Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 4

1 Chapter 1Figure 1.1 Diagnosis and types of myocardial infarction.Figure 1.2 Kinetics of troponin release. Troponin rises above MI cutoff at 2...Figure 1.3 0/1-hour or 0/2-hour ESC algorithm using hs-troponin in patients ...Figure 1.4 Platelet receptors and antiplatelet mechanisms of action.Cycloo...Figure 1.5 Specific effects of the four anticoagulants.A heparin derivativ...Figure 1.6 Summary of anticoagulant use in NSTE-ACS, before catheterization ...Figure 1.7 Duration of dual antiplatelet therapy (DAPT) according to ACC gui...Figure 1.8 Antiplatelet therapy after PCI in patients who also require antic...Figure 1.9 The concentric and eccentric lesions with smooth borders are pred...Figure 1.10 NSTEMI in a healthy 47-year-old woman. Chest pain started during...

2 Chapter 2Figure 2.1 Phases of STEMI.Phase 3 does not imply that MI has already been...Figure 2.2 The patient presents with chest discomfort that has lasted 3 hour...Figure 2.3 Fibrinolysis cascade and mechanism of action of fibrinolytics. Fi...Figure 2.4 The timing of PCI in relation to thrombolysis in the pharmacoinva...Figure 2.5, Stages of negative LV remodeling post-MI, also called infarct ex...Figure 2.6 Dynamic left ventricular outflow tract obstruction in apical infa...Figure 2.7 LV aneurysm and LV pseudoaneurysm.In comparison with the normal...

3 Chapter 3Figure 3.1 Clinical probability of CAD.Figure 3.2 Proposed diagnostic approach to chronic chest pain. Note that CTA...

4 Chapter 4Figure 4.1 Diagnosis of HFpEF by catheterization, echo, or BNP features, acc...Figure 4.2 Diagnosis of HFpEF in subtle cases of dyspnea with no overt conge...Figure 4.3 Change of LV filling pattern between compensated and decompensate...Figure 4.4 (Top) The worsening of a resting defect is indicative of ischemia...Figure 4.5 Case of chronic HF with LV dilatation and mild increase in PCWP....Figure 4.6 Diuretic response in a normal individual and in HF. Note that no ...Figure 4.7 Hemodynamic decompensation starts several weeks before clinical d...Figure 4.8 Effect of HF on renal blood flow and GFR. Renal blood flow is aff...Figure 4.9 Mechanisms through which diuresis and inotropes initiate a benefi...Figure 4.10 Septal motion and LV-RV interdependence in various disease state...

5 Chapter 5Figure 5.1 Diagnosis of amyloid cardiomyopathy. If both tests are positive, ...Figure 5.2 Simultaneous LA and LV pressure recordings in diastole. Normal...Figure 5.3 Cardiac output–preload relationship (Frank–Starling curve = lengt...Figure 5.4 Force (afterload)- velocity relationship. The failing LV is exqui...Figure 5.5 Compliance curve, i.e., pressure–volume relationship in diastole....Figure 5.6 Important HF figure, showing a diastolic superimposition of the F...Figure 5.7 Pressure-volume loops Normal individuals, with pressure–volume...

6 Chapter 6Figure 6.1 (a) Illustration of a horizontal cut across the mitral plane on t...Figure 6.2 Carpentier’s classification of the mechanisms of mitral regurgita...Figure 6.3 Mitral valve prolapse. The long-axis view defines prolapse, while...Figure 6.4 Illustration of ischemic MR on longitudinal views. (a) Normal val...Figure 6.5 (a) Horizontal cut across the mitral valve. Normal structure of t...Figure 6.6 Atrial functional MR vs LV functional MR. In atrial functional MR...Figure 6.7 Difference in V wave and LV diastolic pressure between (1) chroni...Figure 6.8 Unlike (a), the chordae are tied to the mitral annulus before imp...Figure 6.9 Difference between rheumatic MS and MAC MS. In rheumatic MS, the ...Figure 6.10 (a) Long-axis view in diastole. See the hockeystick shape of the...Figure 6.11 Two examples of mitral stenosis with a diastolic pressure gradie...Figure 6.12 False impression of MS resulting from the use of PCWP as a surro...Figure 6.13 Illustration of the difference between rheumatic MS and MAC-MS. ...Figure 6.14 β-blockers slow the heart rate and allow more LA emptying, which...Figure 6.15 Aortic leaflets and their relation to the ascending aorta. A nor...Figure 6.16 1. In acute AI, LV volume is normal and the regurgitant volume l...Figure 6.17 (a) Difference in aortic orifice shape between the tricuspid and...Figure 6.18 Left image- Axial cut of the LVOT, which is elliptical rather th...Figure 6.19 Peak-to-peak gradient is the difference between the two peaks (h...Figure 6.20 Pressure recovery phenomenon. Pressure (potential or static ener...Figure 6.21 TAVR valves and relation to the coronary ostia. TAVR valves cons...Figure 6.22 Normal tricuspid anatomy as viewed from the RA (surgeon’s view)...Figure 6.23 The tricuspid valve is normally oval-shaped in a horizontal plan...Figure 6.24 Repair of functional TR:(i) Kay bicuspidization: plication of ...Figure 6.25 Prosthetic valves. Surgical bioprostheses typically contain meta...Figure 6.26 Left image- Bioprosthetic valve as seen on fluoroscopy. The ring...Figure 6.27 Choice of a mechanical prosthesis vs. bioprosthesis vs TAVR, acc...Figure 6.28 Figure 6.29 Figure 6.30 Figure 6.31

7 Chapter 7Figure 7.1 (a) Asymmetric septal hypertrophy with increased velocity across ...Figure 7.2 Parasternal long-axis view of a patient with HOCM, showing SAM of...Figure 7.3 M-mode of SAM. The star corresponds to the gap between the anteri...Figure 7.4 HOCM hemodynamics.Note the early aortic pressure peaking (blue ...Figure 7.5 Brockenbrough phenomenon after a premature beat in HOCM. Note the...Figure 7.6 LVOT velocity in HOCM: late-peaking dagger-shape LVOT velocity (a...Figure 7.7 In the elderly, elongation of the aorta sharpens the angle betwee...

