ventricular escape rhythm vs junctional escape rhythm

It often occurs due to advanced or complete heart block. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. The most common rhythm arising in the AV node is junctional rhythm, which may also be referred to as junctional escape rhythm. These cookies track visitors across websites and collect information to provide customized ads. Note the typical QRS morphology in lead V1 characteristic of ventricular ectopy from the LV. There is a complete dissociation between the atria and ventricles. Compare the Difference Between Similar Terms. Hafeez, Yamama. With junctional escape rhythm, your healthcare providers focus will most likely be on the condition thats causing it. Depending on the cause, others with symptoms may need: Although getting a pacemaker is usually a safe procedure, some people can have problems afterward. Get useful, helpful and relevant health + wellness information. The heart beats at a rate of less than 50 bpm. Riera AR, Barros RB, de Sousa FD, Baranchuk A. Premature beat: an aberrant impulse released from an automaticity focus which is then conducted before the sinus impulse Escape beat: an aberrant impulse released from an automaticity focus when there is failed conduction within the SA and/or AV nodes Tachycardic ectopic beat: a rapidly-firing beat causing tachycardia. In: StatPearls [Internet]. As such, the AV junction acts as a secondary pacemaker. Your heart has three pacemakers that send electrical impulses through your heart. An impulse created by the SA node causes two atria to contract and pump blood into two ventricles. [4][5], Idioventricular rhythm can also infrequently occur in infants with congenital heart diseases and cardiomyopathies such as hypertrophic cardiomyopathies and arrhythmogenic right ventricular dysplasia. Access free multiple choice questions on this topic. Both arise due to secondary pacemakers. So, this is the key difference between junctional and idioventricular rhythm. But once your heart has healed after surgery, the junctional rhythm may go away. You should contact your provider if you think your pacemaker isnt working or you have an infection. Accelerated junctional rhythm: 60 to 100 BPM. Twitter: @rob_buttner. These signals are what make your atria contract. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://borjigin.lab.medicine.umich.edu/research/ecm/ecm-arrhythmia-library/junctional-arrhythmias/accelerated-junctional-rhythm, https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12410, https://www.ncbi.nlm.nih.gov/books/NBK554520/, https://www.ncbi.nlm.nih.gov/books/NBK507715/, https://www.ncbi.nlm.nih.gov/books/NBK557664/, https://www.ncbi.nlm.nih.gov/books/NBK544253/, https://www.kaweahhealth.org/documents/float-pool/Arrhythmia-Study-Guide-3-Junctional-and-Ventricular.pdf, https://borjigin.lab.medicine.umich.edu/research/ecm/ecm-arrhythmia-library/junctional-arrhythmias/junctional-escape-rhythm, https://my.methodistcollege.edu/ICS/icsfs/mm/junctional_rhythm-resource.pdf?target=5a205551-09a5-4fef-a7ef-e9d1418db53a, https://www.ncbi.nlm.nih.gov/books/NBK459238/, https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-016-0645-9, https://www.ncbi.nlm.nih.gov/books/NBK531498/, https://www.texasheart.org/heart-health/heart-information-center/frequently-asked-patient-questions/can-you-explain-if-when-junctional-rhythm-is-a-serious-issue/, https://www.ncbi.nlm.nih.gov/books/NBK546663/. In such scenarios, cells in the bundle of His (which possess automaticity) will not be reached by the atrial impulse and hence start discharging action potentials and an escape rhythm. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. This site uses Akismet to reduce spam. It is very rare among adults and elderly, but isrelatively commonin children. Junctional escape beats originate in the AV junction and are late in timing. This activity highlights important etiologies and correlating factors contributing to idioventricular rhythms and their management by an interprofessional team. Junctional escape rhythm is an abnormal rhythm that happens because your heartbeat is starting in an area that's taking over for the area that can't start a strong heartbeat. The rate usually is less than 45 beats per minute, which helps to differentiate it from other arrhythmias. At the least, all nurses should be able to identify sinus and lethal rhythms. See your provider for checkups or follow-up visits regularly. Typically, the sinoatrial (SA) node controls the hearts rhythm. Lifestyle, including whether you consume caffeine or use tobacco products or alcohol. These cookies will be stored in your browser only with your consent. Atrioventricular Dissociation: Background, Pathophysiology, Etiology Types include bradyarrhythmia or supraventricular arrhythmia. Junctional rhythm is an abnormal cardiac rhythm caused when the AV node or His bundle act as the pacemaker. Click here to learn more about the SA