Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Your heart may be unusually thick or dilated (stretched). The P-wave in lead II may, however,be slightly asymmetric by having two humps. Mitral regurgitation (backward 1. . Echocardiography is the most useful diagnostic test for Mitral Valve Prolapse. Type 2 Brugada ECG pattern (saddle back) is non-specific. font: 14px Helvetica, Arial, sans-serif; low voltage qrs 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. Your heart rate increases when you breathe in and slows down when you breathe out. Alternately the left atrial enlargement might have caused the AF. In association with left ventricular hypertrophy: Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. Normally the flaps are held tightly closed during left ventricular contraction (systole) by the chordae tendineae (small tendon "cords" that connect the flaps to the muscles of the heart). but I don't see any signs of left atrial enlargement on this EKG. Am Heart J. Figure 1. Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. 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. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. 1 doctor answer 5 doctors weighed in Share Dr. John Munshower answered Family Medicine 32 years experience Healthy lifestyle behaviors and regular exercise are encouraged. Taina M, Sipola P, Muuronen A, Hedman M, Mustonen P, Kantanen AM, Jkl P, Vanninen R. PLoS One. This usually means you have an issue with your heart or lungs that's causing all of this. Cardiology 53 years experience. Other blood pressure drugs. They show how a patient's heart is beating in real-time. 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). Related article: Bays syndrome and interatrial blocks. PR interval. If an atrium becomes enlarged (typically as a compensatory mechanism) its contribution to the P-wave will be enhanced. Assessing the causal role of hypertension on left atrial and left ventricular structure and function: A two-sample Mendelian randomization study. The .gov means its official. In any case, the association between interatrial block and left atrial enlargement is relatively frequent. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. Isolated Sokolow-Lyon voltage criterion for LVH is common in male athletes and does not warrant further investigation. 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. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. Mitral Valve Prolapse may be detected by listening with a stethoscope, revealing a "click" (created by the stretched flaps snapping against each other during contraction) and/or a murmur. 2022 Nov 2;9:1006380. doi: 10.3389/fcvm.2022.1006380. T32HL07350/HL/NHLBI NIH HHS/United States. Hypertension. to leak backward (regurgitation). Front Cardiovasc Med. 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. 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. If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Calculates the QTc interval by entering QTinterval andHR, How not to overlook EKG changes in acute myocardial infarction, Detailed description of each of the EKG wave. poss left atrial enlargement She took an ECG today and it came as borderline abnormal ECG. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. and our Right Atrial Enlargement (RAE) ECG Review | Learn the Heart - Healio Echo 2005 normal for structure issues. In addition, in lead V1, the depth of the negative final component is greater than the height of the initial part. Should I be concerned? Mitral valve prolapse may not cause any symptoms. Please feel free to contact Chris Driver (cdriver@acc.org) or me (chungeug@umich.edu) with any questions. I hope you're alright and the echo gave you some answers! Clipboard, Search History, and several other advanced features are temporarily unavailable. Terminate or adjust any medications that cause or aggravate the bradycardia. 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. In Mitral Valve Prolapse, the flaps enlarge and stretch inward toward the left atrium, sometimes "snapping" during systole, and may allow some backflow of blood into the left atrium (regurgitation). Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.[5]. Echocardiogram (also called echo). background: #fff; [1] Also, a study found that LAE can occur as a consequence of atrial fibrillation (AF),[3] although another study found that AF by itself does not cause LAE. These cookies track visitors across websites and collect information to provide customized ads. This is caused by too much pressure on the heart, which could be related to high blood pressure, stress, and underlying heart disease. Calculate the heart axis by entering the QRS amplitude inI andIII. Cardiomegaly can happen to your whole heart or just parts of it. (P wave 2.5 mm in II and aVF). Echocardiogram This imaging technique uses sound waves to project a. Regular rhythm with ventricular rate slower than 50 beats per minute. possible left atrial enlargement borderline ecg. 2014; 64: 1205-1211. doi: 5. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. 1995; 25: 1155-1160. doi: 4. Permanent symptomatic bradycardias are treated with artificial pacemakers. All rights reserved. A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. low voltage qrs Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Electrocardiogram (ECG or EKG). 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. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Left atrial enlargement , r-axis -57 As it is to be supposed, the dilation of the Left Atrium produces, in most cases, changes in the Pwave, especially in its final component. This can be in the form of . 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. 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 . For these, please consult a doctor (virtually or in person). 