8 Chapter 8Figure 8.1 Approach to narrow QRS complex tachycardias.Figure 8.2 Narrow complex tachycardia, regular, rate ~200 bpm. Differential ...Figure 8.3 Explanation of how a wide QRS complex (aberrancy) may occur with ...Figure 8.4 There are two types of SVT with pre-excitation, i.e., SVT with an...Figure 8.5 Difference in QRS morphology between bundle branch block and VT. ...Figure 8.6 QRS morphology when VT originates in the posterior wall or the ap...Figure 8.7 Differences in morphology between SVT with aberrancy and VT. SVT ...Figure 8.8 Run of wide complex tachycardia on a telemetry strip: is it VT or...Figure 8.9 Wide complex tachycardia: VT or SVT? Look for P waves, i.e., l...Figure 8.10 Two short tachycardia runs. The tachycardia starts after a regul...Figure 8.11 Wide complex, regular tachycardia, at a rate of ~135 bpm. QRS lo...Figure 8.12 The baseline rhythm is sinus, consisting of QRS complexes (R) pr...Figure 8.13 Very wide QRS complex tachycardia (particularly wide in lead I, ...Figure 8.14 Short RP narrow complex tachycardia, initially suggestive of AVN...Figure 8.15 Two types of QRS complexes are seen: (1) narrow complexes preced...Figure 8.16 Again, two types of QRS complexes are seen: (1) narrow complexes...Figure 8.17 Alternation between wide and narrow QRS complexes. Both QRS comp...Figure 8.18 A run of wide complex tachycardia. It is irregular, but this doe...Figure 8.19 Regular wide complex tachycardia, QRS width ~180 ms (lead II)....Figure 8.20 Wide complex tachycardia, regular, at a rate of ~155 bpm. The QR...Figure 8.21 This is the baseline ECG of the patient in Figure 8.20. It shows...Figure 8.22 Wide complex tachycardia on telemetry or Holter monitoring. Is i...Figure 8.23 Run of wide complex tachycardia. Is it VT or SVT? Look at how...Figure 8.24 The baseline rhythm is AF and the baseline QRS is marked by line...Figure 8.25 Baseline sinus rhythm with LBBB morphology. Two runs of wide com...

9 Chapter 9Figure 9.1 Wide premature complexes occurring in a trigeminal pattern. These...Figure 9.2 Interpolated PVC. Unlike the common PVC, an interpolated PVC does...Figure 9.3 Tachycardia that seems narrow but has a different morphology than...Figure 9.4 Wide complex rhythm at a rate of 70 bpm. P waves are initially se...Figure 9.5 Torsades de pointes initiation, via short-long-short sequence: (1...Figure 9.6 QT interval is markedly prolonged (QTc = 730 ms). T wave is wide ...Figure 9.7 Torsades de pointes that degenerates into VF (same patient as Fig...Figure 9.8 Example of TdP in a patient whose baseline QTc is 530 ms. Note th...Figure 9.9 Typical ST–T morphologies in hypokalemia, hypocalcemia, and conge...Figure 9.10 Epsilon wave in ARVD. Epsilon wave is a small wiggle wave or a s...Figure 9.11 Brugada patternsFigure 9.12 Top: Early repolarization J wave followed by a downsloping ST se...Figure 9.13

10 Chapter 10Figure 10.1 LV diastolic filling pattern in compensated HF, decompensated HF...Figure 10.2 Chronic antiarrhythmic drug therapy for the prevention of recurr...Figure 10.3 Yearly risk of stroke and intracranial hemorrhage with warfarin ...Figure 10.4 Long sinus pause at the point of transition from AF (top row) to...

11 Chapter 11Figure 11.1 Flutter circuit with illustration of the net atrial vectors of d...Figure 11.2 Aflutter with flutter waves rate (F wave) ~300 per minute and 2:...Figure 11.3 Typical counterclockwise Aflutter with variable conduction: 5:1,...Figure 11.4 Another typical counterclockwise 2:1 Aflutter. See how F is nega...Figure 11.5 Rhythm in lead V₁ (above) and lead II (below) with a ladder diag...Figure 11.6 Coarse fibrillatory AF waves that simulate Aflutter in lead V1. ...Figure 11.7 2:1 atrial tachycardia, with an atrial rate of ~140 per minute. ...Figure 11.8 Atrial escape rhythm (rate ~50 bpm) that developed in a patient ...

12 Chapter 12Figure 12.1 AVNRT usually starts with a PAC that has a long PR interval as i...Figure 12.2 (a) Arrows point to the retrograde P wave that is superimposed o...Figure 12.3 Narrow complex tachycardia with retrograde P waves (arrows) seen...Figure 12.4 P waves are seen just before the QRS, with a PR interval < 110 m...Figure 12.5 Sinus rhythm is present throughout the tracing. Vertical lines i...Figure 12.6 Anatomy of the slow pathway, fast pathway, and compact AV node. ...Figure 12.7 An appropriately timed PAC conducts down the slow pathway but ca...Figure 12.8 Electrocardiographic features of pre-excitation. Arrows point to...Figure 12.9 Amount of myocardium depolarized by the accessory pathway (gray ...Figure 12.10 A slur is seen on the upslope of the QRS complex (e.g., leads I...Figure 12.11 Concealed accessory pathway (AP).The pathway cannot fully con...Figure 12.12 Manifest accessory pathway.The AP can conduct both antegradel...Figure 12.13 Irregular tachycardia with wide, polymorphic, bizarre-looking Q...Figure 12.14 In AVNRT, the occurrence of a PVC (gray bar) either blocks the ...Figure 12.15 Bundle branch block during orthodromic AVRT.Figure 12.16 When the wide complex tachycardia becomes narrow, the R–R inter...Figure 12.17 A 22-year-old woman with no prior cardiac history presents with...Figure 12.18 Two types of QRS complex are seen. This intermittent widening o...Figure 12.19 Another WPW pattern on a baseline ECG. Note the short PR, with ...Figure 12.20 Alternation of a narrow and an equidistant wide QRS (vertical a...Figure 12.21 At first glance, this ECG shows a wide and tall R wave in V₁, Q...

13 Chapter 13Figure 13.1 Wenckebach 3:2 AV block. P–P intervals are typically regular. P–...Figure 13.2 Wenckebach 5:4 AV block. P–P intervals are regular. PR progressi...Figure 13.3 High-grade AV block alternating with Mobitz II AV block.Figure 13.4 Wenckebach AV block. Two groups of beats are seen, which raises ...Figure 13.5 ECG of a patient presenting with palpitations. Looking at parts ...Figure 13.6 Third-degree AV block with regular P rate and regular QRS rate, ...Figure 13.7 Regular, slow QRS rate of ~33 bpm. P rate is mostly regular at ~...Figure 13.8 At first glance, the rhythm seems to be sinus bradycardia, ~40 b...Figure 13.9 Outside the PVC, the rhythm seems regular. But on further analys...Figure 13.10 Long sinus pause at the point of transition from AF (top row) t...Figure 13.11 P blocks (arrow) without being premature and without progressiv...Figure 13.12 Note the block of a P wave (vertical arrow). This blocked P wav...Figure 13.13 Mobitz I vs. Mobitz II AV block. (1) is the right bundle, (2) i...Figure 13.14 Complete AV block, with underlying sinus tachycardia (arrows po...Figure 13.15 Episode of complete AV block on a loop recorder, with 3 non-con...Figure 13.16 Second-degree Mobitz II AV block, with 3:2 block alternating wi...Figure 13.17 P waves and QRS complexes are dissociated on most beats, with m...Figure 13.18 Another example of a high-grade AV block. Most P waves are not ...Figure 13.19 AF with a ventricular rate that is slow and mostly regular. Thi...Figure 13.20 4:3 Mobitz I SA block. Progressive lengthening of the sinus imp...Figure 13.21 A whole P–QRS drops, which may be consistent with a sinus pause...Figure 13.22 3:2 Mobitz type II SA block. Both P and QRS intermittently drop...Figure 13.23 Sinus arrest or complete SA block with a ventricular escape rhy...Figure 13.24 No P wave is seen → complete SA block vs. AF with small fibrill...Figure 13.25 Outside PVCs, the rhythm seems regular, but, on further analysi...Figure 13.26 AV junction refers to the AV node+ His bundle. Subdivisions: 1,...Figure 13.27 Suppose that a tachycardia-mediated LBBB has developed at a rat...Figure 13.28

