Clinical Examination in Cardiology

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Front Cover Front Matter Copyright Dedication PREFACE TO REVISED REPRINT PREFACE TO THE EARLIER EDITION CONTENTS ABBREVIATIONS Part I Basic Anatomy And Physiology Chapter 1 - Anatomy of the Heart Gross Anatomy of the Heart External Features of the Heart The Sulci of the Heart The Surfaces of the Heart The Borders of the Heart The Chambers of the Heart Right Atrium (RA) External Features Internal Features Right Ventricle (RV) External Features Internal Features Left Atrium (LA) External Features Internal Features Left Ventricle (LV) External Features Internal Features The Fibrous Skeleton of the Heart Components and Attachments Extensions The Bundle of His The Valves of the Heart General Description Mitral Valve Mitral Annulus Leaflets Papillary Muscles (PM) Chordae Tendinae (CT) Mitral Valve Closure Tricuspid Valve Tricuspid Annulus Leaflets Papillary Muscles (PM) Chordae Tendineae Semilunar (SL) Valves Annulus Leaflets (Cusps) Commissures Sinuses of Valsalva SL Valve Closure Chapter 2 - Lymphatic System of the Heart Formation Of Right Coronary Channel Formation Of Left Coronary Channel Formation Of Main Supra-Cardiac Channel Formation Of Right Lymphatic Duct Chapter 3 - Venous Drainage of the Heart Coronary Sinus Great Cardiac Vein Oblique Vein of Left Atrium (or Oblique Vein of Marshall) Posterior Vein of the LV Middle Cardiac Vein (or Posterior Interventricular Vein) Small Cardiac Vein Anterior Cardiac Veins Thebesian Veins (Venae Cordis Minimi) Chapter 4 - Arterial Supply of the Heart Left Coronary Artery Left Anterior Descending Artery (LAD) Left Circumflex Artery (LC or LCx) Ramus Intermedius Right Coronary Artery (RCA) Divergent Coronary Anatomy Measurements Length Luminal Diameter Chapter 5 - Nerve Supply of the Heart Cardiac Plexus Superficial Cardiac Plexus Deep Cardiac Plexus Both Sympathetic and Parasympathetic Fibers Baroreceptors and Chemoreceptors Baroreceptors Arterial Baroreceptors Cardiac Baroreceptors Chemoreceptors Chapter 6 - The Conduction System of the Heart Sinoatrial (SA) Node (Pacemaker Node of Keith-Flack, 1907) P Cells (Pale/Nodal Cells) Transitional Cells (T cells) Internal Atrial Myocardium The Anterior Internodal Tract (Bachmann-James) The Middle Internodal Tract (Wenckebach) The Posterior Internodal Tract (Thoral) Atrioventricular Junctional Area Transitional Cell Zone Atrioventricular (AV) Node (Tarawa, 1906) The Bundle of His (AV Bundle, Common Bundle) The Bundle Branches and Terminal Purkinje Fibers The Left Bundle Branch (LBB) The Right Bundle Branch (RBB) Blood Supply The Terminal Purkinje Fibers Chapter 7 - Ultrastructure of the Myocardium P Cells Transitional Cells Purkinje Cells Amoeboid Cells Contractile or Working Myocardial Cells Sarcolemma (Sarco = Flesh; Lemma = Thin Husk) Type I Intrinsic Membrane Protein (Voltage Operated Channels) Type II Intrinsic Membrane Protein (Ligand Receptors or Receptor Operated Channels) Intercalated Discs Desmosome and Fascia Adherens The Gap Junctions Sarcotubular System T-system or Transverse Tubular System Longitudinal Sarcoplasmic Reticulum Diadic Cleft Contractile Proteins Myosin Titin (Connectin) Actin Tropomysin-Troponin Complex Myosin isoforms Chapter 8 - Basic Electrophysiological Principles Sarcolemma, Intercalated Disc Intracellular and Extracellular Ion Concentrations in Cardiac Muscle Properties of Transmembrane Potentials Cardiac Action Potentials Phases of the Cardiac Action Potential Phase 0: the Upstroke or Rapid Depolarization Phase 1: Early Rapid Repolarization Phase 2: Plateau Phase Phase 3: Final Rapid Repolarization Phase 4: (a) the Resting Membrane Potential Phase 4: (b) Diastolic Depolarization Origin and Sequence of Cardiac Activation Atrial Depolarization Decremental Conduction at the AV Node Ventricular Depolarization4 The Atrial Repolarization The Ventricular Repolarization Chapter 9 - Molecular Basis of Muscle Contraction Muscular Contraction Sliding Filament Theory of Huxley and Hanson1 Muscular Relaxation The Velocity and the Amount of Tension The Bowditch, Staircase, or Treppe Phenomenon The Frank-Starling Law of the Heart4 Chapter 10 - The Cardiac Cycle Ventricular Systole Isovolumic Contraction Rapid Ventricular Ejection Phase Slow or Reduced Ventricular Ejection Phase Ventricular Diastole Protodiastole Isovolumic Relaxation Phase Rapid Ventricular Filling Phase Slow Ventricular Filling Phase Atrial Systole Atrial Diastole The Differences in the Events Between Right and Left Sides of the Heart Ecg Changes During Cardiac Cycle Part 2 The History And Symptomatology Chapter 11 - Cardinal Symptoms Importance of History Taking Chest Pain Etiology Cardiovascular Causes Non Cardiovascular Causes The Duration of Chest Pain The Chest Pain Lasting for a Few Seconds The Chest Pain Lasting for a Few Minutes The Chest Pain Lasting for Minutes to Hours The Location and Radiation of Chest Pain Cardiovascular Causes Non Cardiovascular Causes Character and Mode of Onset of Chest Pain Cardiovascular Causes Non Cardiovascular Causes Aggravating and Relieving Factors Angina Pectoris In MVP In Acute Pericarditis The Esophageal Pain The Pain in Acid Peptic Disorders The Pleuritic Chest Pain In Thoracic Outlet Syndrome Patient's Gestures During Chest Discomfort Associated Symptoms Definite Typical Anginal Chest Pain (ACC/AHA 2002 Guidelines)10a Non Cardiac Chest Pain (ACC/AHA 2002 Guidelines)10a Shortness of Breath (Sob)/Dyspnea Dyspnea Pathogenesis of Dyspnea Vital Capacity MVV (or Maximum Voluntary Ventilation or Maximum Breathing Capacity) Pulmonary Ventilation (or Minute Ventilation) Etiology Common Causes of Dyspnea Evaluation Duration Mode of Onset Severity/Aggravating Factors Variants of Dyspnea Relieving Factors Associated Symptoms Palpitation Etiology Cardiac Causes Non Cardiac Causes Evaluation Duration and Frequency of Palpitation Mode of Onset Nature/Character of Palpitation Relieving Factors/How it Stops? Associated Symptoms Fatigue Syncope Etiopathogenesis Cardiac Syncope Non Cardiac Syncope Undetermined (Syncope of Unknown Causes) Cardiac Syncope Non Cardiac Syncope Exercise Induced Syncope Evaluation of Syncope Chapter 12 - Other Symptoms Hemoptysis Etiology Evaluation Duration, Frequency and Recurrence of Hemoptysis Quantity Associations Hoarseness Cyanosis Definition Types Peripheral Cyanosis Central Cyanosis Mixed Cyanosis Methemoglobinemia Evaluation of Cyanosis Duration at What Age Cyanosis Appeared/Notice Distribution of Cyanosis Aggravating Factors Relieving Factors Associations Squatting Part 3 General Physical Examination Chapter 13 - General Examination General Build and Stature Tall Stature Marfan Syndrome Short Stature Built Posture or Attitude Gestures and Signs Facial Appearance Facial Dysmorphism Facial Edema Dull Expressionless Face with Periorbital Puffiness Dull Expressionless Face with Ptosis Butterfly Rash on the Face Malar Rash (Brownish Tint or Flush) Flushing Striking Premature Aging Facial Expression of Fright and Anxiety Moon Face Ape Like Appearance Mongoloid Facies Grotesque Facial Features Elfin Facies Distinctive Unilateral Lower Facial Weakness (7th Cranial Nerve Palsy) Midfacial Growth Deficiency Eyes Hypertelorism Exophthalmos Enophthalmos Nystagmus Eye Lids Conjunctiva Sclera Cornea Iris Brushfield's Spots Congenital Coloboma Pupils Lens Premature Cataracts Subluxation of the