Cardiac catheterization. } Hypertension. The atria may become dilated and/or hypertrophic during pathological circumstances. The P-wave amplitude is >2.5 mm in P pulmonale. 2009;doi:10.1161/CIRCULATIONAHA.108.191095. [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. There the circle starts. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate any narrowing, occlusions, or other abnormalities of specific arteries. had a stress test and holter monitor that came back normal 7 months ago. We hope you enjoy the summaries. More information: Bays syndrome and interatrial blocks. Wide P wave with prominent negative component. 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. min-height: 0px; "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. Mitral regurgitation (backward Study technics (electrocardiogram, echocardiography, exercise test and Holter]. These cookies will be stored in your browser only with your consent. The passage of the electrical stimulus through the atria is reflected in the electrocardiogram as the P wave. If the left atrium encounters increased resistance (due to mitral valve stenosis, mitral valve regurgitation, hypertension, hypertrophic cardiomyopathy) it becomes enlarged (hypertrophy) which enhancesits contribution to the P-wave. 2022 Nov 2;9:1006380. doi: 10.3389/fcvm.2022.1006380. On this Wikipedia the language links are at the top of the page across from the article title. In addition, in lead V1, the depth of the negative final component is greater than the height of the initial part. Other blood pressure drugs. For potential or actual medical emergencies, immediately call 911 or your local emergency service. We also use third-party cookies that help us analyze and understand how you use this website. Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Clin Cardiol. 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. PMC Dr. Jerome Zacks answered. government site. 2023 American College of Cardiology Foundation. Breathing and blood pressure rates are also monitored. Would you like email updates of new search results? [4], Obstructive sleep apnea (OSA) may be a cause of LAE in some cases. A separate entity from left atrial enlargement: a consensus report. The Diagnostic Yield of Routine Electrocardiography in Hypertension and Implications for Care in a Southwestern Nigerian Practice. P-waves with constant morphology preceding every QRS complex. J Med Assoc Thai. borderline/ normal ecg Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. . It is estimated that mitral valve prolapse occurs in around 3 Right atrial enlargement means your heart has an abnormally large right atrium. People with rhythm disturbances may need to be treated with beta blockers or other medications to control tachycardias (fast heart rhythms). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. eCollection 2014. If a Type 2 pattern is seen, the ECG needs to repeated to ensure proper lead placement, and a repeat ECG with V1 and V2 in higher intercostal leads should be performed: if there is no evidence of a Type 1 Brugada pattern, no further assessment is required unless there is a history of syncope or relevant family history. Heart palpitations. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. The following are the most common symptoms of Mitral Valve Prolapse. RBBB is considered a borderline criterion. I hope you're alright and the echo gave you some answers! The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. In all other situations it is necessary to findthe underlyingcauseand direct treatments towards it. The amplitude of the normal P-wave does not exceed 2.5 mm in anylimb lead. Primary Mitral Valve Prolapse. 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. If cardiomyopathy or another type of heart condition is the cause of an enlarged heart, a health care provider may recommend medications, including: Diuretics. Thank you to the FITs for all their hard work. 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. Such a P-wave is calledP pulmonalebecause pulmonary disease is the most common cause (Figure1). Heart hypertrophy as a risk factor. Surawicz B, et al. 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. Normally taking a b complex vi Left atrial enlargement itself has no symptoms. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Related article: Bays syndrome and interatrial blocks. at home i saw that it said possible left atrial enlargement but dr said nothing about this. font: 14px Helvetica, Arial, sans-serif; In any case, the association between interatrial block and left atrial enlargement is relatively frequent. Please feel free to contact Chris Driver (cdriver@acc.org) or me (chungeug@umich.edu) with any questions. I'm not sure how they can tell about the left atrial enlargement from an ecg, until . [3], Indexing the left atrial volume to body surface area (volume/BSA) is recommended by the American Society of Echocardiography and the European Association of Echocardiography. Left atrial abnormality on the electrocardiogram (ECG) has been considered an early sign of hypertensive heart disease. Left atrial enlargement: These symptoms include: Fainting. The mitral valve is located between the left atrium and the left ventricle and is composed of two flaps. It is mandatory to procure user consent prior to running these cookies on your website. Front Cardiovasc Med. need follow up? 1. You had an ecg. Electrocardiogram (ECG or EKG). The Framingham Heart Study. 