14 Chapter 14Figure 14.1 The paced QRS morphology varies according to the vector of depol...Figure 14.2 Ventricular pacing regularly tracking the sinus P activity (DDD ...Figure 14.3 VVI pacing in a patient with no P wave (sinus arrest or subtle A...Figure 14.4 Ventricular pacing that consistently tracks a preceding sinus P ...Figure 14.5 Atrial flutter with variable conduction. Note that when the R–R ...Figure 14.6 Prominent R wave in V₁–V₂ may suggest BiV pacing. However, there...Figure 14.7 DDD pacemaker timing intervals.AP, atrial paced event; AS, atr...Figure 14.8 Sinus/atrial tachycardia with atrial rate > upper rate. Case whe...Figure 14.9 Sinus tachycardia with pseudo-Wenckebach ventricular pacing patt...Figure 14.10 Difference between maximal tracking rate, mode-switch rate, and...Figure 14.11 Various lead configurations for pacemakers (first two images) a...Figure 14.12 Example of a “quick look” or “summary” screen of pacemaker/ICD ...Figure 14.13 Insulation break and lead fracture.Figure 14.14 Triggers and mechanisms of PMT.Figure 14.15 Fusion, pseudofusion, and ventricular safety pacing.Figure 14.16 In fusion beats, the native conduction reaches the ventricle ar...Figure 14.17 Various patterns of LV activation in LBBB. Black arrows indicat...Figure 14.18 CRT: echocardiographic AV synchronizationFigure 14.19 Regular V pacing without any spontaneous ventricular activity. ...Figure 14.20 DDD pacemaker with atrial pacing and AV sequential pacing.Int...Figure 14.21 Atrial and ventricular pacing spikes are seen. The underlying r...Figure 14.22 Ventricular pacing occurs at irregular intervals and one atrial...Figure 14.23 Ventricular pacing spikes are seen. They track sinus P waves at...Figure 14.24 Intracardiac electrograms (EGMs) of VT. The atrial and ventricu...Figure 14.25 Electrograms of a tachycardia that starts with a premature A wa...Figure 14.26 Tachycardia with number of V waves = number of A waves→ could b...Figure 14.27 The analysis of the atrial and ventricular EGMs reveals more at...Figure 14.28 The patient presents with multiple shocks. The marker channel s...Figure 14.29 Electrogram interval plot (same patient as Figure 14.28). It re...Figure 14.30 Interval plot showing at one point two V waves (black dots) for...Figure 14.31 Electrograms and marker channel from the case shown in Figure 1...Figure 14.32 Figure 14.33 Figure 14.34

15 Chapter 15Figure 15.1 Normal His recording.Figure 15.2 Example of a typical A, V, His, and CS recording. AH and HV inte...Figure 15.3 Types of AV block.Figure 15.4 Arrows point to QRS complexes on the ECG, which are the starting...Figure 15.5 AVNRT. V and A almost coincide, with a VA interval <70 ms. On EC...Figure 15.6 AVNRT. After V, the site of earliest A activation is located in ...Figure 15.7 Activation sequence in orthodromic AVRT and antidromic AVRT. As ...Figure 15.8 Earliest site of atrial activation during AVNRT, AVRT, and atria...Figure 15.9 RAO view (side view) of the RA. The crista terminalis is a struc...Figure 15.10 RAO view of the RA. Note the position of the halo mapping cathe...Figure 15.11 Axial view of the RA, RV, and tricuspid valve.Figure 15.12 En face view of the RA and RV. Note the crista terminalis ridge...Figure 15.13 Atrial flutter mapping. Note the atrial activation along the ha...Figure 15.14 Another example of atrial flutter mapping across the right atri...Figure 15.15 (a) Normal atrial activity along the halo catheter when one pac...Figure 15.16 Ventricular pacing in a patient with AVNRT. Always start by ali...Figure 15.17 The reentry circuit is shown as a circle, the pacing point is s...Figure 15.18 Entrainment of atrial tachycardia. The site of earliest A activ...Figure 15.19 Activation mapping of VT. The red area (arrow) is the zone of e...

16 Chapter 16Figure 16.1 Action potential of atrial and ventricular myocardium. Phase 0 c...Figure 16.2 Action potential of the SA and AV nodes is characterized by a sp...Figure 16.3 Illustration of reentry as a mechanism of tachyarrhythmia. In or...Figure 16.4 Slowing the conduction across the reentrant cycle reduces the ar...Figure 16.5 Termination of reentrant arrhythmias. The dashed arrows represen...Figure 16.6 VF initiated by R-on-T phenomenon. In a patient with myocardial ...Figure 16.7 Once the EAD (early afterdepolarization) or DAD (delayed afterde...Figure 16.8 Narrow complex tachycardia. A wide complex is seen, likely PVC o...

17 Chapter 17Figure 17.1 Simultaneous pericardial and RA pressures are recorded in tampon...Figure 17.2 Pulsus paradoxus. Note the drop of systolic and pulse pressure d...Figure 17.3 The normal pericardial pressure is negative and reaches 0 mmHg a...Figure 17.4 General approach to a large, asymptomatic pericardial effusion....Figure 17.5 Heart surfaces in relation to the subxiphoid pericardiocentesis,...Figure 17.6 Various echo views showing the various heart surfaces in a patie...Figure 17.7 Simultaneous RA and LV pressure recordings in constrictive peric...Figure 17.8 Sequence of events occurring during inspiration in constrictive ...Figure 17.9 Simultaneous RV and LV pressure tracings in two different patien...Figure 17.10 Respiratory variations of hepatic venous flow velocities. S flo...Figure 17.11 Hepatic vein Doppler in constrictive pericarditis, with respiro...Figure 17.12 Septal M mode in a patient with constrictive pericarditis. Note...Figure 17.13 Simultaneous LV-RV recordings in a 61-year-old man with no past...

