Practical Cardiovascular Medicine. Elias B. Hanna

These...Figure 9.2 Interpolated PVC. Unlike the common PVC, an interpolated PVC does...Figure 9.3 Tachycardia that seems narrow but has a different morphology than...Figure 9.4 Wide complex rhythm at a rate of 70 bpm. P waves are initially se...Figure 9.5 Torsades de pointes initiation, via short-long-short sequence: (1...Figure 9.6 QT interval is markedly prolonged (QTc = 730 ms). T wave is wide ...Figure 9.7 Torsades de pointes that degenerates into VF (same patient as Fig...Figure 9.8 Example of TdP in a patient whose baseline QTc is 530 ms. Note th...Figure 9.9 Typical ST–T morphologies in hypokalemia, hypocalcemia, and conge...Figure 9.10 Epsilon wave in ARVD. Epsilon wave is a small wiggle wave or a s...Figure 9.11 Brugada patternsFigure 9.12 Top: Early repolarization J wave followed by a downsloping ST se...Figure 9.13

      10 Chapter 10Figure 10.1 LV diastolic filling pattern in compensated HF, decompensated HF...Figure 10.2 Chronic antiarrhythmic drug therapy for the prevention of recurr...Figure 10.3 Yearly risk of stroke and intracranial hemorrhage with warfarin ...Figure 10.4 Long sinus pause at the point of transition from AF (top row) to...

      11 Chapter 11Figure 11.1 Flutter circuit with illustration of the net atrial vectors of d...Figure 11.2 Aflutter with flutter waves rate (F wave) ~300 per minute and 2:...Figure 11.3 Typical counterclockwise Aflutter with variable conduction: 5:1,...Figure 11.4 Another typical counterclockwise 2:1 Aflutter. See how F is nega...Figure 11.5 Rhythm in lead V₁ (above) and lead II (below) with a ladder diag...Figure 11.6 Coarse fibrillatory AF waves that simulate Aflutter in lead V1. ...Figure 11.7 2:1 atrial tachycardia, with an atrial rate of ~140 per minute. ...Figure 11.8 Atrial escape rhythm (rate ~50 bpm) that developed in a patient ...

      12 Chapter 12Figure 12.1 AVNRT usually starts with a PAC that has a long PR interval as i...Figure 12.2 (a) Arrows point to the retrograde P wave that is superimposed o...Figure 12.3 Narrow complex tachycardia with retrograde P waves (arrows) seen...Figure 12.4 P waves are seen just before the QRS, with a PR interval < 110 m...Figure 12.5 Sinus rhythm is present throughout the tracing. Vertical lines i...Figure 12.6 Anatomy of the slow pathway, fast pathway, and compact AV node. ...Figure 12.7 An appropriately timed PAC conducts down the slow pathway but ca...Figure 12.8 Electrocardiographic features of pre-excitation. Arrows point to...Figure 12.9 Amount of myocardium depolarized by the accessory pathway (gray ...Figure 12.10 A slur is seen on the upslope of the QRS complex (e.g., leads I...Figure 12.11 Concealed accessory pathway (AP).The pathway cannot fully con...Figure 12.12 Manifest accessory pathway.The AP can conduct both antegradel...Figure 12.13 Irregular tachycardia with wide, polymorphic, bizarre-looking Q...Figure 12.14 In AVNRT, the occurrence of a PVC (gray bar) either blocks the ...Figure 12.15 Bundle branch block during orthodromic AVRT.Figure 12.16 When the wide complex tachycardia becomes narrow, the R–R inter...Figure 12.17 A 22-year-old woman with no prior cardiac history presents with...Figure 12.18 Two types of QRS complex are seen. This intermittent widening o...Figure 12.19 Another WPW pattern on a baseline ECG. Note the short PR, with ...Figure 12.20 Alternation of a narrow and an equidistant wide QRS (vertical a...Figure 12.21 At first glance, this ECG shows a wide and tall R wave in V₁, Q...

      13 Chapter 13Figure 13.1 Wenckebach 3:2 AV block. P–P intervals are typically regular. P–...Figure 13.2 Wenckebach 5:4 AV block. P–P intervals are regular. PR progressi...Figure 13.3 High-grade AV block alternating with Mobitz II AV block.Figure 13.4 Wenckebach AV block. Two groups of beats are seen, which raises ...Figure 13.5 ECG of a patient presenting with palpitations. Looking at parts ...Figure 13.6 Third-degree AV block with regular P rate and regular QRS rate, ...Figure 13.7 Regular, slow QRS rate of ~33 bpm. P rate is mostly regular at ~...Figure 13.8 At first glance, the rhythm seems to be sinus bradycardia, ~40 b...Figure 13.9 Outside the PVC, the rhythm seems regular. But on further analys...Figure 13.10 Long sinus pause at the point of transition from AF (top row) t...Figure 13.11 P blocks (arrow) without being premature and without progressiv...Figure 13.12 Note the block of a P wave (vertical arrow). This blocked P wav...Figure 13.13 Mobitz I vs. Mobitz II AV block. (1) is the right bundle, (2) i...Figure 13.14 Complete AV block, with underlying sinus tachycardia (arrows po...Figure 13.15 Episode of complete AV block on a loop recorder, with 3 non-con...Figure 13.16 Second-degree Mobitz II AV block, with 3:2 block alternating wi...Figure 13.17 P waves and QRS complexes are dissociated on most beats, with m...Figure 13.18 Another example of a high-grade AV block. Most P waves are not ...Figure 13.19 AF with a ventricular rate that is slow and mostly regular. Thi...Figure 13.20 4:3 Mobitz I SA block. Progressive lengthening of the sinus imp...Figure 13.21 A whole P–QRS drops, which may be consistent with a sinus pause...Figure 13.22 3:2 Mobitz type II SA block. Both P and QRS intermittently drop...Figure 13.23 Sinus arrest or complete SA block with a ventricular escape rhy...Figure 13.24 No P wave is seen → complete SA block vs. AF with small fibrill...Figure 13.25 Outside PVCs, the rhythm seems regular, but, on further analysi...Figure 13.26 AV junction refers to the AV node+ His bundle. Subdivisions: 1,...Figure 13.27 Suppose that a tachycardia-mediated LBBB has developed at a rat...Figure 13.28