node. It is mandatory to procure user consent prior to running these cookies on your website. Policy. There are several potential, often differing, causes compared with junctional rhythm. Sinus pause / arrest (there is a single P wave visible on the 6-second rhythm strip). MNT is the registered trade mark of Healthline Media. If you do have symptoms, they may include: Numerous conditions and medicines can stop your sinoatrial node from sending electrical signals that start your heartbeat. Managing any symptoms and getting treatment can help you feel your best. 1-ranked heart program in the United States. A junctional escape beat is a delayed heartbeat that occurs when "the rate of an AV junctional pacemaker exceeds that of the sinus node." [2] Junctional Rhythms are classified according to their rate: junctional escape rhythm has a rate of 40-60 bpm, accelerated junctional rhythm has a rate of 60-100 bpm, and junctional tachycardia has a rate greater than 100 bpm. The types and associated heart rates include: Symptoms can vary and may not be present in people with a junctional rhythm. margin-right: 10px; Sinoatrial node or SA node is a collection of cells (cluster of myocytes) located in the wall of the right atrium of the heart. 1. Your provider may recommend regular checkups and EKGs to monitor your heart health. What are the three types of junctional rhythms? - Sage-Answers Junctional Bradycardia. There are several types of junctional rhythm. When the rate is between 50 to 110 bpm, it is referred to as accelerated idioventricular rhythm. Willich T, Goette A. Update on management of cardiac arrhythmias in acute coronary syndromes. In most cases, the P-wave is not visible because when impulses are discharged from the junctional area, atria and ventricles are depolarized simultaneously and ventricular depolarization (QRS) dominates the ECG. Its not their normal job, but they can fill in for your sleeping conductor and keep your heart going. [deleted] 3 yr. ago. The cells in the atrioventricular node itself may start discharging impulses under pathological circumstances, such as in ischemia. If the ventricles are activated prior to the atria, a retrograde P-wave (leads II, III and aVF) will be seen after the QRS complex. Dysrhythmia and arrhythmia are both terms doctors use to describe an abnormal heart rate. You can email me at Nursology01@gmail.com. Broad complex escape rhythm at around 27 bpm. Your heart responds by using one of your backup pacemakers instead. Common complications of junctional rhythm can include: The following section provides answers to commonly asked questions about junctional rhythm. 5. Ventricularrhythm arising more distally in the Purkinje plexus of the left ventricular myocardium displays the pattern of right bundle branch block, and those of right ventricular origin display the pattern of left bundle branch block. But if you need treatment, medications or a pacemaker can often relieve your symptoms. Atrioventricular Block: 2nd Degree, 2:1 fixed ratio block, Atrioventricular Block: 2nd Degree, Mobitz II, 'Mystical' psychedelic compound found in normal brains of rats, NATURALLY-OCCURRING MYSTICAL PSYCHEDELIC FOUND IN MAMMAL BRAINS, Normal Human Brains are Producing Psychedelic Drugs On Their Own, Brain Activity May Hasten Death in Cardiac Arrest Patients, Near death experiences: Surge of brain activity accelerates deterioration of heart, Near-Death Brain Activity Could Destabilize The Heart, Near-death brain activity may speed up heart failure, Near-Death Experiences: New Clues to Brain Activity, Near-Death Experiences: What Happens in the Brain Before Dying, Study: Near-death brain signaling accelerates demise of the heart, The Science Behind Near Death Experiences Explained In A Study, Brainstorm Hastens Death During Heart Failure, Brain surge may explain near-death experiences, Near-death experiences aren't figment of imagination, study shows, Near-death experiences may be surging brain activity, Brain Activity Shows Basis of Near-Death 'Light', Brains Of Dying Rats Yield Clues About Near-Death Experiences. Depending upon the junctional escape rate, ventricular function, and clinical symptoms, these patients may benefit from permanent pacing. Complications can occur if a person does not notice symptoms and receive treatment for the underlying condition. It can occur for a variety of reasons, and junctional rhythm itself is not typically a problem. The heart is a complex structure containing many different parts that work together to produce a heartbeat. Care coordination between various patient care teams to determine etiology presenting idioventricular rhythm is very helpful. Idioventricular rhythm is benign in most cases, and appropriate patient education and reassurance are important. Infrequently, patients can have palpitations, lightheadedness, fatigue, and even syncope. Isorhythmic dissociation, fusion or capture beats can occur when sinus and ectopic foci discharge at the same rate.