Normally taking a b complex vi Left atrial enlargement itself has no symptoms. normal sinus rhythm 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). 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 Normal automaticity and pacemaker cells in the heart, Sinus tachycardia & Inappropriate Sinus Tachycardia. LAE is often a precursor to atrial fibrillation. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking Accept, you consent to the use of ALL the cookies. People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). abnormal ecg. doi: 10.1371/journal.pone.0090903. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. J Med Assoc Thai. need cardio follow up? 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 . 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, 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. The unusual 'P'wave is common in cases of left atrial enlargement. P-waves with constant morphology preceding every QRS complex. The values for volume/BSA in the following table are the best validated, and are the same for both men and women.[9]. 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. Left atrial enlargement can develop too, resulting in problems with how blood is pumped out to the body. 2 weeks dizzy on and off When an OSA event occurs, an attempt is made to breathe with an obstructed airway and the pressure inside the chest is suddenly lowered. Disclaimer. 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. In any case, the association between interatrial block and left atrial enlargement is relatively frequent. 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. percent of the population. Left atrial enlargement: This negative deflection is generally <1 mm deep. This condition is usually harmless and does not shorten life expectancy. normal sinus rhythm font: 14px Helvetica, Arial, sans-serif; need follow up? 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. 1. The site is secure. 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. results read "normal sinus rhythm with sinus arrhythmia. sharing sensitive information, make sure youre on a federal Analytical cookies are used to understand how visitors interact with the website. More information: Bays syndrome and interatrial blocks. For more information, please see our But this change is not associated or caused by anxiet. What does sinus rhythm possible right atrial enlargement borderline left axis deviation borderline ecg unconfirmed report mean? The early repolarization pattern accompanied by concave ST segment elevation is seen in 25-40% of highly trained athletes; more common among males, black athletes and those with voltage criteria for LVH; usually seen in leads V5 and V6. 13(5), 541550 (2015). Mitral valve prolapse, also known as click-murmur syndrome, The palpitations are usually associated with premature ventricular contractions (the ventricles beat sooner than they should), but supraventricular rhythms (abnormal rhythms that begin above the ventricles) have also been detected. The most important causes are as follows: Figure 1 shows sinus bradycardia at paper speed 25 mm/s. Right atrial enlargement means your heart has an abnormally large right atrium. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. The murmur is caused by some of the blood leaking back into the left atrium. Atrial enlargement/abnormality often accompanies ventricular enlargement. This is a noninvasive test that produces comprehensive images of the heart. Mitral valve prolapse may not cause any symptoms. The Diagnostic Yield of Routine Electrocardiography in Hypertension and Implications for Care in a Southwestern Nigerian Practice. Reply If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. 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. If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart. On this Wikipedia the language links are at the top of the page across from the article title. Novel Electrocardiographic Patterns for the Prediction of Hypertensive Disorders of Pregnancy--From Pathophysiology to Practical Implications. Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. Always consult your doctor for a diagnosis. worrisome? #mergeRow-gdpr fieldset label { 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). 1995; 25: 1155-1160. doi: 4. The trick is to find out which came first, because the left atrial enlargement might be caused by something else. P wave changes with Left Atrial Enlargement ECG Criteria for Left Atrial Enlargement The amplitude of the normal P-wave does not exceed 2.5 mm in anylimb lead. It often affects people with high blood pressure and. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. Dr. Jerome Zacks answered. Congenital Heart Disease and Pediatric Cardiology. 2014; 64: 1205-1211. doi: 5. 2021 Apr 20;14:1421-1427. doi: 10.2147/IJGM.S282117. . Unconfirmed means a cardiologist hasn't reviewed the EKG yet. 