The publication contains numerous drawings and diagrams illustrating hemodynamic disorders, research methods and modern surgical interventions for valvular pathology. Normative data on the size of the heart and its structures, which is necessary in practical medical practice, are also provided.

2 440 R




The book outlines the clinical, auscultatory and echocardiographic features of heart valve diseases. Modern treatment regimens for valve diseases and conditions that are the causes of acquired defects, including infective endocarditis and rheumatic fever, are presented. In each chapter, the reader will find a clear formulation of the indications for referring a patient to a cardiac surgeon. Of particular value is the chapter reflecting aspects of the management of patients with valve prostheses.

1 790 R




Part I describes the basics of reconstructive heart valve surgery. Part II outlines the anatomy, pathological physiology and techniques for reconstruction of the mitral valve in accordance with the functional classification of A. Carpentier and substantiates its principle. Each lesion has its own technique. In Part III, the reader will find a description of the anatomy, pathological physiology and reconstruction techniques of the tricuspid valve, and in Part IV - the aortic valve, including its replacement with autograft, allograft and xenobioprosthesis implantation. Part V is devoted to a description of the clinical picture of some congenital and acquired heart defects and diseases.

5 190 R




Much attention is paid to the principles of arterial hypertension treatment. The collection contains reference materials on the diagnosis and interpretation of blood pressure monitoring results, structural changes in the heart, dosage and principles of use of drugs for practical work or scientific research.

2 250 R




The book contains information about the use of the ABPM method to assess the effectiveness of antihypertensive therapy, detect white coat hypertension and latent arterial hypertension. The publication analyzes the advantages and limitations of a detailed analysis of ABPM results and describes the current characteristics of the daily blood pressure profile. A separate chapter is devoted to the comparative characteristics of ABPM and the method of self-monitoring of blood pressure.

1 890 R




The manual describes in detail the clinical manifestations of defects and provides the latest domestic and European recommendations for the management of these patients; The book is illustrated with electrocardiograms, echocardiograms and radiographs of patients treated at the City Clinical Hospital named after. S.I. Spasokukotsky. The manual is addressed to all outpatient doctors, therapists and cardiologists.

990 R




The relationship between diabetes mellitus and cardiovascular diseases caused by atherosclerosis has been demonstrated. Information is presented on the need not only to achieve the target glucose and glycated hemoglobin levels, but, first of all, to influence the risks of developing cardiovascular complications.

1 590 R




The issues of predicting cardiovascular and common non-cardiac diseases using scales are considered. The classification, basic principles of use, capabilities and limitations of popular prognostic scales are given.

2 090 R




The book outlines approaches and interpretations of ECGs in an accessible language, but at a modern level, and also presents general principles for the diagnosis and treatment of heart diseases. The publication allows you to study electrocardiography “from scratch”, without requiring initial knowledge of the principle of the method, thanks to which it will be of particular interest to students of medical universities, as well as interns and residents who have just arrived at the clinic.

2 590 R




Of particular value are the illustrations - electrocardiograms describing rare clinical cases from the personal archive of the author, who is a specialist in the field of cardiology and invasive electrophysiology, including implantation of devices for the treatment of conduction and cardiac rhythm disorders. The guide emphasizes the exceptional importance of the initial stage of examination of a patient with syncope (clinical interview, examination and ECG)

1 730 R




The manual provides the reader with a unique opportunity to learn how to apply echocardiography in clinical practice and achieve maximum diagnostic efficiency, i.e. what and how to evaluate depending on the pathology and how to avoid interpretation errors. The book describes numerous methods, methods and techniques, as well as new approaches to diagnosis, without which it is impossible to adequately treat patients. It should be noted that in this practical guide, completeness and clarity of presentation are combined with rich illustrative material. Unique echocardiograms of patients with a wide variety of pathologies are especially valuable for specialists, which makes the manual indispensable in scientific and practical terms.

9 290 R




The book outlines the basic information on the theory of electrocardiography necessary for a doctor to analyze an ECG. Methods for recording ECG in various leads and modifications, the basics of practical analysis, ECG diagnosis of coronary heart disease, including acute myocardial infarction, cardiac rhythm and conduction disturbances, combined arrhythmias, ECG changes in myocardial hypertrophy, various diseases and syndromes are described. A large amount of illustrative material is presented, selected from the author’s own long-term observations. Examples of analysis of complex unique electrocardiograms are given. The new edition includes additions regarding differential ECG diagnostics for changes in the morphology of the ventricular complex, disturbances of heart rhythm and conduction, and other conditions.

