral Valve Prolapse. Aging itself causes left atrial growth, probably in relation to structural changes in the atrial tissue. It is important to note that in patients with ischemic heart disease, wide Pwaves with a left atrium of normal dimensions can be observed, probably due to a delay of the atrial conduction. eCollection 2014. Am Heart J. When left atrial enlargement occurs, it takes longer for cardiac action potentials to travel through the atrial myocardium; thus, the P wave also lengthens. The overflow capacity of attendees and number of live streaming participants exceeded 220 in total. Editor-in-chief of the LITFL ECG Library. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index. (P wave 2.5 mm in II and aVF). Sick sinus syndrome(sinus node dysfunction), which is a common cause of bradycardia, is also discussed separately. Atrial enlargement/abnormality often accompanies ventricular enlargement. display: inline; Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. Left atrial enlargement: This is caused by too much pressure on the heart, which could be related to high blood pressure, stress, and underlying heart disease. Also, LAE is a significant risk factor for developing atrial fibrillation. The following are the most common symptoms of Mitral Valve Prolapse. An enlarged heart may be temporary or permanent, depending on the cause. Left bundle branch block always warrants investigation. PR interval. Ther. Wide P wave with prominent negative component. Conditions that lead to left atrial enlargement include hypertension, heart valve problems, heart failure and atrial fibrillation 1. To learn more, please visit our. More information: Bays syndrome and interatrial blocks. and transmitted securely. Chest pain. If drug side effects are believed to be the cause, it is fundamental to judge the risk of terminatingdrug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Eugene H Chung, MD, FACC Figure 1. Influence of Blood Pressure on Left Atrial Size. Other blood pressure drugs. Patients with tachy-brady syndrome may also necessitate rate controlling drugs (e.g beta-blockers) and anticoagulation (if atrial fibrillation or flutter can be verified). This upper chamber of your heart receives oxygen-poor blood from your body. The left atrium receives newly oxygenated blood from. Type 1 Brugada ECG pattern (coved type) is abnormal. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. 13(5), 541550 (2015). Cardiac catheterization. This usually means you have an issue with your heart or lungs that's causing all of this. The EKG is just a guidance to help us . Appointments 800.659.7822. Depending on the severity of the leak into the left atrium during systole (mitral regurgitation), the left atrium and/or left ventricle may become enlarged, leading to symptoms of heart failure. Breathing and blood pressure rates are also monitored. But this change is not associated or caused by anxiet. The .gov means its official. T wave inversions in contiguous inferior leads or lateral leads warrant investigation in all athletes. hospital never told me. Circulation. normal sinus rhythm The length of the P wave in lead II is greater than 120 milliseconds, The downward deflection of the P wave in lead V1 is greater than 40 milliseconds in length, with greater than 1 millimeter negative deflection (< -1 mm in amplitude). Cookie Notice need cardio follow up? ECG criteria follows: Regular rhythm with ventricular rate slower than 50 beats per minute. Left Atrial Enlargement on the Electrocardiogram Advertising The passage of the electrical stimulus through the atria is reflected in the electrocardiogram as the P wave. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG (ambulatory recording). 8600 Rockville Pike Obesity has also been related to left atrial enlargement, although the mechanism is not very clear2. left ventricular hypertrophy is clearly related to the left atrial enlargement, so those causes that cause LVH as hypertension, aortic stenosis or hypertrophic cardiomyopathy can lead to left atrial enlargement. The interatrial block pattern presents a Pwave widening that is frequently bimodal, which often leads to interpretation as left atrial enlargement, but these two electrocardiographic patterns are two different entities5. Clin Cardiol. Before Anterior wall infarctions, on the other hand, generally leave permanent bradycardia and thus demand permanent pacemaker. Tests may be done to check blood sugar, cholesterol levels, and . The following are key points from his talk: Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology, Keywords: Sports, Athletes, Brugada Syndrome, Bundle-Branch Block, Torsades de Pointes, Hypertrophy, Left Ventricular, Atrioventricular Block, Hypertrophy, Right Ventricular, Atrial Fibrillation, Bradycardia, Depression, Electrocardiography, Cardiomyopathies, Long QT Syndrome, Syncope, Physical Examination, Diabetes Mellitus, Type 2. Get the latest news and education delivered to your inbox, Left Ventricular Hypertrophy (LVH) ECG Review, Poor R Wave Progression (PRWP) ECG Review, Right Atrial Enlargement (RAE) ECG Review, Right Ventricular Hypertrophy (RVH) ECG Review, Left Atrial Enlargement (LAE) ECG (Example 1), Left Atrial Enlargement (LAE) ECG (Example 2), Left Atrial Enlargement (LAE) with P-Mitrale ECG. Aortic insufficiency generates left cavities overload propitiating left atrial and left ventricular enlargement. Beta blockers, angiotensin-converting enzyme . A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. When the bradycardia causes hemodynamic symptoms it should be treated. Electrocardiogram (ECG) This imaging test records the electrical actions of the heart, including the speed of the heartbeats. Cardiomegaly can happen to your whole heart or just parts of it. 2 weeks dizzy on and off Bombelli M, Facchetti R, Cuspidi C et al. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis. The mean left atrial dimension was 3.46 +/- 0.3 cm in normal individuals versus 4.04 +/- 0.3 cm in the hypertensive patients (p less than 0.01). font: 14px Helvetica, Arial, sans-serif; Mitral regurgitation (backward is the bulging of one or both of the mitral valve flaps (leaflets) Note that patients with chronotropic incompetence may require pacemaker to increase exercise capacity and reduce symptoms. The Septal Q wave can hint on a possible left sided disease if any. It is estimated that mitral valve prolapse occurs in around 3 1. Its not uncommon to discover SB in healthy young individuals who are not well-trained. If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart. 2014 Mar 4;9(3):e90903. Bayssyndrome: the association between interatrial block and supraventricular arrhythmias. The mean PR interval at birth is 107 ms (Davignon et al). Athletes with left axis deviation or left atrial enlargement exhibited larger left atrial and ventricular dimensions compared with athletes with a normal ECG and those with other . #mergeRow-gdpr fieldset label { As per the report you have shared, there is normal sinus rhythm, along with normal intervals. As forventricular enlargement, the ECG cannot differentiate dilatation from hypertrophy, which is why some experts have suggested that the termatrial abnormality be used instead of enlargement. Privacy Policy. The negative deflection of biphasic (diphasic) P-waves is generally <1 mm deep. The https:// ensures that you are connecting to the This regurgitation may result in a murmur (abnormal sound in the AO 1.8 and ECG criteria independent of left atrial indexed diameter z-score C1: P wave duration 110msec C2 . While left atrial enlargement can cause chest pain and breathing problems, alerting you to the dangerous condition, right atrial enlargement usually develops with no symptoms at all. In secondary Mitral Valve Prolapse, the flaps are not thickened. need follow up? margin-top: 20px; Accuracy of left atrial enlargement diagnosed by electrocardiography as compared to cardiac magnetic resonance in hypertensive patients. Left atrial enlargement (LAE) is when the left side of the heart enlarges or swells, leading to breathlessness, fatigue, and other symptoms. Surawicz B, et al. Hypertension This category only includes cookies that ensures basic functionalities and security features of the website. had a stress test and holter monitor that came back normal 7 months ago. In some cases, patients may experience palpitations without observed dysrhythmias (irregular heart rhythm). There the circle starts. In case of sale of your personal information, you may opt out by using the link. In addition, the function of the heart and the valves may be assessed. #mc-embedded-subscribe-form .mc_fieldset { sharing sensitive information, make sure youre on a federal A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. The site is secure. In these cases, it is the morphology of the P wave in lead V1 that allows us to determine if there is a left atrial enlargement associated with interatrial block. Prognostic Significance of Left Atrial Enlargement in a General Population. Bays de Luna A, Platonov P, et al. These cookies track visitors across websites and collect information to provide customized ads. Learn how your comment data is processed. The symptoms of mitral valve prolapse may resemble other medical conditions or problems. I'm 68 fem ale, normal weight, swim 3hours a week, practice QiGong, read more DrKarenB Family Medicine Physician MD 373 satisfied customers Can you please read this? He has a passion for ECG interpretation and medical education | ECG Library |, MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. J Med Assoc Thai. A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. 2014; 64: 1205-1211. doi: 5. flow of blood), if present at all, is generally mild. Disclaimer. Left atrial enlargement , r-axis -57 Conditions affecting the left side of the heart", "Atrial Fibrillation (for Professionals)", "Recommendations for chamber quantification", Arrhythmogenic right ventricular dysplasia, https://en.wikipedia.org/w/index.php?title=Left_atrial_enlargement&oldid=1094952349, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 25 June 2022, at 14:45. The second hump in lead II becomes larger and the negative deflection in V1 becomes deeper. Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. ABC of clinical electrocardiography. results read "normal sinus rhythm with sinus arrhythmia. Usually the chest pain is not like classic angina, but can be recurrent and incapacitating. We conclude that echocardiographic left atrial enlargement may be an early sign of hypertensive heart disease in patients with no other discernible cause of left atrial enlargement. The P-wave in lead II may, however,be slightly asymmetric by having two humps. Your findings of low voltage QRS and borderline left atrial enlargement may not be significant, but it is worthwhile to have a cardiologist evaluate y You took a b complex viramin then felt ill and went to ED. This difference is more striking in the lead V1 where the Pwave has a biphasic morphology, with a first positive component (right atrium) and a second negative component (left atrium)1. Mitral valve prolapse, also known as click-murmur syndrome, This is also a normal finding. An axis of 57 degrees is not a 'ri Had an ecg that showed borderline abnormal, possible left atrial enlargement. An enlarged heart (cardiomegaly) describes a heart that's bigger than what is typical. Please enable it to take advantage of the complete set of features! padding-bottom: 0px; Left atrial size and risk of stroke in patients in sinus rhythm. The amplitude of the normal P-wave does not exceed 2.5 mm in anylimb lead. 43 year old female. EKG Left Atrial Enlargement l The EKG Guy - www.ekg.md Join the largest ECG community in the world at https://www.facebook.com/TheEKGGuy/Like this video and . Left atria is one of the chamber of heart out of four chambers its situated above left ventricle it takes oxygenated blood from lungs and forward it to left ventrical so if the left atrial is enlarged it is most commonly in association with diastolic dysfunction, left ventricular hypertrophy, mitral valvular disease, and systemic hypertension. background: #fff; Novel Electrocardiographic Patterns for the Prediction of Hypertensive Disorders of Pregnancy--From Pathophysiology to Practical Implications. The presence of a negative final component of the P wave in lead V1 greater than 40 ms may indicate left atrial enlargement5. Circ Cardiovasc Imaging. This can be in the form of aspirin or warfarin (Coumadin) therapy. . Without seeing the ecg and only given what you wrote, it isn't possible to know whether the ecg is abnormal or not. For the person with symptoms of dizziness or fainting, maintaining adequate hydration (fluid volume in the blood vessels) with liberal salt and fluid intake is important. Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. } Assessing the causal role of hypertension on left atrial and left ventricular structure and function: A two-sample Mendelian randomization study. It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia; in such scenarios, it is generally considered to be evidence based to implement an artificial pacemaker that will allow for drug therapy to continue. The passage of the electrical stimulus through the atria is reflected in the electrocardiogram as the P wave. Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. The presence of electrocardiographic signs of left atrial enlargement is one of the criteria for the diagnosis of left ventricular hypertrophy (LVH), this is one of the few signs of LVH detectable on the EKG in patients with right bundle branch block (read left ventricular hypertrophy). Int J Gen Med. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Heart palpitations. Ekg says "borderline ecg" and "probable left atrial enlargement." If a Type 2 pattern is seen, the ECG needs to repeated to ensure proper lead placement, and a repeat ECG with V1 and V2 in higher intercostal leads should be performed: if there is no evidence of a Type 1 Brugada pattern, no further assessment is required unless there is a history of syncope or relevant family history. Based on a work athttps://litfl.com. poss left atrial enlargement Enlargement of the left and right atria causes typical P-wave changes in lead II and lead V1 (Figure 1, second and third panel). These ECG changes, including T-wave inversions, can often return to normal with detraining (see below ECGs); outside the context of age <16 years and black ethnicity, T wave inversions beyond V2 should be investigated. Twitter: @rob_buttner. One or both of the flaps may not close properly, allowing the blood P-waves with constant morphology preceding every QRS complex. 2016 Aug 1;116(2):206-19. doi: 10.1160/TH15-12-0923. Common abnormal ECG readings that have a low likelihood of correlating with cardiac disease include the following: Isolated atrial enlargement, especially right atrial enlargement; Ectopic atrial rhythms*: right atrial, left atrial, wandering atrial pacemaker at normal rates; First-degree atrioventricular (AV) block; Borderline QTc 0.44-0.45 Editorial Team Lead, Sports & Exercise Cardiology Clinical Topic Collection. eCollection 2021. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Note that sinus bradycardia due to ischemia located to the inferior wall of the left ventricle is typically temporary and resolves within 12 weeks (sinus bradycardia due to infarction/ischemia is discussed separately). . Left atrial enlargement (LAE) or left atrial dilation refers to enlargement of the left atrium (LA) of the heart, and is a form of cardiomegaly . 