Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Federal government websites often end in .gov or .mil. When left atrial enlargement occurs, it takes longer for cardiac action potentials to travel through the atrial myocardium; thus, the P wave also lengthens. People with Mitral Valve Prolapse often have no symptoms and detection of a click or murmur may be discovered during a routine examination. Front Cardiovasc Med. Clin Cardiol. RBBB is considered a borderline criterion. font: 14px Helvetica, Arial, sans-serif; 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). 13(5), 541550 (2015). This condition is usually harmless and does not shorten life expectancy. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. This is a noninvasive test that produces comprehensive images of the heart. flow of blood), if present at all, is generally mild. Hypertension. The following are the most common symptoms of Mitral Valve Prolapse. If you have no symptoms/problems because of any structural heart enlargement or defect than there is nothing to be done. } The reasons for this are explained below. 1996 Dec;19(12):954-9. doi: 10.1002/clc.4960191211. 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 In these cases, it is the morphology of the P wave in lead V1 that allows us to determine if there is a left atrial enlargement associated with interatrial block. Left Atrial Enlargement (LAE) ECG Review | Learn the Heart - Healio The first half of the P-wave is therefore a reflection of right atrial activationand the second half is a reflection of left atrial activation. Cardiology 53 years experience. is the bulging of one or both of the mitral valve flaps (leaflets) LAE is often a precursor to atrial fibrillation. 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. heart due to turbulent blood flow). Bayssyndrome: the association between interatrial block and supraventricular arrhythmias. Mitral valve prolapse may not cause any symptoms. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. An abnormal right axis can also occur in conditions with elevated right . Weight gain. Learn more about conduction defects caused byischemia and infarction. Echocardiogram This imaging technique uses sound waves to project a. Calculates the QTc interval by entering QTinterval andHR, How not to overlook EKG changes in acute myocardial infarction, Detailed description of each of the EKG wave. The overflow capacity of attendees and number of live streaming participants exceeded 220 in total. The passage of the electrical stimulus through the atria is reflected in the electrocardiogram as the P wave. My EKG team recomends you the books that we used to create our website. Research suggests that left atrium size as measured by an echo-cardiograph may be linked to cardiovascular disease. The P-wave in lead II may, however,be slightly asymmetric by having two humps. A test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. 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. Most of them were presenters at CAH, and all are active in the Sports and Exercise Cardiology Section FIT Interest Group. Should I be concerned? This can be in the form of aspirin or warfarin (Coumadin) therapy. There are numerous pathological conditions that cause sinus bradycardia. and transmitted securely. T-wave inversions in leads V1-V4 are present in 12% of black athletes and are usually preceded by J-point elevation and convex ST segment elevation. Read More Created for people with ongoing healthcare needs but benefits everyone. The presence of a negative final component of the P wave in lead V1 greater than 40 ms may indicate left atrial enlargement5. The prolapse may be due to ischemic damage (caused by decreased blood flow as a result of coronary artery disease) to the papillary muscles attached to the chordae tendineae or to functional changes in the myocardium. Regular rhythm with ventricular rate slower than 50 beats per minute. Bethesda, MD 20894, Web Policies This regurgitation may result in a murmur (abnormal sound in the Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. 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. Aortic insufficiency generates left cavities overload propitiating left atrial and left ventricular enlargement. 2016 Aug;9(8):10.1161/CIRCIMAGING.115.004299 e004299. The P-wave will display higher amplitude in lead II and lead V1. ECG Criteria of Right Atrial Enlargement. worrisome? 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). low voltage qrs Support stockings may be beneficial. Left Atrial Enlargement: Tests used to diagnose left ventricular hypertrophy may include: Lab tests. 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. P-wave is positiv in limb lead II. Normally taking a b complex vi Left atrial enlargement itself has no symptoms. Careers. It may be used as a complement to echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery. 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. 