[2]. Junctional Escape Beat - an overview | ScienceDirect Topics } Junctional Rhythm: Causes, Symptoms and Treatment - Cleveland Clinic 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. With treatment, the outlook is good. You can live a healthy life with a junctional rhythm if you: Many people can manage a junctional rhythm with regular visits to their healthcare provider. Save my name, email, and website in this browser for the next time I comment. } PEA encompasses a number of organized cardiac rhythms, including supraventricular rhythms (sinus versus nonsinus) and ventricular rhythms (accelerated idioventricular or escape). Idioventricular rhythm is a benign rhythm, and it does not usually require treatment. Preference cookies are used to store user preferences to provide content that is customized and convenient for the users, like the language of the website or the location of the visitor. We also use third-party cookies that help us analyze and understand how you use this website. This noninvasive test measures and records your hearts rhythm. 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. A junctional rhythm is when the AV node and its automaticity is what's driving the ventricles. @media (max-width: 1171px) { .sidead300 { margin-left: -20px; } } An incomplete right bundle branch block is seen when the pacemaker is in the left bundle branch. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. Policy. Ventricular escape rhythm (Concept Id: C0232216) - National Center for Your healthcare provider will do a physical exam and ask for your medical history. When you have a junctional rhythm, your SA node stops working or sends signals that are too slow or weak. [2], Idioventricular rhythm is mostly benign, and treatment has limited symptomatic or prognostic value. Problems with the devices wires getting out of place. Borjigin Lab - Ventricular Escape Beat/Rhythm - University of Michigan Functionally, SA node is responsible for the rhythmic electrical activity of the heart. Junctional Escape Rhythm-A junctional escape rhythm, also called a junctional rhythm, is a dysrhythmia that occurs when the SA node ceases functioning, and the AV junction takes over as the pacemaker of the heart at a rate of 40-60 BPM.-Rhythm is typically regular, with littler variation between R-R intervals. PR interval: Short PR interval (less than 0.12) if P-wave not hidden. Electrical cardioversion is ineffective and should be avoided (electrical cardioversion may be pro-arrhythmogenic in patients on digoxin). When the sinoatrial node is blocked or suppressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional . The conductor from a later stop takes over giving commands for your heart to beat. So let us continue to Junctional Rhythms which occurs when the primary pacemaker of the heart is the AV node. Electrical signatures of consciousness in the dying brain, How do near-death experiences arise? QRS complexes are broad ( 120 ms) and may have a LBBB or RBBB morphology. Junctional and ventricular rhythms. Ventricular escape beat [Online image]. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. An incomplete left bundle branch block pattern presents if ventricular rhythm arises from the right bundle branch block. In mild cases of junctional rhythm, you may not feel any different. You may need treatment if your blood oxygen levels are too low or your symptoms bother you. The default pacemaker area is the SA node. Retrograde P-wave before or after the QRS, or no visible P-wave. By using this site, you agree to its use of cookies. In junctional tachycardia, it is higher than 100 beats per minute, while in junctional bradycardia, it is lower than 40 beats per minute. Your treatment may include: There is no guaranteed way to prevent this condition. [2], Diagnosis of Ventricular Escape Rhythm on the ECG, 2019 Regents of the University of Michigan | U-M Medical School, | Department of Molecular & Integrative Physiology | Complete Disclaimer | Privacy Statement | Contact Michigan Medicine. It is a hemodynamically stable rhythm and can occur after a myocardial infarction during the reperfusion phase.[2]. It may be very difficult to differentiate junctional tachycardia from AVNRT. Response to ECG Challenge. It initiates an electrical impulse that travels through the hearts electrical conduction system to cause the heart to contract, or beat. 1 The patient's presenting ECG shows regular flutter waves and regular QRS complexes but with varying intervals from flutter wave to QRS complex. Treatments and outcomes can vary based on the underlying cause. Ventricular pacemaker cells discharge at a slower rate than the SA or AV node. AS is distinguished by bradycardia, junctional (usually narrow complex) escape rhythm, and absence of the P . The 12-lead ECG shown below illustrates a junctional escape rhythm in a well-trained athlete whose resting sinus rate is slower than the