      14 Chapter 14Figure 14.1 The paced QRS morphology varies according to the vector of depol...Figure 14.2 Ventricular pacing regularly tracking the sinus P activity (DDD ...Figure 14.3 VVI pacing in a patient with no P wave (sinus arrest or subtle A...Figure 14.4 Ventricular pacing that consistently tracks a preceding sinus P ...Figure 14.5 Atrial flutter with variable conduction. Note that when the R–R ...Figure 14.6 Prominent R wave in V₁–V₂ may suggest BiV pacing. However, there...Figure 14.7 DDD pacemaker timing intervals.AP, atrial paced event; AS, atr...Figure 14.8 Sinus/atrial tachycardia with atrial rate > upper rate. Case whe...Figure 14.9 Sinus tachycardia with pseudo-Wenckebach ventricular pacing patt...Figure 14.10 Difference between maximal tracking rate, mode-switch rate, and...Figure 14.11 Various lead configurations for pacemakers (first two images) a...Figure 14.12 Example of a “quick look” or “summary” screen of pacemaker/ICD ...Figure 14.13 Insulation break and lead fracture.Figure 14.14 Triggers and mechanisms of PMT.Figure 14.15 Fusion, pseudofusion, and ventricular safety pacing.Figure 14.16 In fusion beats, the native conduction reaches the ventricle ar...Figure 14.17 Various patterns of LV activation in LBBB. Black arrows indicat...Figure 14.18 CRT: echocardiographic AV synchronizationFigure 14.19 Regular V pacing without any spontaneous ventricular activity. ...Figure 14.20 DDD pacemaker with atrial pacing and AV sequential pacing.Int...Figure 14.21 Atrial and ventricular pacing spikes are seen. The underlying r...Figure 14.22 Ventricular pacing occurs at irregular intervals and one atrial...Figure 14.23 Ventricular pacing spikes are seen. They track sinus P waves at...Figure 14.24 Intracardiac electrograms (EGMs) of VT. The atrial and ventricu...Figure 14.25 Electrograms of a tachycardia that starts with a premature A wa...Figure 14.26 Tachycardia with number of V waves = number of A waves→ could b...Figure 14.27 The analysis of the atrial and ventricular EGMs reveals more at...Figure 14.28 The patient presents with multiple shocks. The marker channel s...Figure 14.29 Electrogram interval plot (same patient as Figure 14.28). It re...Figure 14.30 Interval plot showing at one point two V waves (black dots) for...Figure 14.31 Electrograms and marker channel from the case shown in Figure 1...Figure 14.32 Figure 14.33 Figure 14.34

      15 Chapter 15Figure 15.1 Normal His recording.Figure 15.2 Example of a typical A, V, His, and CS recording. AH and HV inte...Figure 15.3 Types of AV block.Figure 15.4 Arrows point to QRS complexes on the ECG, which are the starting...Figure 15.5 AVNRT. V and A almost coincide, with a VA interval <70 ms. On EC...Figure 15.6 AVNRT. After V, the site of earliest A activation is located in ...Figure 15.7 Activation sequence in orthodromic AVRT and antidromic AVRT. As ...Figure 15.8 Earliest site of atrial activation during AVNRT, AVRT, and atria...Figure 15.9 RAO view (side view) of the RA. The crista terminalis is a struc...Figure 15.10 RAO view of the RA. Note the position of the halo mapping cathe...Figure 15.11 Axial view of the RA, RV, and tricuspid valve.Figure 15.12 En face view of the RA and RV. Note the crista terminalis ridge...Figure 15.13 Atrial flutter mapping. Note the atrial activation along the ha...Figure 15.14 Another example of atrial flutter mapping across the right atri...Figure 15.15 (a) Normal atrial activity along the halo catheter when one pac...Figure 15.16 Ventricular pacing in a patient with AVNRT. Always start by ali...Figure 15.17 The reentry circuit is shown as a circle, the pacing point is s...Figure 15.18 Entrainment of atrial tachycardia. The site of earliest A activ...Figure 15.19 Activation mapping of VT. The red area (arrow) is the zone of e...

      16 Chapter