Lens Retina Nose Ears Ear Lobe Crease Cauliflower (Floppy) Ear Low Set Ears Deafness Oral Cavity Lips Mucous Membrane Teeth Gums Tongue Color of the Tongue Macroglossia Glossoptosis (Retracted Tongue) Palate Neck Short Neck Webbed Neck Low Hair Line Lymphadenopathy Thyromegaly Parotid Enlargement Spine Skin Pigmentation Skin Texture Xanthomas Type I Hyperlipoproteinemia or Familial Chylomicronemia Type V Hyperlipoproteinemia or Familial Mixed Triglyceridemia Nodules Cyanosis, Icteru, and Pallor Extremities Digits Nails Grades of Clubbing Causes of Clubbing Unilateral Clubbing of Fingers Unidigital clubbing Differential Clubbing Feet Joints Migrating Polyarthritis Jaccord's Arthritis Polychondritis Rheumatoid Arthritis Gouty Arthritis Peripheral Edema Pathogenesis Liquid Accumulation = K (Pc - Pi) - (πc - πi) - Qlymph Causes Imbalance of Starling Forces Capillary Endothelial Damage Types and Site of Peripheral Edema Localized Anasarca Leg Edema Characteristics of Peripheral Edema Chapter 14 - Arterial Pulse Definition Genesis of the Arterial Pulse Pulse Wave Pattern In Ascending Aorta In Peripheral Arterial Pulse Examination of the Arterial Pulse Rate of the Pulse Tachycardia Bradycardia Pulse Deficit Rhythm Regularly Irregular Pulse Irregularly Irregular Pulse Character of the Pulse Pulsus Tardus (Slow Rising Pulse) Water-Hammer (Collapsing) Pulse or Corrigan Pulse or Pulsus Celer Twice Beating Pulse Irregularly Regular Pulse Pulsus Paradoxus Volume of the Pulse Pulsus Parvus Pulsus Magnus Hyperkinetic or Bounding Pulse Condition of the Vessel Wall Radial Pulse Synchronicity Absent or Delayed Femoral Pulsations Characteristic Features of Pulse in Common Clinical Conditions Aortic Stenosis (AS) Aortic Regurgitation (AR) Pulse BP Eyes Head and Neck Upper Limb Lower Limb Abdomen Chapter 15 - Measurement of the Blood Pressure Definition and Components of Arterial Blood Pressure Determinants of Arterial Blood Pressure Measurement of Arterial Blood Pressure Direct Methods Indirect Methods History Palpatory Method Auscultatory Method Flush Method of BP Recording Ultrasound Doppler Method Continuous Non-invasive BP Monitoring by Oscillometric Method or Arterial Tonometry Self-Monitoring of BP Ambulatory BP Monitoring (ABPM) Hypertension Causes of Hypertension Mechanisms of Primary Hypertension Complications of Hypertension Part 4 Jugular Venous Pulse Chapter 16 - Introduction and Jugular Venous Pulse Waves Introduction History Examination of Jugular Venous Pulse (JVP) Which JVP? The Internal Jugular Vein is Preferred to the External Jugular Vein The Right IJV is Preferred to Left IJV Position of the Patient Analysis of the Jugular Venous Pulsations a Wave x Descent (Systolic Collapse) x' Descent c Wave v Wave y Descent or Diastolic Collapse h Wave Abnormalities of the Waves Abnormalities of a Wave Prominent or Large a Waves Giant a Waves or Cannon Waves Absent a Waves Abnormalities of x Descent Absent x Descent Prominent x Descent Abnormalities of v Wave Prominent v Wave Prominent v Wave in Absence of Tricuspid Regurgitation Prominent a and v Waves Abnormalities of y Descent Rapid (Diastolic Collapse) y Descent Slow y Descent Chapter 17 - Estimation of Venous Pressure and JVP in Diseased Conditions Estimation of Venous Pressure Measurement of Jugular Venous Pressure Abdominal-Jugular Reflux (AJR) Measurement of Venous Pressure by Examining the Veins of the Hand (Gaertner's Method) Assessment of Venous Pressure by Examining the Visible Engorged Veins on the Undersurface of the Tongue (May's Sign) JVP in Diseased Conditions JVP in Arrhythmias JVP in Conduction Defects JVP in Valvular Lesions JVP in Mitral Stenosis (MS) JVP in Mitral Regurgitation (MR) JVP in