18 Chapter 18Figure 18.1 Interatrial septum. Embryologically, blood coming from the IVC i...Figure 18.2 Bicaval TEE view showing a PFO between the septum primum (thin, ...Figure 18.3 Types of ASD. Secundum ASD results from excessive involution of ...Figure 18.4 En face view of the interatrial septum. Occasionally, both a PFO...Figure 18.5 Goose-neck deformity of the LVOT in primum ASD.Figure 18.6 Interatrial septum viewed from the side. Various rims are identi...Figure 18.7 Anatomic and echocardiographic localization of VSD. The membrano...Figure 18.8 Gerbode defect on an apical five-chamber view. Perimembranous VS...Figure 18.9 Anatomy in normal patients and in tetralogy of Falllot. In tetra...Figure 18.10 Radiographic cardiac and mediastinal silhouettes in various con...Figure 18.11 CXR in tetralogy with and without right-sided aortic archFigure 18.12 Tricuspid atresia and Fontan procedure (top 2 rows). Hypoplasti...Figure 18.13 D-TGA is characterized by RV–aorta on the right, while l-TGA is...Figure 18.14 Normally, the aorta is more posterior than the PA and to the ri...

19 Chapter 19Figure 19.1 (a) The peripheral arterial pressure has three phases (1, 2, 3)....Figure 19.2 Three-year patency of percutaneous therapy and 5-year patency of...Figure 19.3 Aortobifemoral bypass grafting.Figure 19.4 (a) SFA is totally occluded all the way from the ostium to the p...Figure 19.5 In the ECST method, the stenosis is measured in reference to the...Figure 19.6 Compare the right and left kidneys. Note the right renal atrophy...

20 Chapter 20Figure 20.1 In acute aortic dissection, the false lumen (F) is tense with sl...Figure 20.2 Chest X-ray in aortic dissection or dilatation.Figure 20.3 (a) Widening of aortic knob (arrow) indicative of descending aor...Figure 20.4 Axial cut across aortic dissection. True lumen (T) and false lum...Figure 20.5 Mechanisms of aortic insufficiency (AI) with aortic dissection: ...Figure 20.6 Descending aortic dissection with false lumen extending into the...Figure 20.7 Various aortic measurements. The annulus is a stable structure t...Figure 20.8 Pitfalls of aortic measurements by axial CT and TEE. On TEE or T...Figure 20.9 Ascending aortic repair with valve sparing (top) and with compos...Figure 20.10 Throracoabdominal endograft covering the renal arteries, celiac...Figure 20.11 Debranching of the brachiocephalic vessels followed by antegrad...

21 Chapter 21Figure 21.1 Algorithm for the diagnosis of pulmonary embolism*Most hospita...Figure 21.2 (a) Massive bilateral PEs in the proximal right and left pulmona...

22 Chapter 22Figure 22.1 Aggressive early therapy of septic shock (the first 3 hours). Ea...Figure 22.2 General approach to cardiogenic shock. Right heart catheterizati...Figure 22.3 Relationship between stroke volume and CVP. A true Frank–Starlin...

23 Chapter 23Figure 23.1 Effect of ACE-I/ARB on the renal flow and renal function. Angiot...Figure 23.2 Autoregulation curve. Autoregulation of microvascular (mainly ar...

24 Chapter 25Figure 25.1 Diagnostic approach to distinguish between precapillary PH (pulm...Figure 25.2 Treatment algorithm for patients with PAH. Connective tissue dis...Figure 25.3

25 Chapter 26Figure 26.1 Management of syncope. Also, consider severe hypovolemia, bleedi...Figure 26.2 Rhythm monitoring in a 63-year-old patient with episodic prolong...Figure 26.3 Episode of complete AV block on loop recorder, with 3 non-conduc...

26 Chapter 27Figure 27.1 Quick rule-in and rule-out algorithm using hs-troponin (in ng/L,...

27 Chapter 28Figure 28.1 Aortic or mitral endocarditis can extend into the valvular annul...Figure 28.2 The AV node, and particularly the His bundle coming off the AV n...Figure 28.3 (a) Duration of antibiotic therapy in patients with device infec...

28 Chapter 30Figure 30.2 (a) Normal posteroanterior chest X-ray. Note that the RV does no...Figure 30.3 Chest X-ray in HF. (1) Cephalization and vessel extension to the...Figure 30.4 Various morphologies of cardiomegaly. LA enlargement is characte...Figure 30.5 The same X-ray is shown (a) without and (b) with annotations. Pr...Figure 30.6 Lateral chest X-ray. Note that the LA shadow is surrounded by th...