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. By clicking Accept, you consent to the use of ALL the cookies. For more information, please see our Secondary Mitral Valve Prolapse. Would you like email updates of new search results? Breathing and blood pressure rates are also monitored. [Heart effect of arterial hypertension. In association with left ventricular hypertrophy: Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. These symptoms include weakness, fatigue, and shortness of breath. border: none; Results of the PAMELA Study. The ECG has, as one could expect, low sensitivity but high specificity with respect todetecting atrial enlargement. HHS Vulnerability Disclosure, Help Dr. Sanjay Sharma, co-senior author of the International Recommendations for ECG Interpretation in Athletes, reviewed his approach to the Athlete's ECG. Signs and symptoms [ edit] Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. LAE produces a broad, bifid P wave in lead II (Pmitrale) and enlarges the terminal negative portion of the P wave in V1. 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). These symptoms include: Fainting. Ther. Surawicz B, Knilans TK. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index. 1. The duration of the P-wave will exceed 120 milliseconds in lead II. abnormal ecg. Review how to diagnose this on an ECG here. In most cases, limiting stimulants, such as caffeine and cigarettes, is all that is needed to control symptoms. hospital never told me. Cardiomegaly can happen to your whole heart or just parts of it. In case of sale of your personal information, you may opt out by using the link. She had an ECG taken a month back and it was normal. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. For example, because of the smaller distance in the thoracic cavity between the sternum and spine, compared to the other directions, less room exists for enlargement of the left atrium along the anteroposterior axis. J Med Assoc Thai. margin-top: 20px; 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. 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. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. P-waves with constant morphology preceding every QRS complex. P wave changes with Left Atrial Enlargement ECG Criteria for Left Atrial Enlargement last week ecg read: The cause of Mitral Valve Prolapse is unknown, but is thought to be linked to heredity. 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. 8600 Rockville Pike Assessing the causal role of hypertension on left atrial and left ventricular structure and function: A two-sample Mendelian randomization study. Philadelphia: Elservier; 2008. Conditions that lead to left atrial enlargement include hypertension, heart valve problems, heart failure and atrial fibrillation 1. 2014 Mar;97 Suppl 3:S132-8. Other blood pressure drugs. eCollection 2022. 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). The full CAH agenda can be accessed here. Cookie Notice Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Learn how we can help 290 views Answered >2 years ago Thank A 36-year-old female asked: Expert Rev. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Permanent symptomatic bradycardias are treated with artificial pacemakers. (P wave 2.5 mm in II and aVF). They show how a patient's heart is beating in real-time. [7] However, if atrial fibrillation is present, a P wave would not be present. Difficulty breathing. Edhouse J, Thakur RK, Khalil JM. 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. The most important causes are as follows: Figure 1 shows sinus bradycardia at paper speed 25 mm/s. Ekg says "borderline ecg" and "probable left atrial enlargement." Primary and secondary forms of Mitral Valve Prolapse are described below. Circ Cardiovasc Imaging. Hypertension. No patient met ECG criteria for left atrial abnormality. . Barlow's syndrome, balloon mitral valve, or floppy valve syndrome, The https:// ensures that you are connecting to the The juvenile ECG pattern (T-wave inversion in leads V1-V3) is acceptable up to age 16 years. Left atrial enlargement (LAE) is when the upper left part of your heartone of the heart's four chambers is larger than it should be. Beta blockers, angiotensin-converting enzyme . To confirm left atrial enlargement, the best investigation would be an ECHO. But opting out of some of these cookies may have an effect on your browsing experience. We hope you enjoy the summaries. When an OSA event occurs, an attempt is made to breathe with an obstructed airway and the pressure inside the chest is suddenly lowered. Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. This may be due to pulmonary valve stenosis, increased pulmonary artery pressureetc. 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 . Type 1 Brugada ECG pattern (coved type) is abnormal. If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. This rule does not apply to aVL. In an asymptomatic athlete, RBBB in isolation with QRS duration <140msec and in the absence of significant repolarization abnormalities does not warrant further investigation. If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. But this change is not associated or caused by anxiet Anxiety isn't a cause of left atrial enlargement. Right atrial enlargement produces a peaked P wave ( P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2. Int J Gen Med. Blood and urine tests may be done to check for conditions that affect heart health. [4], Obstructive sleep apnea (OSA) may be a cause of LAE in some cases. To learn more, please visit our. The