Tricuspid Stenosis (TS) JVP in Tricuspid Regurgitation (TR) JVP in Aortic Stenosis (AS) JVP in Aortic Regurgitation (AR) JVP in Pulmonary Stenosis (PS) JVP in Acyanotic CHD JVP in Atrial Septal Defect (ASD) JVP in Ventricular Septal Defect (VSD) JVP in Cyanotic CHD JVP in Eisenmenger Complex and Syndrome JVP in Tetralogy of Fallot (TOF) or TOF Like Physiology JVP in PS with Intact Interventricular Septum and Right to Left Shunt JVP in Tricuspid Atresia JVP in Transposition of Great Arteries (TGA) or Total Anomalous Pulmonary Venous Connection (TAPVC) with Increased Pulmona ... JVP in Cardiomyopathy JVP in Pericardial Diseases Part 5 Cardiovascular System Examination Chapter 18 - Inspection of the Precordium Examination of the Chest Shape of the Chest Cutaneous Lesions Breast Abnormalities Distended Vessels Over the Chest and Back Veins Arteries Examination of the Precordium Ossification of the Sternum Ossification of the Ribs Cardiovascular Pulsations Apical Impulse Absent Apical Impulse Double Apical Impulse Lateral Retraction of the Apical Impulse (Skoda's Sign) Displacement of Apical Impulse Extent of Apical Impulse Pulsations in the (Aortic Area) Right and Left (Pulmonary Area) 2nd Intercostal Spaces Pulsations in the Sternoclavicular Area Left Parasternal Pulsations Pulsations in the Epigastrium Cardiac Pulsations in the Epigastrium Aortic Pulsations in the Epigastrium Hepatic Pulsations in the Epigastrium Pulsations in the Ectopic Areas Chapter 19 - Palpation of the Precordium Examination of the Chest for the Shape and Distended Vessels Palpation of the Precordium for any Tenderness Palpation of the Cardiovascular Pulsations, Palpable Sounds, Thrills and Rubs Palpation of the Cardiac Apex Size and Extent of the Cardiac Apex Character of the Apex Beat Palpable Low Frequency Sounds at the Apex Palpable High Frequency Sounds at the Apex Palpable Murmurs-Thrills at the Apex Palpation of Left Parasternal Area Left Parasternal Lift Palpable Low Frequency Sounds Palpation of Lower Left Sternal Area (Tricuspid Area) Palpable Low Frequency Sounds Palpable High Frequency Sounds Palpable Murmurs-Thrills Palpation of Aortic and Pulmonary Areas Palpable High Frequency Sounds Palpable Murmurs-Thrills Palpation of Sternoclavicular Areas Palpation of Epigastrium Palpation in the Ectopic Areas Ectopic LV Impulse Ectopic LA Impulse Ectopic RA Impulse Due to PDA Tracheal Tug (Oliver's SIGN) Kinetic Cardiogram The Apical Impulse in Normal Adults Hyperdynamic/Hyperkinetic Apex Sustained/Heaving Apex Hyperkinetic RV Impulse Sustained RV Impulse Systolic Movements are Inconspicuous in Cardiomyopathy In Constrictive Pericarditis Chapter 20 - Percussion of the Precordium and Precordial Findings in Common Heart Diseases Methods of Percussion Direct Percussion Indirect Percussion Auscultatory Percussion The Scheme of Percussion Determination of the Cardiac Borders Right Border of the Heart (see Figs 20.3, 20.4a and 20.4b) Left Border of the Heart Percussion of the Pulmonary and Aortic Areas Direct Percussion of the Sternum Special Percussions Auscultatory Percussion Rotch's Sign Enlarged LA Appendage Determination of the Situs Precordial Findings in Common Heart Diseases Acquired Heart Diseases Mitral Stenosis (MS) Mitral Regurgitation (MR) Aortic Stenosis (AS) Aortic Regurgitation (AR) Acyanotic Congenital Heart Diseases Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Pulmonary Stenosis (PS) Cyanotic Congenital Heart Diseases (CCHD) Precordial Findings in CCHD with Decreased Pulmonary Blood Flow Precordial Findings in CCHD with Increased Pulmonary Blood Flow Precordial Findings in TOF Precordial Findings in Cardiomyopathy Dilated Congestive Coardiomyopathy Hypertrophic