29 Chapter 31Figure 31.1 P–QRS–T complex. P wave represents the atrial depolarization and...Figure 31.2 Arrows show the spread of the electrical depolarization. Ventric...Figure 31.3 Illustration of how the electrical depolarization spreads in the...Figure 31.4 Illustration of how electrical depolarization spreads in the hea...Figure 31.5 Illustration of how electrical depolarization spreads in the hea...Figure 31.6 Frontal view of the precordial leads. Normally, R wave progressi...Figure 31.7 Regular QRS rhythm with a P wave before each QRS complex: sinus ...Figure 31.8 Irregular tachycardia with no repetition of any R–R pattern. No ...Figure 31.9 Narrow complex tachycardia with a pseudo-r’ in lead V₁ that repr...Figure 31.10 Wide complex tachycardia: VT vs. SVT with bundle branch block. ...Figure 31.11 Bradycardia with regular P waves and regular QRS complexes, unr...Figure 31.12 Severe bradycardia with regular P waves and regular QRS complex...Figure 31.13 Irregularity with a pattern. Wide premature complexes with ST–T...Figure 31.14 Atrial flutter with variable conduction (3:1, 4:1). The sawtoot...Figure 31.15 There are two groups of beats followed by pauses (asterisks), w...Figure 31.16 Start by looking at leads I and aVF. If QRS is negative in lead...Figure 31.17 Poor R-wave progression probably secondary to LVH with a sudden...Figure 31.18 Normal and abnormal RA and LA deflections. Atrial depolarizatio...Figure 31.19 Right atrial enlargement and left atrial enlargement. Reproduce...Figure 31.20 LVH with secondary ST–T depression in the left lateral leads, d...Figure 31.21 QRS is (–) in lead I and (+) in lead aVF, implying a right-axis...Figure 31.22 In RBBB, the vector of depolarization spreads from the left sep...Figure 31.23 RBBB. rSR’ is seen in V₁, notched R wave is seen in V₂, and rsR...Figure 31.24 Sinus tachycardia with RBBB (rSR’ in V₁–V₂, wide and slurred S ...Figure 31.25 LBBB. In the lateral leads, there may be an “M-shaped” R wave (...Figure 31.26 LBBB (slurred R wave in the left leads: V₅–V₆ and I–aVL) (arrow...Figure 31.27 WPW with short PR segment and slurred R wave. The upslope of R ...Figure 31.28 In LAFB, the vector of depolarization spreads from the posterio...Figure 31.29 LAFB + RBBB. QRS is wide > 120 ms with rSR’ in V1 and a wide...Figure 31.30 RBBB + LPFB. Since QRS is wide > 120 ms, look in V₁ and in V₆ t...Figure 31.31 (a) Electrical alternans. Note the alternation between two main...Figure 31.32 Wide Q wave (QS or QR) may be normally seen in lead III of a ho...Figure 31.33 Examples of an abnormal Q wave. (a) ECG shows minimal ST elevat...Figure 31.34 Inferior Q waves and anterolateral QS waves (QS waves are wide ...Figure 31.35 QS pattern is seen in leads V₁–V₂, small R wave is seen in lead...Figure 31.36 In expiration, Q wave is wide and deep in leads III and aVF (ar...Figure 31.37 ST-segment and T-wave morphologies in cases of (a) secondary ab...Figure 31.38 Example of left ventricular hypertrophy with typical secondary ...Figure 31.39 Electrocardiogram of a patient with angina at rest and elevated...Figure 31.40 Examples of Wellens-type T-wave abnormalities. (a) Wellens-type...Figure 31.41 Non-Wellens biphasic T waves. (a) Biphasic T wave in leads V₂–VFigure 31.42 Examples of posterior infarction. (a) ST-segment depression in ...Figure 31.43 Example of subtle ST-segment elevation in two contiguous leads ...Figure 31.44 Hypokalemia and electrocardiographic abnormalities. (a) Note th...Figure 31.45 Global T-wave inversion with marked QT prolongation in a 77-yea...Figure 31.46 Examples of normal variants of repolarization. (a) Persistent j...Figure 31.47 (a) Upsloping ST-segment depression in sinus tachycardia. Durin...Figure 31.48 Various patterns of ST-segment elevation. Reproduced with permi...Figure 31.49 Diffuse ST elevation in ~ all leads and ST depression in lead a...Figure 31.50 ECG of a patient who has lung cancer. Sinus tachycardia with di...Figure 31.51 Early repolarization with ST-segment elevation in the inferior ...Figure 31.52 Early repolarization with a normal variant T-wave inversion in ...Figure 31.53 Diffuse ST elevation in most leads, with ST depression in lead ...Figure 31.54 SVT with a typical LBBB in leads I and aVL. Concordant ST eleva...Figure 31.55 LBBB with discordant ST-segment changes. However, the T wave is...Figure 31.56 LBBB with abnormal T waves. (a, b) Discordant ST elevation in VFigure 31.57 At first glance, it seems there is ST elevation in the inferior...Figure 31.58 (a) There are ST elevations in leads V₁–V₄, ST depressions in t...Figure 31.59 Atrial flutter that simulates ST-segment elevation. “F” indicat...Figure 31.60 Atrial flutter that simulates ST-segment depression. The undula...Figure 31.61 Type 1 Brugada pattern in V₁ and V₂, with a downsloping ST elev...Figure 31.62 STEMI ECG variants. Right image- DeWinter complex in V1-V6.Mi...Figure 31.63 QT is not measured using the end of the T wave. Instead, a line...Figure 31.64 Typical ST–T morphologies in hypokalemia, hypocalcemia, congeni...Figure 31.65 On the left, markedly prolonged QT with a notched T wave is see...Figure 31.66 Hypokalemia and a pattern that should not be confused with hypo...Figure 31.67 Two ECG examples of hypokalemia. (a) Prolonged QT (QT ~600 ms, ...Figure 31.68 Stages of hyperkalemia.Figure 31.69 (a) Hyperkalemia of 6.1 mEq/l. Note that T waves are not tall, ...Figure 31.70 Hypocalcemia and hypercalcemia.Figure 31.71 Digitalis effect in a patient with AF. Note the prominent U wav...Figure 31.72 Hypothermia. QRS is prolonged > 120 ms. It is not a typical LBB...Figure 31.73 Change of vector of depolarization between a normal heart and p...Figure 31.74 Poor precordial R-wave progression with a very small R wave < 1...Figure 31.75 Poor precordial R-wave progression with a monophasic Q (QS) in ...Figure 31.76 Approach to narrow complex tachycardias.Figure 31.77 Narrow complex tachycardia. A deflection is seen at the end of ...Figure 31.78 Narrow complex tachycardia, irregular. Differential diagnosis:...Figure 31.79 The rhythm is irregular. Look for P waves: P waves are present,...Figure 31.80 Regular wide complex tachycardia. SVT vs.VT? Look for P wave...Figure 31.81 Run of irregular wide complex tachycardia. The irregularity doe...Figure 31.82 Location of the AV block.Figure 31.83 Repetition of groups of beats separated by a pause. Think of se...Figure 31.84 Regular, narrow complex rhythm, rate ~55 bpm. P waves are seen ...Figure 31.85 AF with a ventricular rate that is slow and mostly regular. Thi...Figure 31.86 Regular wide complex rhythm interrupted by narrower complexes t...Figure 31.87 2:1 AV block that can be easily mistaken for sinus bradycardia,...Figure 31.88 Outside the PVCs, the rhythm seems grossly regular. Analyze the...Figure 31.89 Regular narrow complex rhythm without any P wave. This is a jun...Figure 31.90 Regular narrow complex rhythm (~50 bpm). Negative P waves are s...Figure 31.91 Sinus rhythm is interrupted by a wide complex rhythm. The wide ...Figure 31.92 Right and left arm electrodes switched. The leads’ axis changes...Figure 31.93 Right arm and right leg electrodes switched. The leads’ axis ch...Figure 31.94 Right arm and right leg electrodes switched. Note how lead II i...Figure 31.95 Subendocardial ischemia (diffuse ST depression, not localized t...Figure 31.96 Phases of STEMI.Figure 31.97 The patient presents with chest discomfort that has started 4 h...Figure 31.98 In inferior MI, the LCx current of injury looks to the left and...Figure 31.99 The rhythm initially appears to be sinus bradycardia (~55 bpm)....Figure 31.100 Frontal plane of left-axis deviation. This may be secondary to...Figure 31.101 Horizontal plane of LV hypertrophy. The vector of depolarizati...Figure 31.102 (a) Frontal plane of RV hypertrophy or RV strain such as PE. T...Figure 31.103 (b) Horizontal plane of COPD. (a) Horizontal plane of RV hyper...

