Am Heart J. The primary form of Mitral Valve Prolapse is seen frequently in people with Marfan's Syndrome or other inherited connective tissue diseases, but is most often seen in people with no other form of heart disease. need follow up? Twitter: @rob_buttner. FOIA I am guessing your doctor a You should be fine, trust your doctor, that machine reading is quite common. Cookie Notice The values for volume/BSA in the following table are the best validated, and are the same for both men and women.[9]. 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. National Library of Medicine When the bradycardia causes hemodynamic symptoms it should be treated. Before 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. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. } 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). Mitral regurgitation (backward Electrocardiogram (ECG) This imaging test records the electrical actions of the heart, including the speed of the heartbeats. Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.[5]. eCollection 2022. To confirm left atrial enlargement, the best investigation would be an ECHO. Support stockings may be beneficial. 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. P-waves with constant morphology preceding every QRS complex. ECG data are read by doctors using a series of spikes and drops traced on paper. Surawicz B, Knilans TK. 13(5), 541550 (2015). The left atrium receives newly oxygenated blood from. Atrial enlargement/abnormality often accompanies ventricular enlargement. 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. 8600 Rockville Pike 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 . Necessary cookies are absolutely essential for the website to function properly. Masks are required inside all of our care facilities. Treatment is not usually necessary as Mitral Valve Prolapse is rarely a serious condition. The normal P-wave contour on ECG The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. Review how to diagnose this on an ECG here. border: none; Always consult your doctor for a diagnosis. This site needs JavaScript to work properly. Left atrial enlargement (LAE) is when the left side of the heart enlarges or swells, leading to breathlessness, fatigue, and other symptoms. padding-bottom: 0px; An abnormal right axis can also occur in conditions with elevated right . Cardiology 53 years experience. [2] LAE has been found to be correlated to body size, independent of obesity, meaning that LAE is more common in people with a naturally large body size. An official website of the United States government. Alterations of the mitral valve are the classic causes of left atrial enlargement, both mitral stenosis due to increased pressure, and mitral insufficiency due to volume increase. Congenital Heart Disease and Pediatric Cardiology. LAFB occurs when the anterior fascicle of the left bundle branch can no longer conduct action potentials. last week ecg read: Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. Hypertension. This may be due to pulmonary valve stenosis, increased pulmonary artery pressureetc. doi: 10.1161/CIRCIMAGING.115.004299. You had an ecg. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. I'm not sure how they can tell about the left atrial enlargement from an ecg, until . The negative deflection of biphasic (diphasic) P-waves is generally <1 mm deep. Ther. However, each individual may experience symptoms differently. T32HL07350/HL/NHLBI NIH HHS/United States. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. Also, LAE is a significant risk factor for developing atrial fibrillation. } Preference cookies are used to store user preferences to provide content that is customized and convenient for the users, like the language of the website or the location of the visitor. View all chapters in Cardiac Arrhythmias. at home i saw that it said possible left atrial enlargement but dr said nothing about this. Bookshelf In most cases, limiting stimulants, such as caffeine and cigarettes, is all that is needed to control symptoms. Analytical cookies are used to understand how visitors interact with the website. Atrial fibrillation is both cause and effect of left atrial enlargement, although the presence of AF on the EKG makes it difficult to determine left atrial enlargement signs, because P waves are absent4. The reasons for this are explained below. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. They show how a patient's heart is beating in real-time. Prognostic Significance of Left Atrial Enlargement in a General Population. 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). The amplitude of the normal P-wave does not exceed 2.5 mm in anylimb lead. 1996 Dec;19(12):954-9. doi: 10.1002/clc.4960191211. In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). The unusual 'P'wave is common in cases of left atrial enlargement. If you have no symptoms/problems because of any structural heart enlargement or defect than there is nothing to be done. 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. Difficulty breathing. low voltage qrs Chest pain. 1981 May;47(5):1087-90. doi: 10.1016/0002-9149(81)90217-4. Please enable it to take advantage of the complete set of features! Reply Learn how your comment data is processed. [7] However, if atrial fibrillation is present, a P wave would not be present. In any case, the association between interatrial block and left atrial enlargement is relatively frequent. Benign (physiological) causes of bradycardia (e.g vasovagal reaction, well-trained athletes) need not be treated. No patient met ECG criteria for left atrial abnormality. To learn more, please visit our. 2017 ecg normal. ECG Criteria of Right Atrial Enlargement. Please feel free to contact Chris Driver (cdriver@acc.org) or me (chungeug@umich.edu) with any questions. Secondary Mitral Valve Prolapse may result from damage to valvular structures during acute myocardial infarction, rheumatic heart disease, or hypertrophic cardiomyopathy (occurs when the muscle mass of the left ventricle of the heart is larger than normal). [1], In the general population, obesity appears to be the most important risk factor for LAE. You also have the option to opt-out of these cookies. Int J Gen Med. Atrial volume index was computed using the biplane area-length method. Left atrial enlargement is also referred to asP mitrale, andright atrial enlargement is oftenreferred to as P pulmonale. 