Cardiomyopathy Restrictive Cardiomyopathy Chapter 21 - Cardiac Auscultation Principles and Techniques The Human Acoustic Acuity Factors Affecting Cardiac Sound Transmission Characteristics of the Cardiac Sounds The Stethoscope The Bell of the Stethoscope The Diaphragm of the Stethoscope Tubing of the Stethoscope Binaurals and Earpiece Examination of the Patient Method of Auscultation Phonocardiography The Heart Sounds The First Heart Sound (S1) Characteristics of S1 Determinants of the Intensity of S1 Evaluation of S1 The Second Heart Sound (S2) Characteristics of S2 Intensity of S2 Evaluation of S2 in Common Clinical Conditions Diastolic Sounds The Third Heart Sound (S3) Pericardial Knock (PK) The Fourth Heart Sound (S4) Opening Snaps (OS) Tumor Plop (TP) The Systolic Sounds Systolic Ejection Sounds Non-ejection Sounds or Systolic Clicks Prosthetic Valve Sounds Ball-in-Cage Valves (Starr-Edwards) Tilting Disc Valves (Meditronic Hall) Bileaflet Valves (St. Judes) Bioprosthetic Valves (Porcine Valves) Extra-Cardiac Sounds Pacemaker Sounds Pericardial Rub Mediastinal Crunch The Heart Murmurs Definition Mechanism of Production of the Murmurs Factors for the Production of Murmurs Characteristics of Murmurs Timing of the Murmur Location of the Murmur Duration or Length of the Murmur Intensity or Loudness of the Murmur Character and Frequency (Pitch) of the Murmur Configuration or Shape of the Murmurs (Murmur "Envelope") Transmission of the Murmurs Dynamic Auscultation Systolic Murmurs Classification of SM Diastolic Murmurs Early Diastolic Murmurs (EDM) Pandiastolic or Holodiastolic Murmurs Mid Diastolic Murmurs (MDM) Late Diastolic or Presystolic Murmurs (LDM/PreSM) Continuous Murmurs Causes of Continuous Murmurs Continuous Murmurs Due to High-to-Low Pressure Shunts Continuous Murmurs Due to Rapid Blood Flow Continuous Murmurs Secondary to Localized Arterial Obstruction Part 6a Basic Investigations: Clinicalelectrocardiogram Chapter 22 - Introduction and Basic Concepts Introduction Basic Concepts Electrophysiology of the Heart The Conduction System of the Heart The Contractile or Working Myocardial Cell Electrical Activity of the Heart Electrocardiographic Instrument, Recording Electrodes and Lead Electrocardiographic Instrument Recording Electrodes and Leads The Electrocardiographic Grid Precautions to be Taken for Recording an ECG Chapter 23 - The Normal Electrocardiogram Waves P Wave Q(q) Wave R(r) Wave S(s) Wave R'(r') Wave T Wave U Wave Ta Wave Intervals Segments The Electrical Axis The Hexaxial Reference System Methods of Determination of Electrical Axis Equiphasic Method Classical Method9,11 Simplified Method12 Effect of Heart Position on ECG Electrical Rotation of the Heart in Frontal Plane on Anteroposterior Axis Electrical Rotation of the Heart in Horizontal Plane on Long Axis Normal Ecg Variants Normal ECG in Infants and Children Juvenile Pattern Early Repolarization Anxiety and Hyperventilation Postprandial Response Effect of Deep Respiration Chapter 24 - Abnormal P, T and U Waves Abnormal P Waves Abnormal Sites of Atrial Activation Dextrocardia Left Atrial Enlargement or LA Abnormality Duration Morphology P Terminal Force Frontal P Axis In Atrial Fibrillation Right Atrial Enlargement or RA Abnormality Amplitude Initial Positive Portion of Diphasic P Wave in Lead V1 Frontal P Axis QRS Complex Abnormalities With Echocardiographic Correlation Biatrial Enlargement or Abnormality Abnormal T Waves Tall T Waves Flat T Waves T Wave Inversion T Wave Inversion with ST Changes T Wave Inversion without Significant ST Changes (Mostly Primary T Wave Inversion) Abnormal U Waves Large Prominent U Waves Inverted U Waves (in Leads I, II, V5 and V6) Chapter 