30 Chapter 32Figure 32.1 (a) Frontal view showing how the parasternal short-axis views cut...Figure 32.2 (a) Diagram of the parasternal short-axis view and various LV se...Figure 32.3 (a) Parasternal short-axis view at the level of the mitral valve...Figure 32.4 Diagram of the parasternal short-axis view at the level of the a...Figure 32.5 Parasternal short-axis view as described in Figure 32.4. A bicus...Figure 32.6 (a) Diagram of the parasternal long-axis view. Concerning the ao...Figure 32.7 (a) Parasternal long-axis view. Measurements are obtained from t...Figure 32.8 (a) Parasternal RV inflow view, which is obtained by angling the...Figure 32.9 (a) Diagram and (b) echocardiogram of the apical four-chamber vi...Figure 32.10 (a) Diagram and (b) echocardiogram of the apical two-chamber vi...Figure 32.11 (a) Diagram and (b) example of the subcostal view.Figure 32.12 Subcostal view with a medial tilt to visualize the IVC. A large...Figure 32.13 Arterial distribution of various echo segments on the short-axi...Figure 32.14 (a) Example of RV enlargement and RV volume overload on the para...Figure 32.15 During systole, in LBBB: (1) the septum moves in towards the LV...Figure 32.16 M-mode imaging shows paradoxical septal motion of RV volume ove...Figure 32.17 Constrictive pericarditis. Two septal abnormalities and one pos...Figure 32.18 Pericardial processes are characterized by septal compression t...Figure 32.19 Posterior mitral leaflet prolapse. In systole, the leaflet prol...Figure 32.20 Rheumatic mitral valve. (a) Long-axis view in diastole. See the...Figure 32.21 Posterior mitral annular calcifications (MAC) in the long-axis ...Figure 32.22 Difference in aortic orifice shape between the tricuspid and bi...Figure 32.23 MR, four-chamber view. The blue, backward flow between the LV a...Figure 32.24 Severe MR on four-chamber TEE view. Severity criteria of MR:...Figure 32.25 MR, long-axis view. The blue flow between LV and LA is MR (arro...Figure 32.26 Systolic flow reversal of pulmonary venous flow in a patient wi...Figure 32.27 CW Doppler across the mitral valve on an apical four-chamber vi...Figure 32.28 Severe TR seen from the short-axis view (aortic valve level) (a...Figure 32.29 TR. CW Doppler across the tricuspid valve on a four-chamber vie...Figure 32.30 Aortic insufficiency (AI). Long-axis view shows blue–backward f...Figure 32.31 AI. The width of the AI jet may also be assessed on the aortic ...Figure 32.32 AI on three-chamber apical view. This view is not accurate for ...Figure 32.33 AI spectral Doppler assessment on an apical five-chamber view. ...Figure 32.34 AS. CW Doppler across the aortic valve on the apical five-chamb...Figure 32.35 Severely increased velocity on aortic Doppler. Several features...Figure 32.36 MS assessment. (a) CW Doppler across the mitral valve (MV) on ...Figure 32.37 PW Doppler at the level of the mitral valve. During diastole, f...Figure 32.38 PW Doppler across the pulmonary veins on a four-chamber view, p...Figure 32.39 Myocardial tissue Doppler at the level of the mitral annulus. T...Figure 32.40 2D tissue strain imaging of the LV on a two-chamber view. Strai...Figure 32.41 M-mode across the mitral valve on the parasternal long-axis vie...Figure 32.42 M-mode across the aortic valve on the long-axis view. The first...Figure 32.43 Examples of M-mode across the mitral valve. (a) Posterior mitral...Figure 32.44 Diffuse pericardial effusion on long-axis view, identified as a...Figure 32.45 Pericardial effusion on multiple views. In a supine position, a...Figure 32.46 (a) Pericardial effusion (stars) and pleural effusion (bar). Th...Figure 32.47 Diagnosis of diastolic dysfunction and assessment of LA pressur...Figure 32.48 Assessment of LA pressure in patients with depressed EF: criter...Figure 32.49 Aliasing velocity of the regurgitant color, which is red in thi...Figure 32.50 Simultaneous LV pressure and PCWP recording is shown on the lef...Figure 32.51 PISA of MS on a long-axis view. PISA of MS consists of flow acc...Figure 32.52 LV–aortic pressure tracings in acute AI and chronic AI. In acut...Figure 32.53 Correlations between A, X, V, and Y waves on the LA pressure tr...Figure 32.54 Types of prosthetic valves. Surgical bioprostheses typically ha...Figure 32.55 Bioprosthetic porcine valve as evidenced by the large struts/ve...Figure 32.56 (a) Metallic mitral prosthesis. As in bioprostheses, a hyperech...Figure 32.57 (a) Frequency of the reflected wave. On pulsed-wave Doppler, the...Figure 32.58 In this interrogation of the aortic valve in the apical five-ch...Figure 32.59 The Doppler cursor is placed across the mitral valve (double ar...Figure 32.60 Illustration of angle rotation and anteflexion on TEE.Figure 32.61 TEE: 0° four- and five-chamber views.Figure 32.62 TEE two-chamber and long-axis views. To understand the orientat...Figure 32.63 Illustration of an axial view of the mitral plane, showing the ...Figure 32.64 TEE four-chamber 0° view. Note the calcification of the mi...Figure 32.65 TEE five-chamber view. Another case of restricted leaflets from...Figure 32.66 Severe eccentric MR is seen on the TEE four-chamber view, “hugg...Figure 32.67 MR is seen on the 90° two-chamber view. Note that, in this view...Figure 32.68 TEE long-axis (120°) view.Figure 32.69 Aortic valve short-axis view. Anteflexion is necessary to see t...Figure 32.70 Anteflexion from the level of the short-axis view leads to the Figure 32.71 (a) Clockwise torque from the 0° four-chamber view allows a focu...Figure 32.72 From a 90–120° LV/aortic view, torquing the TEE probe to the le...Figure 32.73 Interatrial septum (IAS) bicaval view (“Mickey Mouse” view). Tr...Figure 32.74 (a) Bicaval view opening the thin part of the interatrial septu...Figure 32.75 Bicaval view showing an ostium secundum ASD. ASD is a defect; i...Figure 32.76 (a) Bicaval view showing sinus venous ASD (arrow). Note the lac...Figure 32.77 0° view at a high level, allowing visualization of structures a...Figure 32.78 Anteflexion from Figure 32.77 shows an even higher level. The P...Figure 32.79 Short-axis 0° transgastric view, showing both the LV and RV.Figure 32.80 (a) Short-axis 0° transgastric view with more anteflexion than ...Figure 32.81 (a) Transgastric two-chamber view showing the LA–LV (90°). (b) ...Figure 32.82 Transgastric long-axis view (120°) (deeper gastric level than F...Figure 32.83 Three-dimensional TEE view of the mitral valve (en-face view). ...Figure 32.84 Three layers of LV myocardial fibers: (1) outer oblique fibers ...

31 Chapter 33Figure 33.1 Stress testing modality. *Baseline ECG abnormalities precluding...Figure 33.2 During sinus tachycardia, atrial repolarization becomes accentua...Figure 33.3 Nuclear images are displayed in three views: Short-axis cuts...Figure 33.4 A severe defect (arrows) is noted in the inferior and septal wal...Figure 33.5 Gated SPECT myocardial excursion of the previous case (Figure 33...Figure 33.6 This is an axial CT view. The right ventricle is the most anteri...Figure 33.7 This is an oblique view of the proximal LAD (a vertical cut thro...Figure 33.8 This is a curved view of the RCA. The curved view is a processed...Figure 33.9 This is an axial CT view. The LAD has a soft plaque proximally (...Figure 33.10 The basal septum is normal, that is, black and does not enhance...Figure 33.11 Patterns of LGE in ischemic and various non-ischemic cardiomyop...Figure 33.12 Myocarditis in a 26-year-old man. Note the subepicardial white ...