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). There the circle starts. Took a b-complex vitamin supplement last week that landed me in er. 43 year old female. When left atrial enlargement occurs, it takes longer for cardiac action potentials to travel through the atrial myocardium; thus, the P wave also lengthens. Isolated Sokolow-Lyon voltage criterion for LVH is common in male athletes and does not warrant further investigation. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Int J Mol Sci. 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. 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. Read More Created for people with ongoing healthcare needs but benefits everyone. 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. If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. The symptoms of mitral valve prolapse may resemble other medical conditions or problems. Bayssyndrome: the association between interatrial block and supraventricular arrhythmias. As per the report you have shared, there is normal sinus rhythm, along with normal intervals. This category only includes cookies that ensures basic functionalities and security features of the website. ECG criteria follows: Sinus bradycardia (SB) is considered a normal finding in the following circumstances: In all other situations, sinus bradycardia should be regarded as a pathological finding. 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. Would you like email updates of new search results? (P wave 2.5 mm in II and aVF). Read More Created for people with ongoing healthcare needs but benefits everyone. Accessibility J Electrocardiol. There are numerous pathological conditions that cause sinus bradycardia. It is mandatory to procure user consent prior to running these cookies on your website. These cookies will be stored in your browser only with your consent. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. [9] By approximating the shape of the left atrium as an ellipsoid, its volume can be calculated from measurements of its dimensions along three perpendicular directions. The mean PR interval at birth is 107 ms (Davignon et al). Ecg borderline left atrial abnormality Ecg borderline left atrial abnormality Share this page Hi, My sister was having a pain on left side under her arm pit and shoulder since a month. The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) 4. #mc-embedded-subscribe-form input[type=checkbox] { If an atrium becomes enlarged (typically as a compensatory mechanism) its contribution to the P-wave will be enhanced. Most of them were presenters at CAH, and all are active in the Sports and Exercise Cardiology Section FIT Interest Group. Calculate the heart axis by entering the QRS amplitude inI andIII. Your heart may be unusually thick or dilated (stretched). Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Taina M, Sipola P, Muuronen A, Hedman M, Mustonen P, Kantanen AM, Jkl P, Vanninen R. PLoS One. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. This regurgitation may result in a murmur (abnormal sound in the poss left atrial enlargement Philadelphia: Elservier; 2008. min-height: 0px; The left atrial index was also higher in the hypertensive group, 2.18 +/- 0.45 versus 1.88 +/- 0.10 cm/m2 (p less than 0.05), and the left atrial-to-aortic root dimension ratio was significantly higher in the hypertensive group, 1.36 +/- 0.20 versus 1.17 +/- 0.07 (p less than 0.01). 2014; 64: 1205-1211. doi: 5. Echocardiogram This imaging technique uses sound waves to project a. ECG criteria follows: Regular rhythm with ventricular rate slower than 50 beats per minute. Hypertension. The normal Pwave measures less than 2.5mm (0.25mV) in height and less than 0.12s in length (3small squares). 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 Surawicz B, et al. Vaziri SM, Larson MG, Lauer MS, et al. had a stress test and holter monitor that came back normal 7 months ago. 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. [Heart effect of arterial hypertension. Join our newsletter and get our free ECG Pocket Guide! Swelling in your arms or legs. Bombelli M, Facchetti R, Cuspidi C et al. . "Clinical Implications of Left Atrial Enlargement: A Review", "The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging: The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study", "Atrial enlargement as a consequence of atrial fibrillation A prospective echocardiographic study", "Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up", "The Relationship between Obstructive Sleep Apnea and Atrial Fibrillation: A Complex Interplay", "ABC of clinical electrocardiography. LAE is often a precursor to atrial fibrillation. 2. Echocardiogram (also called echo). Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality. In all other situations it is necessary to findthe underlyingcauseand direct treatments towards it. . possible left atrial enlargement borderline ecg. 