junctional rate. The patient may have underlying cardiac structural etiology, ischemia as a contributory cause, orit could be secondary to anesthetic type, medication, or an electrolyte disturbance. An idioventricular rhythm also occurs if the SA node becomes blocked. PR interval: Normal or short if there is a P-wave present. sinus rhythm). You also have the option to opt-out of these cookies. Other Cardiology.pdf - Cardiology Study Guide - 2021 Thus, this is the summary of what is the difference between junctional and idioventricular rhythm. A doctor will also likely conduct a physical examination. Junctional tachycardia (junctional ectopic tachycardia) is a rare heart rhythm that starts from a natural pacemaker, but not the one your heart normally uses. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Junctional rhythm can be without p wave or with inverted p wave, while p wave is absent in idioventricular rhythm. Rhythm analysis indicates a third degree heart block and junctional escape rhythm at 40 bpm. It occurs equally between males and females. Ventricular escape beats occur when the rate of electrical discharge reaching the ventricles (normally initiated by the heart's sinoatrial node, transmitted to the atrioventricular node, and then further transmitted to the ventricles) falls below the base rate determined by the ventricular pacemaker cells. They can better predict a persons success rate and overall outlook. Atrioventricular Conduction During Atrial Flutter | Circulation You can learn more about how we ensure our content is accurate and current by reading our. A persons outlook is generally positive when a healthcare professional identifies and treats the condition causing the junctional rhythm. Your provider sticks electrodes (pads) on your chest, arms and legs that are connected to a special computer. Your ventricles do all the contracting and pumping, but they cant pump as much blood on their own. 18 Identify the following rhythm a Ventricular tachycardia b Course Ventricular Escape Rhythm: A ventricular rhythm with a rate of 20-40 bpm. Junctional bradycardia: Less than 40 BPM. With the slowing of the intrinsic sinus rate and ventricular takeover, idioventricular rhythm is generated. It is often found in children or adults who have: During a normal heartbeat, your SA node sends a signal to the AV node, which travels to your bundle of His. A junctional rhythm is a heart rhythm problem that can make your heartbeat too slow or too fast. Rhythms originating from the AV junction are called junctional dysrhythmias or junctional rhythms. Junctional Rhythms | Junctional Escape Rhythms | Junctional Tachycardia Included in the structure are natural pacemakers that help regulate how often the heart beats. Digitalis-induced accelerated idioventricular rhythms: revisited. Slow ventricular tachycardia. Idioventricular rhythm can be seen in and potentiated by various etiologies. Similarities Junctional and Idioventricular Rhythm, Junctional vs Idioventricular Rhythmin Tabular Form, Summary Junctional vs Idioventricular Rhythm, Difference Between Coronavirus and Cold Symptoms, Difference Between Coronavirus and Influenza, Difference Between Coronavirus and Covid 19, Difference Between High Tea and Afternoon Tea, Difference Between Chlorosis and Necrosis, Difference Between Savings and Checking Account, What is the Difference Between Syphilis and Chancroid, What is the Difference Between Open and Closed Mitosis, What is the Difference Between Typical and Atypical Trigeminal Neuralgia, What is the Difference Between Menactra and Menveo, What is the Difference Between Soft Skills and Technical Skills, What is the Difference Between Idiopathic Hypersomnia and Narcolepsy. The below infographic lists the differences between junctional and idioventricular rhythm in tabular form for side by side comparison. Last reviewed by a Cleveland Clinic medical professional on 05/20/2022. EKG interpretation is a critical skill that nurses must master. In occasional scenarios when there is AV dissociation leading to syncope or sustained or incessant AIVR, the risk of sudden death is increased and arrhythmia should be treated.[12]. In fact, many people call it "Junctional Escape." Broad complex escape rhythm with a LBBB morphology at a rate of 25 bpm. This is called normal sinus rhythm. The outlook for junctional escape rhythm is good. . But some people with a junctional rhythm experience: Your healthcare provider will ask you about your symptoms and do a physical examination. clear: left; Summarize how the interprofessional team can improve outcomes for patients with idioventricular rhythms. View all chapters in Cardiac Arrhythmias. If the normal sinus impulse disappears (e.g. Learn more. Identify the following rhythm a Sinus bradycardia b Junctional rhythm c A normal sinus beat followed by a premature ventricular beat resets the sinus node timing cycle. However, if the SA node paces too slowly, or not at all, the AV junction may be able to pace the heart. But opting out of some of these cookies may have an effect on your browsing experience. Retrograde P waves are hidden in the ST-T waves and best seen in leads II . 