2022 Nov 2;9:1006380. doi: 10.3389/fcvm.2022.1006380. This may be due to pulmonary valve stenosis, increased pulmonary artery pressureetc. Tiredness. But this change is not associated or caused by anxiet Anxiety isn't a cause of left atrial enlargement. borderline/ normal ecg These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. ECG data are read by doctors using a series of spikes and drops traced on paper. Additional procedures may include: Stress test (also called treadmill or exercise ECG). National Library of Medicine Weight gain. In addition, in lead V1, the depth of the negative final component is greater than the height of the initial part. References: P-waves with constant morphology preceding every QRS complex. Read More Created for people with ongoing healthcare needs but benefits everyone. Epub 2016 Apr 14. The normal P wave measures less than 2.5 mm (0.25 mV) in height and less than 0.12 s in length (3 small squares). Interatrial blocks. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. It is also composed of two components, an initial component where the depolarization of the right atrium is observed and a final component caused by the depolarization of the left atrium. Your heart rate increases when you breathe in and slows down when you breathe out. Unable to load your collection due to an error, Unable to load your delegates due to an error. The juvenile ECG pattern (T-wave inversion in leads V1-V3) is acceptable up to age 16 years. The normal P-wave contour on ECG The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. However, studies that have found LAE to be a predictor for mortality recognize the need for more standardized left atrium measurements than those found in an echo-cardiogram. Hypertension. Right atrial enlargement produces a peaked P wave ( P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2. The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. LAE is suggested by an electrocardiogram (ECG) that has a pronounced notch in the P wave. No patient met ECG criteria for left atrial abnormality. Review how to diagnose this on an ECG here. Vaziri SM, Larson MG, Lauer MS, et al. 2017 ecg normal. Seen a cardiologistecg normal apart from possible left atrial enlargement, no further tests done and discharged.please advise? } Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. could the abnormal been anxiety produced?, and is it something to be worried about? Signs and symptoms [ edit] Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. T32HL07350/HL/NHLBI NIH HHS/United States. Therefore, the criteria for diagnosing LAE on a 12-lead ECG is as follows: P-mitrale occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This site needs JavaScript to work properly. Surawicz B, et al. Analytical cookies are used to understand how visitors interact with the website. Left atrial enlargement is also referred to asP mitrale, andright atrial enlargement is oftenreferred to as P pulmonale. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate any narrowing, occlusions, or other abnormalities of specific arteries. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. . The presence of two or more borderline ECG findings warrants additional investigation to exclude pathological cardiac disease. The negative intrathoracic pressure may cause the left atrium to expand and stretch its walls during each OSA event. at home i saw that it said possible left atrial enlargement but dr said nothing about this. Biatrial abnormality implies that the ECG indicates both left and right atrial enlargement; i.e a large P-wave in lead II and a large biphasic P-wave in lead V1. However, each individual may experience symptoms differently. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. Characterizing the size of the left atrium according to its volume is preferred over a single linear dimension since enlargement can be different for different directions. If severe mitral regurgitation resulting from a floppy mitral leaflet, rupture of the chordae tendineae, or extreme lengthening of the valve should occur, surgical repair may be indicated. 1. still having mild vertigo, dizziness and fatigue. If the left atrium encounters increased resistance (due to mitral valve stenosis, mitral valve regurgitation, hypertension, hypertrophic cardiomyopathy) it becomes enlarged (hypertrophy) which enhancesits contribution to the P-wave. Atrial volume index was computed using the biplane area-length method. Regular rhythm with ventricular rate slower than 50 beats per minute. In an asymptomatic athlete, RBBB in isolation with QRS duration <140msec and in the absence of significant repolarization abnormalities does not warrant further investigation. Primary and secondary forms of Mitral Valve Prolapse are described below. An abnormal right axis can also occur in conditions with elevated right . Sinus bradycardia <40 bpm, Mobitz type 1 second degree AVB and junctional rhythm are not uncommon and don't warrant further investigation in asymptomatic athletes. Cardiac MRI. She had an ECG taken a month back and it was normal. Benign (physiological) causes of bradycardia (e.g vasovagal reaction, well-trained athletes) need not be treated. Clinical electrocardiography and ECG interpretation, Cardiac electrophysiology: action potential, automaticity and vectors, The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG), The Cabrera format of the 12-lead ECG & lead aVR instead of aVR, ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave), How to interpret the ECG / EKG: A systematic