25 - Ventricular Hypertrophy Left Ventricular Hypertrophy (LVH) ECG Changes Changes in QRS Complex Changes in ST Segment and T Waves Changes in Axis in Frontal Plane Other Changes Systolic and Diastolic Overload of the Left Ventricle Diagnostic ECG Criteria for LVH Sokolow-Lyon Voltage Criteria5 Romhilt-Estes Point Score System9 Glassglow Scoring System Cornell Voltage Criteria10 Cornell Product (voltage-duration measurement)11 Cornell Regression Equation10 Novacode Criteria12 Seigel's Total QRS Voltage Criteria The Hernandez Padial Voltage Criterion12 Natural History Series-2 (1993)13 The Talbot Criterion14 The Koito and Spodick Criterion15 Diagnosis of LVH in Left Bundle Branch Block (LBBB) Diagnosis of LVH in the Presence of Left Anterior Fascicular Block (LAFB) Diagnosis of LVH in Presence of Right Bundle Branch Block (RBBB) Right Ventricular Hypertrophy (Rvh) ECG Changes Changes in QRS Complex Changes in ST Segment and T Waves Frontal QRS Axis Other Changes Diagnostic ECG Criteria for RVH Natural History Series (1993)13 Milnor Modified Sokolow and Lyon Criteria21 Butler-Legger Criteria22 Other Criteria Types of RVH Systolic and Diastolic Overload of the Right Ventricle Biventricular Hypertrophy (Bivh) Chapter 26 - Intraventricular Conduction Defects Right Bundle Branch Block (RBBB) WHO/International Society and Federation for Cardiology (ISFC) Task Force Criteria for RBBB (1985) Variants RBBB Incomplete RBBB Brugada Syndrome Arrhythmogenic Right Ventricular Dysplasia Left Bundle Branch Block WHO/International Society and Federation for Cardiology (ISFC) Task Force Criteria Clinical Significance WHO/ISFC Task Force Criteria Fascicular Blocks Left Anterior (Hemiblock) Fascicular Block Left Posterior (Hemiblock) Fascicular Block WHO/ISFC Task Force Criteria Multifascicular Blocks Bifascicular Blocks Trifascicular Block Chapter 27 - Myocardial Infarction and Ischemia Myocardial Infarction (MI) Depolarization Abnormalities Abnormalities of Q Waves Abnormalities of R Waves Repolarization Abnormalities ST Segment Changes T Wave Changes Other Changes Ischemic U Wave Changes Increased QT Interval Dispersion Evolution of ECG Changes Myocardial Ischemia Nonspecific ST-T Changes Localization of Ischemia or Infarction Right Ventricular Infarction Following are the Diagnostic Criteria for RV Infarction in Presence of Inferior wall Infarction Atrial Infarction Prediction of the Site of Coronary Artery Occlusion Occlusion of Coronary Artery Coronary Artery Occlusion and ECG Correlation Predicting RCA or LCx Occlusion in Inferior Wall MI Predicting LAD Occlusion Site in Anterior Wall Infarction ECG Diagnosis of MI in Bundle Branch Blocks and During RV Pacing MI in RBBB MI in LBBB ECG Diagnosis of MI During RV Pacing Sensitivity, Specificity and Prognostic Value of the ECG The Sensitivity of the ECG Prognostic Value of ECG for MI Q Wave Infarction Site of Infarction Abnormal T Waves Associated BBB QT Dispersion Chapter 28 - Pericarditis and Myocarditis Pericarditis ECG Changes Due to Pressure Effects ECG Changes Due to Superficial Myocarditis Evolution of ECG Changes ECG Variants in Pericarditis ECG Changes During Progression of Pericarditis Myocarditis Chapter 29 - Drug Effects and Electrolyte Abnormalities Digitalis Digitalis Effects Therapeutic Effects Excessive or Toxic Effects Unequivocal Toxic Effects Mechanism of Digitalis Induced Arrhythmias Electrolyte Abnormalities and Ecg Changes: Hyperkalemia Modification of Hyperkalemic Effects by Other Electrolytes Hypokalemia Modification of Hypokalemic Effects by Other Electrolytes Hypercalcemia Hypocalcemia Hypermagnesemia Hypomagnesemia Chapter 30 - Arrhythmias Sinus Nodal Disturbances and Arrhythmias Sinus