Left Atrial Enlargement (LAE) ECG Review | Learn the Heart - Healio into the left atrium during the contraction of the heart. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Right Atrial Enlargement (RAE) ECG Review | Learn the Heart - Healio Type 2 Brugada ECG pattern (saddle back) is non-specific. This usually means you have an issue with your heart or lungs that's causing all of this. 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. 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 results read "normal sinus rhythm with sinus arrhythmia. need follow up? Therefore, the criteria for diagnosing LAE on a 12-lead ECG is as follows: P-mitrale occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. [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. Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality. 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). Ecg done and dr said everything was normal. [Heart effect of arterial hypertension. This condition is usually harmless and does not shorten life expectancy. Echocardiography is the most useful diagnostic test for Mitral Valve Prolapse. P-wave is positiv in limb lead II. . Review how to diagnose this on an ECG here. However, each individual may experience symptoms differently. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. 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. Bayssyndrome: the association between interatrial block and supraventricular arrhythmias. FOIA 2016 Aug 1;116(2):206-19. doi: 10.1160/TH15-12-0923. 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. Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. Other blood pressure drugs. Interatrial blocks. at home i saw that it said possible left atrial enlargement but dr said nothing about this. This is often (but not always) seen on ordinary ECG tracings and it is explained by the fact that the atria are depolarized sequentially, with the right atrium being depolarized before the left atrium. Other effects are fibrosis (scarring) of the flap surface, thinning or lengthening of the chordae tendineae, and fibrin deposits on the flaps. eCollection 2022. The values for volume/BSA in the following table are the best validated, and are the same for both men and women.[9]. Analytical cookies are used to understand how visitors interact with the website. P wave changes with Left Atrial Enlargement ECG Criteria for Left Atrial Enlargement 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. 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, P pulmonale: right atrial enlargement (hypertrophy, dilatation), P mitrale: left atrial enlargement (hypertrophy, dilatation), P mitrale: leftatrial enlargement (hypertrophy, dilatation). By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. worrisome? 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. [1], In the general population, obesity appears to be the most important risk factor for LAE. eCollection 2021. Ekg says "borderline ecg" and "probable left atrial enlargement." Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. 2. Get the latest news and education delivered to your inbox, Left Ventricular Hypertrophy (LVH) ECG Review, Poor R Wave Progression (PRWP) ECG Review, Right Atrial Enlargement (RAE) ECG Review, Right Ventricular Hypertrophy (RVH) ECG Review, Left Atrial Enlargement (LAE) ECG (Example 1), Left Atrial Enlargement (LAE) ECG (Example 2), Left Atrial Enlargement (LAE) with P-Mitrale ECG. A systematic review. Doctors typically provide answers within 24 hours. I'm not sure how they can tell about the left atrial enlargement from an ecg, until . Enlargement of the left and right atria causes typical P-wave changes in lead II and lead V1 (Figure 1, second and third panel). Int J Mol Sci. Taina M, Sipola P, Muuronen A, Hedman M, Mustonen P, Kantanen AM, Jkl P, Vanninen R. PLoS One. . Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Left atrial enlargement can develop too, resulting in problems with how blood is pumped out to the body. 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). Prognostic Significance of Left Atrial Enlargement in a General Population. New York, NY A 29-year-old female asked: Ekg says "borderline ecg" and "probable left atrial enlargement." is this anything of concern? At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. If an atrium becomes enlarged (typically as a compensatory mechanism) its contribution to the P-wave will be enhanced. An official website of the United States government. display: inline; This is also a normal finding. 1. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). Sun Y, Zhang Y, Xu N, Bi C, Liu X, Song W, Jiang Y. borderline/ normal ecg . These tracings are recordings of the rhythm of the heart. ABC of clinical electrocardiography. eCollection 2014. 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 . A pathological Q-wave (depth exceeding 25% of the height of proceeding R wave) is abnormal. Results of the PAMELA Study. In most cases, limiting stimulants, such as caffeine and cigarettes, is all that is needed to control symptoms. Epub 2016 Apr 14. In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). 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). Dreslinski GR, Frohlich ED, Dunn FG, Messerli FH, Suarez DH, Reisin E. Am J Cardiol. A separate entity from left atrial enlargement: a consensus report. Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. Before Echocardiogram This imaging technique uses sound waves to project a. normal sinus rhythm By using our website, you consent to our use of cookies. 2016 Aug;9(8):10.1161/CIRCIMAGING.115.004299 e004299. Note that patients with chronotropic incompetence may require pacemaker to increase exercise capacity and reduce symptoms. 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. padding-bottom: 0px; The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. The atria may become dilated and/or hypertrophic during pathological circumstances. 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). 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). Wide P wave, greater than 0.12s, Pmitrale (red arrow). 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. [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 symptoms include: Fainting. Enlargement of the right atrium is commonly a consequence of increased resistance to empty blood into the right ventricle. MeSH 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. Privacy Policy. It is also composed of two components, an initial component where the depolarization of the right atrium is observed and a final component caused by the depolarization of the left atrium. but I don't see any signs of left atrial enlargement on this EKG. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. But opting out of some of these cookies may have an effect on your browsing experience. is the bulging of one or both of the mitral valve flaps (leaflets) These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. The duration of the P-wave will exceed 120 milliseconds in lead II. abnormal ecg. 2021 Apr 20;14:1421-1427. doi: 10.2147/IJGM.S282117. More information: Bays syndrome and interatrial blocks. LAE is often a precursor to atrial fibrillation. An axis of 57 degrees is not a 'ri Had an ecg that showed borderline abnormal, possible left atrial enlargement. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. Should I be concerned? BMJ 2002;324:1264. doi: 3. The site is secure. PR interval. This can be in the form of . Accessibility A QTc 500 msec is suggestive of long QT syndrome. The murmur is caused by some of the blood leaking back into the left atrium. Regular rhythm with ventricular rate slower than 50 beats per minute. Tests may be done to check blood sugar, cholesterol levels, and . A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. Left atrial enlargement can be mild, moderate or severe depending on the severity of the underlying condition. 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. 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. ECG criteria for LAE and RAE were assessed by an expert observer blinded to CMR data. . This upper chamber of your heart receives oxygen-poor blood from your body. Left atrial enlargement is also referred to asP mitrale, andright atrial enlargement is oftenreferred to as P pulmonale. 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. Usually the chest pain is not like classic angina, but can be recurrent and incapacitating. Mitral valve prolapse may not cause any symptoms. Treatment is not usually necessary as Mitral Valve Prolapse is rarely a serious condition. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. In any case, the association between interatrial block and left atrial enlargement is relatively frequent. Dr. Sanjay Sharma, co-senior author of the International Recommendations for ECG Interpretation in Athletes, reviewed his approach to the Athlete's ECG. 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. #mergeRow-gdpr fieldset label { 2014 Mar 4;9(3):e90903. margin-right: 10px; If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart. Editor-in-chief of the LITFL ECG Library. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Habibi M, Samiei S, Ambale Venkatesh B, Opdahl A, Helle-Valle TM, Zareian M, Almeida AL, Choi EY, Wu C, Alonso A, Heckbert SR, Bluemke DA, Lima JA. The presence of a negative final component of the P wave in lead V1 greater than 40 ms may indicate left atrial enlargement5. last week ecg read: 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. "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. 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. What does sinus rhythm possible right atrial enlargement borderline left axis deviation borderline ecg unconfirmed report mean? Unauthorized use of these marks is strictly prohibited. Right atrial enlargement means your heart has an abnormally large right atrium. 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. still having mild vertigo, dizziness and fatigue. AO 1.8 and ECG criteria independent of left atrial indexed diameter z-score C1: P wave duration 110msec C2 . The normal P-wave contour on ECG The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. Science Photo Library / Getty Images Types Diego Conde D, Seoane L, et al. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Unconfirmed means a cardiologist hasn't reviewed the EKG yet. Although other factors may contribute, left atrium size has been found to be a predictor of mortality due to both cardiovascular issues as well as all-cause mortality. You also have the option to opt-out of these cookies. Left atrial enlargement can cause medical problems such as arrhythmias or abnormal heart rhythms. The .gov means its official. Always consult your doctor for a diagnosis. Cardiomegaly can happen to your whole heart or just parts of it. Cardiology 53 years experience. is this anything of concern? J Electrocardiol. Signs and symptoms [ edit] Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.[5]. An abnormal right axis can also occur in conditions with elevated right . An enlarged heart may be temporary or permanent, depending on the cause. 2 weeks dizzy on and off The following are key points from his talk: Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology, Keywords: Sports, Athletes, Brugada Syndrome, Bundle-Branch Block, Torsades de Pointes, Hypertrophy, Left Ventricular, Atrioventricular Block, Hypertrophy, Right Ventricular, Atrial Fibrillation, Bradycardia, Depression, Electrocardiography, Cardiomyopathies, Long QT Syndrome, Syncope, Physical Examination, Diabetes Mellitus, Type 2. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2015 Aug 7;16(8):18454-73. doi: 10.3390/ijms160818454. HHS Vulnerability Disclosure, Help 43 year old female. Learn how we can help 290 views Answered >2 years ago Thank A 36-year-old female asked: Learn how we can help Answered May 14, 2022 Thank 1 thank Dr. Donald Colantino answered Your heart may be unusually thick or dilated (stretched). low voltage qrs Look for other features of arrhythmogenic cardiomyopathy if the preceding J-point is not elevated. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index. My EKG team recomends you the books that we used to create our website. 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. This is a noninvasive test that produces comprehensive images of the heart. References: } T32HL07350/HL/NHLBI NIH HHS/United States. Aging itself causes left atrial growth, probably in relation to structural changes in the atrial tissue. Terminate or adjust any medications that cause or aggravate the bradycardia. [8] In any case, LAE can be diagnosed and measured using an echocardiogram (ECHO) by measuring the left atrial volume (LAVI). It often affects people with high blood pressure and. People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). Vaziri SM, Larson MG, Lauer MS, et al. Reddit and its partners use cookies and similar technologies to provide you with a better experience. National Library of Medicine The Framingham Heart Study. Int J Gen Med. Clin Cardiol. She had an ECG taken a month back and it was normal. Borderline EKG: 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. The full CAH agenda can be accessed here. (P wave 2.5 mm in II and aVF). Its not uncommon to discover SB in healthy young individuals who are not well-trained. PMC Determinants of left atrial appendage volume in stroke patients without chronic atrial fibrillation. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis. When the bradycardia causes hemodynamic symptoms it should be treated. 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. This is caused by too much pressure on the heart, which could be related to high blood pressure, stress, and underlying heart disease. Eugene H Chung, MD, FACC 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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