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 . 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 . Dr. Sanjay Sharma, co-senior author of the International Recommendations for ECG Interpretation in Athletes, reviewed his approach to the Athlete's ECG. Left Atrial Enlargement (LAE) ECG Review | Learn the Heart - Healio [8] In any case, LAE can be diagnosed and measured using an echocardiogram (ECHO) by measuring the left atrial volume (LAVI). An enlarged heart may be temporary or permanent, depending on the cause. Atrial volume index was computed using the biplane area-length method. background: #fff; Int J Gen Med. If drug side effects are believed to be the cause, it is fundamental to judge the risk of terminatingdrug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. Cardiac MRI. Medications. For the most common type of sinus arrhythmia, the time between heartbeats can be slightly shorter or longer depending on whether you're breathing in or out. The https:// ensures that you are connecting to the Enlargement of the left and right atria causes typical P-wave changes in lead II and lead V1 (Figure 1, second and third panel). 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. Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, Sixth Edition, Saunders, Philadelphia, 2008. Chous electrocardiography in clinical practice, 6th ed. Federal government websites often end in .gov or .mil. could the abnormal been anxiety produced?, and is it something to be worried about? #mc-embedded-subscribe-form input[type=checkbox] { If atrial fibrillation or severe left atrial enlargement is present, treatment with an anticoagulant may be recommended. Am Heart J. Left atrial enlargement (LAE) or left atrial dilation refers to enlargement of the left atrium (LA) of the heart, and is a form of cardiomegaly . FOIA Clipboard, Search History, and several other advanced features are temporarily unavailable. She took an ECG today and it came as borderline abnormal ECG. Palpitations (sensation of fast or irregular heart beat) are the most common complaint among patients with Mitral Valve Prolapse. New York, NY A 29-year-old female asked: Ekg says "borderline ecg" and "probable left atrial enlargement." is this anything of concern? A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. This can be in the form of . 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. In fact, it has been considered that the bimodal P wave is better explained because of underlying interatrial block than the longer distance that the impulse has to go across6. Conditions that lead to left atrial enlargement include hypertension, heart valve problems, heart failure and atrial fibrillation 1. Epub 2016 Apr 14. Bookshelf Assessing the causal role of hypertension on left atrial and left ventricular structure and function: A two-sample Mendelian randomization study. Left atrial enlargement (LAE) is due to pressure or volume overload of the left atrium. Sinus bradycardia <40 bpm, Mobitz type 1 second degree AVB and junctional rhythm are not uncommon and don't warrant further investigation in asymptomatic athletes. Symptoms may vary depending on the degree of prolapse present and may include: Palpitations. The P-wave will display higher amplitude in lead II and lead V1. Its not uncommon to discover SB in healthy young individuals who are not well-trained. But this change is not associated or caused by anxiet. flow of blood), if present at all, is generally mild. 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. Bays de Luna A, Platonov P, et al. Possible hemiblock: An abnormal right axis plus minimally prolonged qrs duration defines what is termed a left posterior hemiblock (block of the posteroinferior fascicle of the left branch of the bundle of his). LAE is suggested by an electrocardiogram (ECG) that has a pronounced notch in the P wave. Calculate the heart axis by entering the QRS amplitude inI andIII. The duration of the P-wave will exceed 120 milliseconds in lead II. These symptoms include weakness, fatigue, and shortness of breath. One or both of the flaps may not close properly, allowing the blood 1. Editor-in-chief of the LITFL ECG Library. 2. margin-top: 20px; Diego Conde D, Seoane L, et al. Due to changes in sympathetic and parasympathetic tone, the PR interval decreases to 98 ms (mean) by the age of 1 month. This is shown in Figure 1 (upper panel). doi: 10.1371/journal.pone.0090903. This condition is usually harmless and does not shorten life expectancy. Conditions affecting the left side of the heart. Left atrial enlargement , r-axis -57 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. It is feasible the AF caused the left atrial enlargement. 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. Over time, the repetitive stretching of the left atrium may result in a persistent left atrial enlargement.[5]. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index. Surgical Fellow Doctoral Degree 997 satisfied customers EKG said sinus tachycardia, left atrial enlargement, EKG said sinus tachycardia, left atrial enlargement, borderline report. Unconfirmed means a cardiologist hasn't reviewed the EKG yet. to leak backward (regurgitation). 