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. Surawicz B, Knilans TK. [1], In the general population, obesity appears to be the most important risk factor for LAE. Learn how we can help Answered May 14, 2022 Thank 1 thank Dr. Donald Colantino answered Prognostic Significance of Left Atrial Enlargement in a General Population. The symptoms of mitral valve prolapse may resemble other medical conditions or problems. A noninvasive test that uses sound waves to evaluate the heart's chambers and valves. It may be used as a complement to echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery. Primary Mitral Valve Prolapse. 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. ECG data are read by doctors using a series of spikes and drops traced on paper. This condition is usually harmless and does not shorten life expectancy. By using our website, you consent to our use of cookies. We are vaccinating all eligible patients. 2014 Mar;97 Suppl 3:S132-8. Ther. Circ Cardiovasc Imaging. Primary and secondary forms of Mitral Valve Prolapse are described below. The normal P-wave contour on ECG The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. sharing sensitive information, make sure youre on a federal In some cases, patients may experience palpitations without observed dysrhythmias (irregular heart rhythm). The following are the most common symptoms of Mitral Valve Prolapse. The presence of two or more borderline ECG findings warrants additional investigation to exclude pathological cardiac disease. measurement results are as follows: qrs 68ms qtqtcb 376-441ms pr 140ms p 102ms rr-pp 726-720ms p-qrs-t 79-66-7? Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Left bundle branch block always warrants investigation. padding-bottom: 0px; Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. View all chapters in Cardiac Arrhythmias. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Barlow's syndrome, balloon mitral valve, or floppy valve syndrome, The ECG has, as one could expect, low sensitivity but high specificity with respect todetecting atrial enlargement. Left Atrial Enlargement: 13(5), 541550 (2015). Analytical cookies are used to understand how visitors interact with the website. 1. References: Bayssyndrome: the association between interatrial block and supraventricular arrhythmias. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. } results read "normal sinus rhythm with sinus arrhythmia. Review how to diagnose this on an ECG here. 2009;doi:10.1161/CIRCULATIONAHA.108.191095. 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 . These cookies do not store any personal information. Appointments 800.659.7822. The P-wave amplitude is >2.5 mm in P pulmonale. New York, NY A 29-year-old female asked: Ekg says "borderline ecg" and "probable left atrial enlargement." is this anything of concern? #mergeRow-gdpr fieldset label { LAFB occurs when the anterior fascicle of the left bundle branch can no longer conduct action potentials. The duration of the P-wave will exceed 120 milliseconds in lead II. Blood and urine tests may be done to check for conditions that affect heart health. The negative deflection of biphasic (diphasic) P-waves is generally <1 mm deep. The overflow capacity of attendees and number of live streaming participants exceeded 220 in total. Anterior wall infarctions, on the other hand, generally leave permanent bradycardia and thus demand permanent pacemaker. Please enable it to take advantage of the complete set of features! The latter study also showed that the persistent type of AF was associated with LAE, but the number of years that a subject had AF was not. Cardiovasc. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint. LAE is suggested by an electrocardiogram (ECG) that has a pronounced notch in the P wave. Left atrial enlargement can be mild, moderate or severe depending on the severity of the underlying condition. Left atrial enlargement: Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). eCollection 2022. Left atrial size and risk of stroke in patients in sinus rhythm. These drugs reduce the amount of sodium and water in the body, which can help lower blood pressure. The Septal Q wave can hint on a possible left sided disease if any. 1996 Dec;19(12):954-9. doi: 10.1002/clc.4960191211. The trick is to find out which came first, because the left atrial enlargement might be caused by something else. [Heart effect of arterial hypertension. This regurgitation may result in a murmur (abnormal sound in the Without seeing the ecg and only given what you wrote, it isn't possible to know whether the ecg is abnormal or not. Also, LAE is a significant risk factor for developing atrial fibrillation. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Left atrial enlargement can cause medical problems such as arrhythmias or abnormal heart rhythms. Look for other features of arrhythmogenic cardiomyopathy if the preceding J-point is not elevated. Edhouse J, Thakur RK, Khalil JM. 1989 Jun;117(6):1409-10. doi: 10.1016/0002-8703(89)90455-9. This may be due to pulmonary valve stenosis, increased pulmonary artery pressureetc. and transmitted securely. hospital never told me. The site is secure. In addition, the function of the heart and the valves may be assessed. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. 1981 May;47(5):1087-90. doi: 10.1016/0002-9149(81)90217-4. Cookie Notice The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) 4. worrisome? Influence of Blood Pressure on Left Atrial Size. Left atrial enlargement (LAE) is due to pressure or volume overload of the left atrium. If you have no symptoms/problems because of any structural heart enlargement or defect than there is nothing to be done. The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. 