2. Join our newsletter and get our free ECG Pocket Guide! Patients with junctional or idioventricular rhythms may be asymptomatic. Also note, the QRS complexes are narrow as the AV node is above the ventricles. Learn how your comment data is processed. Having another heart condition, especially another type of arrhythmia, also puts you at a higher risk of having a junctional rhythm. Degree in Plant Science, M.Sc. Idioventricular rhythm is similar to ventricular tachycardia, except the rate is less than 60 bpm and is alternatively called a 'slow ventricular tachycardia.' A junctional rhythm is a type of arrhythmia (irregular heartbeat). http://creativecommons.org/licenses/by-nc-nd/4.0/ However, impulses are occasionally discharged in the atrioventricular node or by cells near the node. 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. Junctional rhythm can also occur in young athletes and children, particularly during sleep. Ventricular Rhythm & Accelerated Ventricular Rhythm (Idioventricular Rhythm), Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT) & Wolff-Parkinson-White (WPW) syndrome), Atrioventricular nodal reentry tachycardia (AVNRT), Sinus tachycardia (ST), Inappropriate Sinus tachycardia (IST) and Sinoatrial Node Reentry Tachycardia (SANRT), Management and diagnosis of tachycardias (narrow complex tachycardia and wide complex tachycardia). Dont stop taking them unless your provider tells you to do so. The heart has several built-in pacemakers that help control its rhythm. To prevent a junctional rhythm from getting worse, see your provider regularly. Necessary cookies are absolutely essential for the website to function properly. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. People without symptoms dont need treatment, but those with symptoms may need medicine or a procedure to fix the problem. The QRS complex is generally normal, unless there is concomitant intraventricular conduction disturbance. in Molecular and Applied Microbiology, and PhD in Applied Microbiology. Rhythmsarising in the anterior or posterior fascicle of the left bundle branch exhibit a pattern of incomplete right bundle branch block with left posterior fascicular block and left anterior fascicular block, respectively.[8]. 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. so if the AV node is causing the contraction of the ventricles does that mean the SA node has failed, which means it's a junctional escape rhythm? The QRS complex is generally normal, unless there is concomitant intraventricular conduction disturbance. EKG Refresher: Atrial and Junctional Rhythms. Junctional rhythm is an abnormal cardiac rhythm caused when the AV node or His bundle act as the pacemaker. But there are different ways your heartbeat may change when this happens. A Premature Junctional Contraction (PJC) is a junctional ectopic beat that occurs prematurely. Third Degree Heart Block with Junctional Escape Rhythm Other people may need treatment for an underlying condition, such as Lyme disease or heart failure. Sinus bradycardiab. Angsubhakorn N, Akdemir B, Bertog S, et al. #mc_embed_signup { P-waves can also be hidden in the QRS. The major reason can be an advanced or complete heart block. With this issue, its common to get junctional rhythm. Management is clinical monitoring. P-waves can also be hidden in the QRS. When symptoms do occur, they typically reflect the underlying condition causing the junctional rhythm. AV dissociation due to third-degree AV-block. The difference between Junctional Escape Beats and Premature Junctional Contractions is the timing of the impulse. It regularly causes a heart rate of less than 50, though other types can cause increased heart rate, as with different types of junctional rhythm. What is Junctional Rhythm Your symptoms are getting worse or they prevent you from doing daily activities. But it does not occur in the normal fashion. font-weight: normal; If you have not done so already, I suggest you read my articles on the Hearts Electrical System, Sinus Rhythms and Sinus arrest: ECG Interpretation, and Atrial Rhythms: ECG Interpretation. This site uses cookies from Google to deliver its services and to analyze traffic. Various medicationssuch as digoxin at toxic levels, beta-adrenoreceptor agonistslike isoprenaline, adrenaline,anestheticagents including desflurane, halothane, and illicit drugs like cocaine have reported being etiological factorsin patientswith AIVR. (1980). Some people with junctional rhythm may not need treatment if they have no underlying conditions or issues. A junctional rhythm is a type of arrhythmia (irregular heartbeat). 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.

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