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. Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. It often affects people with high blood pressure and. The ECG contour of the normal P-wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) 4. Echocardiogram This imaging technique uses sound waves to project a. Congenital Heart Disease and Pediatric Cardiology. Twitter: @rob_buttner. People with Mitral Valve Prolapse often have no symptoms and detection of a click or murmur may be discovered during a routine examination. ABC of clinical electrocardiography. Type 1 Brugada ECG pattern (coved type) is abnormal. In secondary Mitral Valve Prolapse, the flaps are not thickened. Left atrial enlargement is also referred to as P mitrale, and right atrial enlargement is often referred to as P pulmonale. Primary Mitral Valve Prolapse is distinguished by thickening of one or both valve flaps. This is calledP mitrale, because mitral valve disease is a common cause (Figure 1). ecg read: 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). 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. Reddit and its partners use cookies and similar technologies to provide you with a better experience. 2014 Mar 4;9(3):e90903. The second hump in lead II becomes larger and the negative deflection in V1 becomes deeper. Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis). Terminate or adjust any medications that cause or aggravate the bradycardia. It's located in the upper half of the heart and on the left side of your body. poss left atrial enlargement The symptoms of mitral valve prolapse may resemble other medical conditions or problems. LAFB occurs when the anterior fascicle of the left bundle branch can no longer conduct action potentials. When left atrial enlargement occurs, it takes longer for cardiac action potentials to travel through the atrial myocardium; thus, the P wave also lengthens. In the next few weeks, we will post summaries of key sessions written by cardiology Fellows-in-Training (FIT). results read "normal sinus rhythm with sinus arrhythmia. Should I be concerned? An official website of the United States government. Bombelli M, Facchetti R, Cuspidi C et al. Masks are required inside all of our care facilities. Left atrial size and risk of stroke in patients in sinus rhythm. An axis of 57 degrees is not a 'ri Had an ecg that showed borderline abnormal, possible left atrial enlargement. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Vaziri SM, Larson MG, Lauer MS, et al. Ecg done and dr said everything was normal. The full CAH agenda can be accessed here. 2014; 64: 1205-1211. doi: 5. Characterizing the size of the left atrium according to its volume is preferred over a single linear dimension since enlargement can be different for different directions. Taina M, Sipola P, Muuronen A, Hedman M, Mustonen P, Kantanen AM, Jkl P, Vanninen R. PLoS One. into the left atrium during the contraction of the heart. LAE is often a precursor to atrial fibrillation. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Enlargement of the right atrium is commonly a consequence of increased resistance to empty blood into the right ventricle. 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. 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). The click or murmur may be the only clinical sign. Normal automaticity and pacemaker cells in the heart, Sinus tachycardia & Inappropriate Sinus Tachycardia. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. (P wave 2.5 mm in II and aVF). Interatrial blocks. #mergeRow-gdpr { Science Photo Library / Getty Images Types As per the report you have shared, there is normal sinus rhythm, along with normal intervals. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. Obesity has also been related to left atrial enlargement, although the mechanism is not very clear2. left ventricular hypertrophy is clearly related to the left atrial enlargement, so those causes that cause LVH as hypertension, aortic stenosis or hypertrophic cardiomyopathy can lead to left atrial enlargement. 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. They show how a patient's heart is beating in real-time. Patients with tachy-brady syndrome may also necessitate rate controlling drugs (e.g beta-blockers) and anticoagulation (if atrial fibrillation or flutter can be verified). 2012 Sep;45(5):445-51. doi: 6. 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). Disclaimer. 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. The EKG is just a guidance to help us . Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial abnormality. ECG criteria for left (LAE) and right atrial enlargement (RAE) were compared to CMR atrial volume index measurements for 275 consecutive subjects referred for CMR (67% males, 51 14 years). Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Edhouse J, Thakur RK, Khalil JM. Right Atrial Enlargement (RAE) ECG Review | Learn the Heart - Healio Seen a cardiologistecg normal apart from possible left atrial enlargement, no further tests done and discharged.please advise? 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).