8600 Rockville Pike Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. Philadelphia: Elservier; 2008. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. 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). 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). A systematic review. Study technics (electrocardiogram, echocardiography, exercise test and Holter]. There are numerous pathological conditions that cause sinus bradycardia. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. 2. } Breathing and blood pressure rates are also monitored. Note that left atrial enlargement is not able to be diagnosed in the presence of atrial fibrillation because this rhythm is defined by erratic atrial activity and no visible P wave on the ECG. 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. Join our newsletter and get our free ECG Pocket Guide! Type 1 Brugada ECG pattern (coved type) is abnormal. heart due to turbulent blood flow). 2012 Sep;45(5):445-51. doi: 6. P-wave is positiv in limb lead II. People with Mitral Valve Prolapse often have no symptoms and detection of a click or murmur may be discovered during a routine examination. need follow up? Science Photo Library / Getty Images Types min-height: 0px; Novel Electrocardiographic Patterns for the Prediction of Hypertensive Disorders of Pregnancy--From Pathophysiology to Practical Implications. Int J Mol Sci. Bays de Luna A, Platonov P, et al. A borderline ECG is the term used when there is an element of irregularity in the ECG result. 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. This is also a normal finding. Reddit and its partners use cookies and similar technologies to provide you with a better experience. 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? When left atrial enlargement occurs, it takes longer for cardiac action potentials to travel through the atrial myocardium; thus, the P wave also lengthens. Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. The click or murmur may be the only clinical sign. Unauthorized use of these marks is strictly prohibited. ECG Criteria of Right Atrial Enlargement. Benign (physiological) causes of bradycardia (e.g vasovagal reaction, well-trained athletes) need not be treated. Unable to load your collection due to an error, Unable to load your delegates due to an error. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. 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. Tiredness. To confirm left atrial enlargement, the best investigation would be an ECHO. . Left atrial enlargement (LAE) is due to pressure or volume overload of the left atrium. [4], Obstructive sleep apnea (OSA) may be a cause of LAE in some cases. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. 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). ABC of clinical electrocardiography. #mc-embedded-subscribe-form .mc_fieldset { Left atrial enlargement is also referred to as P mitrale, and right atrial enlargement is often referred to as P pulmonale. For more information, please see our The juvenile ECG pattern (T-wave inversion in leads V1-V3) is acceptable up to age 16 years. In order to determine if echocardiographic left atrial enlargement is an early sign of hypertensive heart disease, we evaluated 10 normal and 14 hypertensive patients undergoing routine diagnostic cardiac catheterization for echocardiographic left atrial enlargement. 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. 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. The cause of Mitral Valve Prolapse is unknown, but is thought to be linked to heredity. These symptoms include weakness, fatigue, and shortness of breath. #mc_embed_signup { Patients with bradycardia due to myocardial ischemia/infarction only demand treatment if cardiac output is compromised or if the bradycardia predisposes to more malign arrhythmias (the algorithm above applies to this situation as well). 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. border: none; eCollection 2021. This upper chamber of your heart receives oxygen-poor blood from your body. doi: 10.1371/journal.pone.0090903. 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). It is mandatory to procure user consent prior to running these cookies on your 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. Dreslinski GR, Frohlich ED, Dunn FG, Messerli FH, Suarez DH, Reisin E. Am J Cardiol. Before is this anything of concern? In case of sale of your personal information, you may opt out by using the link. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. 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. Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. No patient met ECG criteria for left atrial abnormality. We also use third-party cookies that help us analyze and understand how you use this website. If cardiomyopathy or another type of heart condition is the cause of an enlarged heart, a health care provider may recommend medications, including: Diuretics. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. Atrial volume index was computed using the biplane area-length method. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. A QTc 500 msec is suggestive of long QT syndrome. But this change is not associated or caused by anxiet. Sick sinus syndrome(sinus node dysfunction), which is a common cause of bradycardia, is also discussed separately. The right atrium must then enlarge (hypertrophy) in order to manage to pump blood into the right ventricle. In order to determine if echocardiographic left atrial enlargement is an early sign of hypertensive heart disease, we evaluated 10 normal and 14 hypertensive patients undergoing ro 2016 Aug;9(8):10.1161/CIRCIMAGING.115.004299 e004299. 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.