2 290 R




This brochure discusses the mechanisms of normal and pathological thrombus formation and the possibilities of its regulation. International recommendations for the use of various antiplatelet agents in the prevention of ischemic stroke, based on the latest evidence, are presented. For neurologists, cardiologists, therapists.

890 R




The book discusses the basic principles of managing patients with complaints of pain, the most common causes of pain and the most common methods of dealing with it, and provides numerous examples from practice. A separate section is devoted to invasive methods of treating pain under fluoroscopic control.

2 890 R




The textbook reflects modern views on the etiology, pathogenesis and classification of major diseases of the cardiovascular system. Information is provided on the epidemiology, clinical picture of diseases of the cardiovascular system, criteria for their diagnosis, differential diagnosis, treatment and prevention.

1 590 R




The reference book discusses in detail the issues of neuroimaging, methods of recanalization and secondary prevention of ischemic stroke. The chapters on differential diagnosis of ischemic stroke and conditions simulating ischemic stroke, basic therapy, and methods of recanalization of cerebral arteries (including thromboembolic extraction) have been expanded and supplemented. Recommendations for the correction of risk factors, prevention and treatment of complications, as well as rehabilitation of patients with ischemic stroke are outlined in detail.

790 R




The book outlines the main methodological and diagnostic aspects of ultrasound examination for acquired heart defects. A modern assessment of the severity of defects is provided, which makes it possible to correctly determine the tactics of patient management. The importance of various ultrasound diagnostic methods in diagnosing heart disease and identifying its complications is shown.

2 190 R




ECG ruler wooden site is designed for deciphering an electrocardiogram taken at a speed of 50 or 25 mm/sec

790 R




The methodological foundations and practical recommendations for the rehabilitation of patients who have suffered a myocardial infarction, surgery on the heart and coronary vessels are outlined. The technological process of rehabilitation is disclosed in accordance with clinical recommendations and the requirements of governing documents, with an emphasis on the second stage of rehabilitation in a three-stage model.

1 590 R




The manual contains modern information on the provision of emergency care to patients with a therapeutic profile, taking into account generally accepted recommendations and standards for diagnosis and treatment.

1 790 R




Modern data on the mechanisms of development, treatment and prevention of acute and chronic vascular complications of diabetes mellitus are presented. Acute complications include ketoacidosis, hypoglycemic coma, lactic acidosis and hyperosmolar hyperglycemic state. The greatest attention is paid to vascular complications of diabetes mellitus, such as chronic kidney disease, diabetic retinopathy, cardiovascular diseases, including acute coronary syndrome.

3 690 R




The book covers in detail the etiology, pathogenesis, clinical picture and differential diagnosis of acute coronary syndrome. Based on international and Russian recommendations, as well as their own experience, the authors discuss early diagnosis and treatment for various clinical types of myocardial infarction and unstable angina.

2 290 R




The book contains information on the prevention, diagnosis, treatment and rehabilitation of patients with acute cerebrovascular accidents. Changes in the theory and practice of providing care to patients with cardiovascular diseases are reflected.

2 890 R




The manual discusses in detail the issues of diagnosis and treatment of symptomatic (secondary) arterial hypertension caused by diseases of the kidneys, large arterial vessels, endocrine pathology and other reasons. Particular attention is paid to the features of the clinical course of secondary forms of arterial hypertension of various etiologies, and the importance of early detection of pathology leading to the development of arterial hypertension is substantiated.

2 390 R




Along with the latest laboratory and instrumental research methods, much attention is paid to the possibilities of differential diagnosis at the first contact of a doctor with a patient: anamnesis, complaints, physical examination data. New methods of ultrasound and other instrumental research methods can significantly simplify the examination scheme for the differential diagnosis of patients with heart damage and, accordingly, facilitate the individualization of medical tactics.

1 890 R




The book reflects the classification and mechanisms of development of bradyarrhythmias, modern approaches to their diagnosis and treatment. Indications for the placement of pacemakers, individual choice of types of implanted devices and features of long-term monitoring of such patients are considered.