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). Atrial volume index was computed using the biplane area-length method. poss left atrial enlargement Secondary Mitral Valve Prolapse. Took a b-complex vitamin supplement last week that landed me in er. In addition, the function of the heart and the valves may be assessed. A borderline ECG is the term used when there is an element of irregularity in the ECG result. Beta blockers, angiotensin-converting enzyme . What are the symptoms of left atrial enlargement? Careers. Thank you to the FITs for all their hard work. measurement results are as follows: qrs 68ms qtqtcb 376-441ms pr 140ms p 102ms rr-pp 726-720ms p-qrs-t 79-66-7? Specific treatment for mitral valve prolapse will be determined by your doctor based on: Your tolerance for specific medications, procedures, or therapies, Expectations for the course of the disease. 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? This regurgitation may result in a murmur (abnormal sound in the MeSH 1981 May;47(5):1087-90. doi: 10.1016/0002-9149(81)90217-4. 2009;doi:10.1161/CIRCULATIONAHA.108.191095. T wave inversions preceded by ST-segment depressions are suggestive of underlying pathology; ST segment depressions should always be considered abnormal; upright T wave in aVR in the context of T wave inversion in V5/V6 is suggestive of pathology involving the left ventricular apex. There the circle starts. I am guessing your doctor a You should be fine, trust your doctor, that machine reading is quite common. 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. Left atrial enlargement , r-axis -57 The .gov means its official. Left Atrial Enlargement: We are vaccinating all eligible patients. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. doi. Join our newsletter and get our free ECG Pocket Guide! In an asymptomatic athlete, RBBB in isolation with QRS duration <140msec and in the absence of significant repolarization abnormalities does not warrant further investigation. Cardiology 53 years experience. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. Barlow's syndrome, balloon mitral valve, or floppy valve syndrome, The P-wave will display higher amplitude in lead II and lead V1. Heart palpitations. Left atrial enlargement (LAE) is due to pressure or volume overload of the left atrium. Left Atrial Enlargement (LAE) ECG Review | Learn the Heart - Healio The cause of Mitral Valve Prolapse is unknown, but is thought to be linked to heredity. Type 2 Brugada ECG pattern (saddle back) is non-specific. Dr. Sanjay Sharma, co-senior author of the International Recommendations for ECG Interpretation in Athletes, reviewed his approach to the Athlete's ECG. Primary and secondary forms of Mitral Valve Prolapse are described below. 2022 Nov 2;9:1006380. doi: 10.3389/fcvm.2022.1006380. } Bombelli M, Facchetti R, Cuspidi C et al. 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). If you have no symptoms/problems because of any structural heart enlargement or defect than there is nothing to be done. [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. This upper chamber of your heart receives oxygen-poor blood from your body. The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) 4. Ecg done and dr said everything was normal. 2017 ecg normal. The mean PR interval at birth is 107 ms (Davignon et al). This usually means you have an issue with your heart or lungs that's causing all of this. } LAE is often a precursor to atrial fibrillation. 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. Left bundle branch block always warrants investigation. The duration of the P-wave will exceed 120 milliseconds in lead II. Additional procedures may include: Stress test (also called treadmill or exercise ECG). Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality. Based on a work athttps://litfl.com. Possible left atrial enlargement is a nonspecific finding which is commonly seen in 12 lead EKG. . Note that patients with chronotropic incompetence may require pacemaker to increase exercise capacity and reduce symptoms. High blood pressure and blood volume cause right atrial enlargement. Determinants of left atrial appendage volume in stroke patients without chronic atrial fibrillation. Learn how we can help 290 views Answered >2 years ago Thank A 36-year-old female asked: is the bulging of one or both of the mitral valve flaps (leaflets) The full CAH agenda can be accessed here. 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. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. font-weight: normal; RBBB is considered a borderline criterion. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG (ambulatory recording). but I don't see any signs of left atrial enlargement on this EKG. 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. Sick sinus syndrome(sinus node dysfunction), which is a common cause of bradycardia, is also discussed separately. [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. 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). Cookie Notice Type 1 Brugada ECG pattern (coved type) is abnormal. Before Echo 2005 normal for structure issues. In secondary Mitral Valve Prolapse, the flaps are not thickened. (P wave 2.5 mm in II and aVF). Diego Conde D, Seoane L, et al. I hope you're alright and the echo gave you some answers! Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.[5]. We also use third-party cookies that help us analyze and understand how you use this website. #mc_embed_signup { 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. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Summarizing: The most striking sign of the left atrial enlargement is a wide Pwave, greater than 0.12s or 3small squares, with a predominance of the negative final component in leadV1. Should I be concerned? The overflow capacity of attendees and number of live streaming participants exceeded 220 in total. 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. Right Atrial Enlargement (RAE) ECG Review | Learn the Heart - Healio The passage of the electrical stimulus through the atria is reflected in the electrocardiogram as the P wave. Dreslinski GR, Frohlich ED, Dunn FG, Messerli FH, Suarez DH, Reisin E. Am J Cardiol. 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. Terminate or adjust any medications that cause or aggravate the bradycardia. still having mild vertigo, dizziness and fatigue. Find more COVID-19 testing locations on Maryland.gov. Unauthorized use of these marks is strictly prohibited. We hope you enjoy the summaries. 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). Tiredness. Learn how your comment data is processed. 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. Left atrial enlargement (LAE) is when the left side of the heart enlarges or swells, leading to breathlessness, fatigue, and other symptoms. Weight gain. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Would you like email updates of new search results? [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. When the bradycardia causes hemodynamic symptoms it should be treated. There are numerous pathological conditions that cause sinus bradycardia. Bookshelf 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. In all other situations it is necessary to findthe underlyingcauseand direct treatments towards it. The normal P-wave contour on ECG The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. In association with left ventricular hypertrophy: Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. 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. Swelling in your arms or legs. Difficulty breathing. Twitter: @rob_buttner. 1 doctor answer 5 doctors weighed in Share Dr. John Munshower answered Family Medicine 32 years experience 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. If cardiomyopathy or another type of heart condition is the cause of an enlarged heart, a health care provider may recommend medications, including: Diuretics. Clipboard, Search History, and several other advanced features are temporarily unavailable. All rights reserved. Hypertension. ECG criteria follows: Regular rhythm with ventricular rate slower than 50 beats per minute. BMJ 2002;324:1264. doi: 3. width: auto; 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. Surgical Fellow Doctoral Degree 997 satisfied customers EKG said sinus tachycardia, left atrial enlargement, EKG said sinus tachycardia, left atrial enlargement, borderline report. Mitral regurgitation (backward 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. These symptoms include: Fainting. The reasons for this are explained below. Learn more about conduction defects caused byischemia and infarction. 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. National Library of Medicine The Septal Q wave can hint on a possible left sided disease if any. 43 year old female. This website uses cookies to improve your experience while you navigate through the website. In addition to a complete medical history and physical examination, diagnostic procedures for Mitral Valve Prolapse may include any, or a combination, of the following: Electrocardiogram (ECG or EKG). An enlarged heart (cardiomegaly) describes a heart that's bigger than what is typical. display: inline; The juvenile ECG pattern (T-wave inversion in leads V1-V3) is acceptable up to age 16 years. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Masks are required inside all of our care facilities. Left atrial enlargement can be mild, moderate or severe depending on the severity of the underlying condition. 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. 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. This is calledP mitrale, because mitral valve disease is a common cause (Figure 1). Unable to load your collection due to an error, Unable to load your delegates due to an error. New York, NY A 29-year-old female asked: Ekg says "borderline ecg" and "probable left atrial enlargement." is this anything of concern? LAE is suggested by an electrocardiogram (ECG) that has a pronounced notch in the P wave. Please enable it to take advantage of the complete set of features! 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. } Eugene H Chung, MD, FACC 2023 American College of Cardiology Foundation. #mc-embedded-subscribe-form input[type=checkbox] { Alternately the left atrial enlargement might have caused the AF. As per the report you have shared, there is normal sinus rhythm, along with normal intervals. } P-wave is positiv in limb lead II. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. For potential or actual medical emergencies, immediately call 911 or your local emergency service. 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.