32 Chapter 34Figure 34.1 RCA course and branches. The intersection of the AV groove and t...Figure 34.2 (a) Left coronary system on LAO cranial view. (b) LV walls on cr...Figure 34.3 The top two rows show the difference in morphology between stabl...Figure 34.4 LAO view, cranial. Note the diaphragm overlapping with the heart...Figure 34.5 Shallow RAO view, cranial. Note the diaphragm overlapping with t...Figure 34.6 Illustration of the difference between caudal and cranial views. Figure 34.7 View orthogonal to a segment vs. view foreshortening a segment....Figure 34.8 Heart in an anteroposterior view. Imagine how you look at the co...Figure 34.9 RAO caudal view (25°, 25°).Figure 34.10 RAO caudal view. Distal LM bifurcation area is well seen; if no...Figure 34.11 RAO caudal view. The ribs are looking down towards the right-ha...Figure 34.12 RAO caudal view in a patient with a vertical heart. Note that, ...Figure 34.13 (a) RAO caudal with a large diagonal and a totally occluded LAD...Figure 34.14 AP caudal view. Similarly to RAO caudal view, the AP caudal vie...Figure 34.15 LAO caudal view (40°, 30°). Catheter tip is at the center of he...Figure 34.16 LAO caudal view of a vertical heart. The catheter tip (star) is...Figure 34.17 LAO caudal view of a horizontal heart. Note that the catheter t...Figure 34.18 (a) Vertical heart. LAO caudal is not orthogonal to the LM bifu...Figure 34.19 Shallow RAO cranial view (5°, 35°).Figure 34.20 Shallow RAO cranial view. Note the overlap of the distal LM, pr...Figure 34.21 LAO cranial view (40°, 30°). The LCx and OMs run on the border ...Figure 34.22 LAO cranial view. Note the overlap at the level of the distal L...Figure 34.23 LAO cranial view showing a dominant LCx. The distal PLBs and PD...Figure 34.24 LAO cranial view. If there is too much overlap in the proximal ...Figure 34.25 RAO caudal view. One gets the impression that the LAD is patent...Figure 34.26 LAO cranial view of the patient from Figure 34.25. What seems l...Figure 34.27 RAO cranial view (30°, 30°). The circled area is the area where...Figure 34.28 Best views for ostial left main, and best views for distal left...Figure 34.29 RCA views: LAO straight vs. LAO cranial. LAO cranial opens the ...Figure 34.30 Note how the LAO cranial opens the distal RCA branches (arrows)...Figure 34.31 AP cranial view. Note how the distal RCA is well laid out.Figure 34.32 The true RCA has two distal bends on the LAO and AP cranial vie...Figure 34.33 (a) LAO cranial view. It may seem that the RCA continues down a...Figure 34.34 (a) LAO cranial view of the RCA. Try to identify the true RCA, ...Figure 34.35 RAO straight (30°) looks at the AV groove from the side rather ...Figure 34.36 AP cranial view properly showing the SVG-to-RCA anastomosis and...Figure 34.37 On this LAO cranial view, the grafted artery is at the left rat...Figure 34.38 AP caudal view showing sequential SVG to OM2 and OM3. In this v...Figure 34.39 RAO cranial view (diaphragm is seen over the heart shadow, ribs...Figure 34.40 (a) Occluded SVG to RCA on LAO view (catheter at the left of th...Figure 34.41 Sequential and split grafts (RAO caudal view). Graft anastomose...Figure 34.42 Left lateral view showing the LIMA-to-LAD anastomosis.Figure 34.43 Top figure: Illustration of how the RAO and LAO views “look” at...Figure 34.44 LAO straight vs. LAO cranial view. LAO cranial better opens the...Figure 34.45 Left ventriculogram on LAO straight view vs. LAO cranial view....Figure 34.46 Left ventriculogram performed in LAO straight view.Figure 34.47 (a) Illustration of how the RAO and LAO views look at the mitra...Figure 34.48 RAO view of the LV. Look how the aorta overlaps with the LA. Go...Figure 34.49 Steep RAO view shows severe MR with full delineation of the LA,...Figure 34.50 Axial cuts across the aortic cusps and the PA, showing the cour...Figure 34.51 Anomalous origin of LM as visualized on RAO aortography. Always...Figure 34.52 Anomalous RCA engaged with AL1. Two cases (1 and 2) are present...Figure 34.53 Right oblique view of the aorta, iliac and femoral arteries. No...Figure 34.54 Femoropopliteal anatomy. A right lower extremity is shown. Dash...Figure 34.55 Axial CT scan images showing the SFA anatomy. Top: note the...Figure 34.56 OmniFlush or IMA catheter used to selectively engage the left i...Figure 34.57 External iliac occlusion extending into the common femoral arte...Figure 34.58 Totally occluded left SFA from the ostium to the popliteal leve...Figure 34.59 Totally occluded right distal SFA with collaterals mostly origi...Figure 34.60 Differentiate SFA from profunda in the case of SFA occlusion.Figure 34.61 Same patient as Figure 34.60. An almost lateral view (left pane...Figure 34.62 Aortic arch types I, II, and III. The distance between the top ...Figure 34.63 (a) On an LAO view, the JB1 catheter is torqued counterclockwis...Figure 34.64 Simmons catheter used to engage the innominate and carotid arte...

33 Chapter 35Figure 35.1 (a) Axial cut at the level of sinuses of Valsalva. R is the righ...Figure 35.2 (a) Judkins left (JL) catheter. The size of the Judkins catheter...Figure 35.3 In the case of an elongated or enlarged aorta (elderly, hyperten...Figure 35.4 The Amplatz left (AL) catheter has a “duck” shape. AL may be use...Figure 35.5 AL sits both on the back wall of the aorta and on the aortic val...Figure 35.6 AL engaging the RCA. AL looks up if the AL curve is proportionat...Figure 35.7 The primary-to-secondary distance distinguishes Amplatz right (A...Figure 35.8 Engagement of RCA. The catheter must be positioned on the right ...Figure 35.9 The 3DRC catheter is, in a way, a JR4 that is already torqued. I...Figure 35.10 (a) Origin of the RCA in a young patient. (b) Origin of the RCA...Figure 35.11 Axial cut at the level of the sinuses of Valsalva. Instead of L...Figure 35.12 Relationship of the conus branch and RCA. If JR4 falls into the...Figure 35.13 (a) Engagement of the left coronary artery in patients with nor...Figure 35.14 In (i), the whole catheter falls down and tip points up→a longe...Figure 35.15 JL catheter engagement when it falls slightly below the left co...Figure 35.16 Catheterization of the left coronary artery with an Amplatz lef...Figure 35.17 Small-arm Amplatz catheter. Pushing it may further dive it insi...Figure 35.18 Extra-backup guides and AL guide for the left coronary artery. ...Figure 35.19 Small-arm AL guide catheter (AL1) is used to engage the LCx in ...Figure 35.20 Guide catheters for superior RCA takeoff and inferior RCA takeo...Figure 35.21 AL1 guide catheter engaging the RCA, and providing good backup ...Figure 35.22 Location of SVGs: Down to up: SVG-to-RCA, SVG-to-LAD or diag...Figure 35.23 LAO view is orthogonal to the marker of SVG-to-RCA, perfectly l...Figure 35.24 Shapes of various catheters.Figure 35.25 (a) A hockeystick 2 guide catheter is used to engage the SVG-to...Figure 35.26 (a) Engagement of the left subclavian artery with a JR4 cathete...Figure 35.27 Pigtail catheter advancement. This is an LAO view. Advance the ...Figure 35.28 Dealing with a situation when the pigtail bend is in the LV, bu...Figure 35.29 Various aortic root shapes, with various locations of the aorti...Figure 35.30 Engagement of a coronary artery through a radial approach.(...Figure 35.32 Right transradial engagement of the left coronary artery in a p...Figure 35.33 AL2 is used to engage the left coronary artery through a right ...Figure 35.34 Severe right subclavian/ innominate tortuosity or loop is prese...Figure 35.35 Specific radial catheters, particularly helpful for a right rad...Figure 35.36 Ikari left catheter engagement. Ikari left is, in a way, a modi...Figure 35.37 Examples of damping and ventricularization of the aortic pressu...Figure 35.38 Damping, ventricularization, and effect of side-hole catheters....Figure 35.39 (a) Catheter loop at the lateral RA wall allows advancement int...