Tachycardia Sinus Bradycardia Sinus Arrhythmia Sinus Pause or Sinus Arrest Sinoatrial (SA) Exit Block Wandering Pacemaker Sick Sinus Syndrome (Bradycardia-Tachycardia Syndrome) Sinus Node Reentry Tachycardia Atrial Arrhythmias Premature Atrial Contractions (PACs) Atrial Tachycardias (AT) Focal Atrial Tachycardia Multifocal Atrial Tachycardia (MAT) or Chaotic Atrial Tachycardia (CAT) Atrial Flutter (Afl) Incidence and Etiology Types of Afl Atrial Fibrillation (Af) Incidence: Etiology Mechanism of Af ECG Features Classification AV Junctional Arrhythmias AV Junctional Escape Beats Mechanism ECG Findings AV Junctional Rhythm AV Junctional Premature Beats or Premature AV Junctional Beats AV Junctional Tachycardia Focal Junctional Tachycardia Non-paroxysmal Junctional Tachycardia AV Nodal Reciprocating (Reentrant) Tachycardia (AVNRT) Typical AVNRT (Slow-Fast AV Node Reentry) Atypical AVNRT (Fast-Slow AV Node Reentry) Common Features of AV Junctional Arrhythmias Pre-Excitation Syndrome (PES) Accessory Pathways (AP) Location Types Concealed Accessory Pathways Pre-Excitaion Syndrome PES With Sinus Rhythm-WPW Syndrome PES with Tachyarrhythmias Mahaim Tachycardia Lown-Ganong-Levine (LGL) Syndrome Permanent form of AV Junctional Reciprocating Tachycardia (PJRT) Narrow QRS Tachycardia Irregular Tachycardia Regular Tachycardia Ventricular Arrhythmias Premature Ventricular Complexes (PVCs) or Ventricular Premature Beats (VPBs) ECG Recognition Types of PVCs Estimation of Risk of PVCs Differentiation of PVCs from Premature Supraventricular Complexes (SVCs) with Aberrant Ventricular Conduction (AVC) Ventricular Tachycardia (VT) ECG Recognition Types of VT Localizing the Site of Origin of VT Idioventricular Rhythm (IVR) Ventricular Flutter (Vfl) and Ventricular Fibrillation (Vf) ECG Recognition Wide QRS Tachycardia Regular Wide QRS Tachycardia Irregular Wide QRS Tachycardia Heart Block AV Block First Degree AV Block Second Degree AV Block Complete or Third Degree AV Block Part 6b Basic Investigations: Radiology Ofthe Heart And Great Vessels Chapter 31 - Introduction and Evaluation of Heart Cardiac Imaging Technologies Technical Facts Involved in Chest Roentgenogram Cardiac Fluoroscopy Evaluation of Chest Roentgenogram Cardiac Size, Contours, Borders, Chambers and Great Vessels Cardiac Size Cardiac Contour Cardiac Borders, Chambers, and Great Vessels Chapter 32 - The Pulmonary Vasculature Normal Pulmonary Vascularity Abnormal Pulmonary Vascularity Increased PBF Decreased PBF Abnormal PBF Patterns Centralization Lateralization Localization Collateralization Cephalization Both Lateralization and Localization Pulmonary Interstitial Edema Chapter 33 - Cardiac Calcification Valvular Calcification Mitral Valve Calcification Aortic Valve Calcification Calcification of the Pulmonary Valve Calcification of the Tricuspid Valve Myocardial Calcification Left Ventricular Calcification Left Atrial Calcification Vascular Calcification Calcification of the Aorta Calcification of the Pulmonary Artery Coronary Artery Calcification Pericardial Calcification Tumor Calcification Chapter 34 - Evaluation of Extracardiac Structures and Chest X-ray in Other Views Evaluation of Extracardiac Structures Bronchi and Sinuses Situs Pleura Bones and Joints Soft Tissues Over the Chest Evaluation of Chest X-Ray in Other Views Chest X-ray in Left Lateral Projection The Anterior Border The Arch of Aorta Posterior Border Lateral Projection Chest X-ray in RAO View The Anterior Border of the Heart The Posterior Border This View Permits Chest X-ray in LAO View The Anterior Border of the Heart The Posterior Border Visualization of Other Structures in LAO View INDEX A B C D E F G H I J K L M N O P R S T U V W X