approach, Mechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry), Aberrant ventricular conduction (aberrancy, aberration), Premature ventricular contractions (premature ventricular complex, premature ventricular beats), Premature atrial contraction(premature atrial beat / complex): ECG & clinical implications, Sinus rhythm: physiology, ECG criteria & clinical implications, Sinus arrhythmia (respiratory sinus arrhythmia), Sinus bradycardia: definitions, ECG, causes and management, Chronotropic incompetence (inability to increase heart rate), Sinoatrial arrest & sinoatrial pause (sinus pause / arrest), Sinoatrial block (SA block): ECG criteria, causes and clinical features, Sinus node dysfunction (SND) and sick sinus syndrome (SSS), Sinus tachycardia & Inappropriate sinus tachycardia, Atrial fibrillation: ECG, classification, causes, risk factors & management, Atrial flutter: classification, causes, ECG diagnosis & management, Ectopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT), Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management, Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW) syndrome, Junctional rhythm (escape rhythm) and junctional tachycardia, Ventricular rhythm and accelerated ventricular rhythm (idioventricular rhythm), Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment, Long QT (QTc) interval, long QT syndrome (LQTS) & torsades de pointes, Ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest, Pacemaker mediated tachycardia (PMT): ECG and management, Diagnosis and management of narrow and wide complex tachycardia, Introduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECG, Classification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI), Clinical application of ECG in chest pain & acute myocardial infarction, Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms, Myocardial Ischemia & infarction: Reactions, ECG Changes & Symptoms, The left ventricle in myocardial ischemia and infarction, Factors that modify the natural course in acute myocardial infarction (AMI), ECG in myocardial ischemia: ischemic changes in the ST segment & T-wave, ST segment depression in myocardial ischemia and differential diagnoses, ST segment elevation in acute myocardial ischemia and differential diagnoses, ST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECG, T-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's sign, ECG signs of myocardial infarction: pathological Q-waves & pathological R-waves, Other ECG changes in ischemia and infarction, Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction, ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit), The ECG in assessment of myocardial reperfusion, Approach to patients with chest pain: differential diagnoses, management & ECG, Stable Coronary Artery Disease (Angina Pectoris): Diagnosis, Evaluation, Management, NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management, STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management, First-degree AV block (AV block I, AV block 1), Second-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 block, Third-degree AV block (3rd degree AV block, AV block 3, AV block III), Management and treatment of AV block (atrioventricular blocks), Intraventricular conduction delay: bundle branch blocks & fascicular blocks, Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment, Left bundle branch block (LBBB): ECG criteria, causes, management, Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria, Fascicular block (hemiblock): left anterior & left posterior fascicular block on ECG, Nonspecific intraventricular conduction delay (defect), Atrial and ventricular enlargement: hypertrophy and dilatation on ECG, ECG in left ventricular hypertrophy (LVH): criteria and implications, Right ventricular hypertrophy (RVH): ECG criteria & clinical characteristics, Biventricular hypertrophy ECG and clinical characteristics, Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG, Digoxin - ECG changes, arrhythmias, conduction defects & treatment, ECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockers, ECG changes due to electrolyte imbalance (disorder), ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome, Brugada syndrome: ECG, clinical features and management, Early repolarization pattern on ECG (early repolarization syndrome), Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy), Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment, Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade, Exercise stress test (treadmill test, exercise ECG): Introduction, Indications, Contraindications, and Preparations for Exercise Stress Testing (exercise ECG), Exercise stress test (exercise ECG): protocols, evaluation & termination, Exercise stress testing in special patient populations, Exercise physiology: from normal response to myocardial ischemia & chest pain, Evaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performance, Normal (physiological) causes of sinus bradycardia, Abnormal (pathological) causes of sinus bradycardia, Treatment of sinus bradycardia: general aspects of management, Algorithm for acute management of bradycardia, Permanent (long-term) treatment of bradycardia, sinus bradycardia due to infarction/ischemia, conduction defects caused byischemia and infarction.

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