34 Chapter 36Figure 36.1 The Swan–Ganz balloon flotation catheter has four ports. (...Figure 36.2 Timing of atrial, ventricular, and arterial pressures in relatio...Figure 36.3 Atrial pressure tracing (RA or PCWP). A wave corresponds to atri...Figure 36.4 RA, RV, PA, and PCWP tracings obtained while advancing the cathe...Figure 36.5 Typical deep X and deep Y descents on RA tracing, consistent wit...Figure 36.6 Deep X with flat Y on RA tracing, suggestive of tamponade. This ...Figure 36.7 Ventricularized RA pressure in a patient with severe TR. The V w...Figure 36.8 On gross inspection of both figures, they may seem similar. In f...Figure 36.9 (a, b) PCWP tracing shows a large V wave of ~38 mmHg, with a mea...Figure 36.10 Diastolic superimposition of LA pressure (or PCWP, in blue) and...Figure 36.11 LVEDP corresponds to the bump seen on the LV upstroke (arrows),...Figure 36.12 O₂ saturation at various levels. Note that MV O₂ and SA O₂ used...Figure 36.13 Aortic stenosis. Peak-to-peak gradient is the difference bet...Figure 36.14 This simultaneous LV–aortic pressure recording simulates severe...Figure 36.15a Two examples of mitral stenosis with a diastolic pressure grad...Figure 36.15b Illustration of the difference between rheumatic MS and MAC-MS...Figure 36.16 LV, aortic (Ao) and PCWP tracing in a patient with AS (LV–Ao gr...Figure 36.17 LV–aortic pressure tracings in acute AI and chronic AI. I...Figure 36.18 (A) On the aortic tracing, the aortic pressure drops precipitou...Figure 36.19 Dynamic LVOT obstruction. (a) The LVOT obstruction worsens thr...Figure 36.20 Contrast LV–aortic tracings in HOCM vs. AS. In HOCM, the aortic...Figure 36.21 Brockenbrough phenomenon after a premature beat in HOCM. Note t...Figure 36.22 LV–aortic pullback using an endhole catheter in a patient...Figure 36.23 (a) Simultaneous pericardial and RA pressures are recorded in t...Figure 36.24 Simultaneous LV-RV recordings in a 61-year-old man with no past...Figure 36.25 PCWP rise with exercise. In normal individuals, as preload and ...Figure 36.26 The numerator of the Qp/Qs is in blue (extreme chambers), while...Figure 36.27 Figure 36.28 Figure 36.29 Figure 36.30 Figure 36.31

35 Chapter 37Figure 37.1 The left image is duplicated on the right with blue shading high...Figure 37.2 The left image is duplicated on the right with blue shading high...Figure 37.3 (a) Intima is marked in blue in the right-hand image. Note that ...Figure 37.4 (a) Ostial LAD with LCx adjacent to it. The blue shading marks t...Figure 37.5 Diseased LAD at the level of first septal and first diagonal bra...Figure 37.6 (a, b) Two IVUS images of a left main bifurcating into LAD and L...Figure 37.7 Positive and negative remodeling.Figure 37.8 Example of positive remodeling (EEM area has expanded to accommo...Figure 37.9 Lesion with necrotic core. Intima and necrotic core are highligh...Figure 37.10 Ulcerated lesions. (a) Ulcer demarcated at 6 o’clock. (b) Steno...Figure 37.11 Further examples of ulcers. (a) LAD ulcer at 6 o’clock (star). ...Figure 37.12 Stent thrombosis and neointimal hyperplasia.Figure 37.13 Illustration of various IVUS-determined areas. The luminal diam...Figure 37.14 Stents. (a) Ostial LM stent with intima seen underneath the str...Figure 37.15 Stent with neointimal hyperplasia. In-stent restenosis percent ...Figure 37.16 Causes of lesion haziness. Interpretation of how a severe steno...Figure 37.17 The stent is well expanded in the ostial LAD with one strut han...Figure 37.18 OCT. Fibrotic plaque is characterized by being bright (high sig...Figure 37.19 Thrombus, macrophage accumulation, and cholesterol crystals ima...Figure 37.20 Stent edge dissection. Arrows show the dissection planes. The d...

36 Chapter 38Figure 38.1 Main mechanism of action of balloon angioplasty. Angioplasty pus...Figure 38.2 A pseudoaneurysm is characterized by a non-clotted active bleed ...Figure 38.3 IABP catheter connected to two lumens: arterial lumen and gas lu...Figure 38.4 Unassisted and assisted aortic pressure. Balloon inflation occur...Figure 38.5 1:2 IABP inflation. Note that in a 1:2 or 1:3 mode, the SBP that...Figure 38.6 IABP monitor showing the ECG, the arterial pressure waveform, an...Figure 38.7 Impella CP assist device. Blood is pulled from the LV through th...Figure 38.8 (a) The Impella console shows two waveforms: the aortic waveform...Figure 38.9 Both the motor current and the pressure waveform are flat, which...Figure 38.10 Simultaneous LV-aortic pressure waveforms in a patient with sev...Figure 38.11 Concept of FFR. FFR evaluates the ratio of maximal myocardial f...Figure 38.12 The drop in pressure and thus the drop in flow across a stenosi...Figure 38.13 The upper tracing illustrates Pa, the pressure at the guide cat...Figure 38.14 Serial stenoses. The calculation of local FFR across each steno...Figure 38.15

37 1Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Figure 28 Figure 29 Figure 30 Figure 31 Figure 32 Figure 33 Figure 34 Figure 35 Figure 36 Figure 37 Figure 38 Figure 39 Figure 40 Figure 41 Figure 42 Figure 43 Figure 44 Figure 45 Figure 46 Figure 47 Figure 48 Figure 49 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 61 Figure 62 Figure 63 Figure 64 Surgeon’s view of the tricuspid and mitral valves. Note their rela...Figure 65