normal P-wave (Figure 1, upper panel) is typically smooth, symmetric and positive. It's located in the upper half of the heart and on the left side of your body. at home i saw that it said possible left atrial enlargement but dr said nothing about this. T-wave inversions beyond V2 after age 16 warrants further assessment in Caucasian athletes. Heart palpitations. Doctors typically provide answers within 24 hours. Privacy Policy. In some cases, patients may experience palpitations without observed dysrhythmias (irregular heart rhythm). Treatment is not usually necessary as Mitral Valve Prolapse is rarely a serious condition. Twitter: @rob_buttner. is this anything of concern? [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. had a stress test and holter monitor that came back normal 7 months ago. However, each individual may experience symptoms differently. font-weight: normal; 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. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. This is also a normal finding. P-waves with constant morphology preceding every QRS complex. 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. Learn how your comment data is processed. If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart. 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. Eugene H Chung, MD, FACC Its not uncommon to discover SB in healthy young individuals who are not well-trained. Chest pain associated with Mitral Valve Prolapse is different from chest pain associated with coronary artery disease and is a frequent complaint. 1 doctor answer 5 doctors weighed in Share Dr. John Munshower answered Family Medicine 32 years experience It is feasible the AF caused the left atrial enlargement. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, Sixth Edition, Saunders, Philadelphia, 2008. Cardiac MRI. Swelling in your arms or legs. In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). Influence of Blood Pressure on Left Atrial Size. Appointments 800.659.7822. Always consult your doctor for a diagnosis. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. For the person with symptoms of dizziness or fainting, maintaining adequate hydration (fluid volume in the blood vessels) with liberal salt and fluid intake is important. Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. sharing sensitive information, make sure youre on a federal Electrocardiogram (ECG) This imaging test records the electrical actions of the heart, including the speed of the heartbeats. borderline/ normal ecg The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) 4. Such a P-wave is calledP pulmonalebecause pulmonary disease is the most common cause (Figure1). Am Heart J. LAFB occurs when the anterior fascicle of the left bundle branch can no longer conduct action potentials. The amplitude of the normal P-wave does not exceed 2.5 mm in anylimb lead. The site is secure. Benign causes of sinus bradycardia (SB) do not require treatment. Based on a work athttps://litfl.com. 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. FOIA Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. BMJ 2002;324:1264. doi: 3. 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. 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). government site. low voltage qrs You also have the option to opt-out of these cookies. worrisome? Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. 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. Aguilera Saldaa MA, Garca Moreno LM, Rodrguez Padial L, Navarro Lima A, Snchez Domnguez J. Overvad TF, Nielsen PB, Larsen TB, Sgaard P. Thromb Haemost. Left atrial enlargement can be mild, moderate or severe depending on the extent of the underlying condition. This negative deflection is generally <1 mm deep. Find more COVID-19 testing locations on Maryland.gov. Please feel free to contact Chris Driver (cdriver@acc.org) or me (chungeug@umich.edu) with any questions. 2016 Aug 1;116(2):206-19. doi: 10.1160/TH15-12-0923. Editor-in-chief of the LITFL ECG Library. clear: left; 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. People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). Surgical Fellow Doctoral Degree 997 satisfied customers EKG said sinus tachycardia, left atrial enlargement, EKG said sinus tachycardia, left atrial enlargement, borderline report. There the circle starts. The murmur is caused by some of the blood leaking back into the left atrium. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia; in such scenarios, it is generally considered to be evidence based to implement an artificial pacemaker that will allow for drug therapy to continue. She took an ECG today and it came as borderline abnormal ECG. The mean left atrial dimension was 3.46 +/- 0.3 cm in normal individuals versus 4.04 +/- 0.3 cm in the hypertensive patients (p less than 0.01). 2022 Nov 2;9:1006380. doi: 10.3389/fcvm.2022.1006380. 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. 2009;doi:10.1161/CIRCULATIONAHA.108.191095. This upper chamber of your heart receives oxygen-poor blood from your body. Moreover, the P-wavemay be slightly biphasic (diphasic) in lead V1, implying that the terminal part of the P-wave is negative (Figure 1, upper panel). 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.