Concise Cardiology by Martin Kaltenbach MD, Ronald E. Vlietstra MB, ChB (auth.)

By Martin Kaltenbach MD, Ronald E. Vlietstra MB, ChB (auth.)

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However, an overloaded demand (for example, induced by severe systemic hypertension or aortic stenosis) may lead to coronary insufficiency even when stenosis is absent. Diastole is the most important phase of the cardiac cycle for blood supply to the myocardium, because only in diastole is there a sufficient pressure gradient between the coronary artery and the capillary bed. A decrease in diastolic aortic pressure will therefore affect the coronary circulation in a manner similar to an increase in diastolic ventricular pressure.

Increased pulmonary circulation due to a left-to-right shunt is usually associated with pulmonary arterial and venous engorgement. Chest fluoroscopy Calcification of the cardiac valves , the pericardium, and the coronary arteries can be detected with fluoroscopy. The evaluation of densities , especially those in the mediastinal area may be clarified by rotation of the patient. 6 Determination of the heart volume Determination of the heart volume in the recumbent position allows a clearer distinction between a normal and an abnormal cardiac size than does simple measuring of the usual upright chest x-ray.

The most positive QRS complex is marked with an arrow in all three ECG examples. o r /\I--r- v, ~ v, ....... R II aVF -- -- V-' '- v- - - n,. -- Left hyper1rophy III r-- Right hyper1rophy V, V- I'"" ,I - r---- , - r-'" -- /\ I ' - -..... J ~ .... J v, I--. J~ ;-- I--- RighI hyper1rophy Fig. 7. Example of left and right ventricular hypertrophy in limb (extremity) and precordial (chest wall) leads. 20 when the diaphragm is displaced downward in a tall, thin subject. Many pathological conditions also influence the frontal plane axis.

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