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. Unauthorized use of these marks is strictly prohibited. EKG normal sinus rhythm / possible left atrial enlargement / borderline ECG - having chest and neck pressure (no pain) - can't get me in for an echo for 3 weeks. heart due to turbulent blood flow). Left atrial enlargement , r-axis -57 The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Diagnosis of long QT syndrome in an athlete with a QT interval 460490 msec should be considered in the presence of at least one of the following: unheralded syncope, torsades de pointes, identification of a long QTc in first degree relative, family history of sudden unexplained death, notched T waves or paradoxical QT prolongation with exercise. For these, please consult a doctor (virtually or in person). The P-wave in lead II may, however,be slightly asymmetric by having two humps. need cardio follow up? Mitral valve prolapse may not cause any symptoms. This rule does not apply to aVL. The negative intrathoracic pressure may cause the left atrium to expand and stretch its walls during each OSA event. Editor-in-chief of the LITFL ECG Library. As the left atrium depolarizes after the right atrium, an enlargement thereof will cause a longer duration of the depolarization time and therefore a widening of the Pwave, greater than 0.12s. Sometimes the right and left component of the Pwave are separated slightly giving the Pwave a form of "letterm" lower case, classically called Pmitrale. A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. It was normal or at least not concerning. Possible hemiblock: An abnormal right axis plus minimally prolonged qrs duration defines what is termed a left posterior hemiblock (block of the posteroinferior fascicle of the left branch of the bundle of his). Accuracy of left atrial enlargement diagnosed by electrocardiography as compared to cardiac magnetic resonance in hypertensive patients. to leak backward (regurgitation). [3], Indexing the left atrial volume to body surface area (volume/BSA) is recommended by the American Society of Echocardiography and the European Association of Echocardiography. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). Left atrial enlargement (LAE) is a marker for diastolic cardiac dysfunction. The full CAH agenda can be accessed here. ECG criteria for left (LAE) and right atrial enlargement (RAE) were compared to CMR atrial volume index measurements for 275 consecutive subjects referred for CMR (67% males, 51 14 years). The P-wave amplitude is >2.5 mm in P pulmonale. The site is secure. This website uses cookies to improve your experience while you navigate through the website. Aguilera Saldaa MA, Garca Moreno LM, Rodrguez Padial L, Navarro Lima A, Snchez Domnguez J. Overvad TF, Nielsen PB, Larsen TB, Sgaard P. Thromb Haemost. This negative deflection is generally <1 mm deep. Conditions affecting the left side of the heart, Electrocardiography in Emergency, Acute, and Critical Care, Critical Decisions in Emergency and Acute Care Electrocardiography, Chous Electrocardiography in Clinical Practice: Adult and Pediatric, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, Bifid P wave with > 40 ms between the two peaks, Biphasic P wave with terminal negative portion > 40 ms duration, Biphasic P wave with terminal negative portion > 1mm deep, Broad (>110ms), bifid P wave in lead II (P mitrale) with > 40ms between the peaks. 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. Related article: Bays syndrome and interatrial blocks. Heart hypertrophy as a risk factor. Dear Sports and Exercise Cardiology Enthusiasts: Care of the Athletic Heart 2019 (CAH), directed by Matthew Martinez MD, and Jonathan Kim, MD, convened June 20-22 at the American College of Cardiology's Heart House in Washington, DC. The reasons for this are explained below. Palpitations (sensation of fast or irregular heart beat) are the most common complaint among patients with Mitral Valve Prolapse. A pathological Q-wave (depth exceeding 25% of the height of proceeding R wave) is abnormal. Without seeing the ecg and only given what you wrote, it isn't possible to know whether the ecg is abnormal or not. Type 1 Brugada ECG pattern (coved type) is abnormal. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. 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. 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. This can be in the form of . Figure 1. A separate entity from left atrial enlargement: a consensus report. font-weight: normal; 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). 2016 Aug;9(8):10.1161/CIRCIMAGING.115.004299 e004299. Should I be concerned? Normal automaticity and pacemaker cells in the heart, Sinus tachycardia & Inappropriate Sinus Tachycardia. The presence of left axis deviation, right axis deviation, voltage criterion for left atrial enlargement, voltage criterion for right atrial enlargement or voltage criterion for right ventricular hypertrophy in isolation or with other Group 1 changes (e.g., sinus bradycardia, first degree AVB, incomplete right bundle branch block [RBBB], early repolarization, isolated QRS voltage criteria for LVH) does not warrant investigation in asymptomatic athletes with a normal physical examination. Aortic insufficiency generates left cavities overload propitiating left atrial and left ventricular enlargement. Additional procedures may include: Stress test (also called treadmill or exercise ECG). Clin Cardiol. } The most important causes are as follows: Figure 1 shows sinus bradycardia at paper speed 25 mm/s. The P-wave will display higher amplitude in lead II and lead V1. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Learn how we can help 290 views Answered >2 years ago Thank A 36-year-old female asked: A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. This upper chamber of your heart receives oxygen-poor blood from your body. 2021 Apr 20;14:1421-1427. doi: 10.2147/IJGM.S282117. 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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