1 890 R




The book presents existing approaches to the diagnosis and treatment of cardiovascular changes in connective tissue dysplasia. The differences between congenital developmental anomalies and dysplastic-related disorders are covered in detail.

2 090 R




Contains brief information on the pathogenesis, diagnosis and treatment of vascular diseases. Approaches to non-invasive and invasive diagnostic methods are described in detail. Presents chapters on assessing the risk of cardiovascular diseases, including before surgery and in the early postoperative period. The most significant nosological forms of vascular diseases are described with clinical recommendations for drug therapy

1 590 R




The guide reflects modern approaches to the management of cardiac patients suffering from type 2 diabetes mellitus. Modern classifications, diagnostic criteria, approaches to the treatment and prevention of type 2 diabetes mellitus, features of the course and treatment of cardiovascular diseases against the background of diabetes mellitus are presented. The latest provisions of evidence-based medicine in these areas of knowledge are outlined.

2 090 R




It has everything you need to organize care for patients who have cardiac disorders and manage patients in a hospital setting. All information is presented from the point of view of evidence-based medicine.

2 190 R




The practical guide describes the etiology, pathogenesis, diagnosis, clinical course and treatment of supraventricular cardiac arrhythmias. Issues of both drug and interventional treatment are presented from the perspective of evidence-based medicine and in accordance with current international and Russian recommendations. Particular attention is paid to drug prevention of thromboembolic complications in patients with atrial fibrillation.

1 890 R




The book discusses practical issues in the diagnosis and treatment of heart rhythm and conduction disorders. This publication includes information from modern clinical recommendations, presents the results of the latest scientific research, and supplements clinical cases.

1 990 R




A detailed clinical and pharmacological characteristics of the main classes of antihypertensive drugs and the possibilities of combination pharmacotherapy are presented. Much attention is paid to the individualized approach and algorithm of the doctor’s actions in various clinical situations, in the presence of concomitant diseases and complications.

1 690 R




It is known that insufficient familiarity of doctors with the clinical manifestations of congenital anomalies, malformations, deformations and chromosomal disorders, in particular with connective tissue dysplasia syndromes, creates unjustified diagnostic difficulties, limits the conduct of rational therapy, treatment of complications and the organization of primary prevention of associated diseases.

1 890 R




A detailed, illustrated guide to transesophageal echocardiography (TPE), written by leading US cardiac anesthesiologists, covers general ultrasound issues and specific aspects of the use of TPE intraoperatively in all types of cardiac surgery and in intensive care.

3 790 R




The theoretical foundations of cardiac catheterization, physiological and pathophysiological principles necessary for the effective implementation of diagnostic and therapeutic interventions are presented in clear language. Much attention is paid to the technical details of the method, description of instruments and equipment, and consumables. Intervention techniques are described in detail and step by step. The book is equipped with detailed full-color illustrations that make the material easier to understand.

4 890 R




The publication analyzes the advantages and limitations of a detailed analysis of ABPM results and describes the current characteristics of the daily blood pressure profile. A separate chapter is devoted to the comparative characteristics of ABPM and the method of self-monitoring of blood pressure.

1 790 R




Contains descriptions of medicinal products on the Russian pharmaceutical market and the “Parapharmaceuticals” section, which includes dietary supplements, medical products, medical nutrition and medicinal cosmetics. Information pages of manufacturing companies contain contact information, a list of drugs, their classification and other information.

2 399 R




Questions of the theory of ultrasound examination of the heart and the practical use of various echocardiographic modes, in particular tissue ones. A separate section is devoted to modern methods of quantitative assessment of echocardiogram and assessment of cardiac function.

1 690 R




The main task of writing the book is to present the modern possibilities of testing with physical activity under ECG control, carried out for the purpose of diagnosis, prediction and development of an optimal mode of physical activity.

2 290 R




An original six-step method is presented that allows for ECG interpretation under time pressure. Much attention is paid to accurate nosological diagnosis of heart rhythm disorders. A separate chapter covers current issues in the diagnosis of hereditary arrhythmias. Brief information on changes in the ECG is given

1 490 R




It will allow specialists to adequately assess the situation in the country in the provision of care to patients with pathology of the heart and blood vessels using surgical and endovascular methods, identify trends and prospects for the development of this service, get an idea of ​​the spectrum and frequency of operated nosological forms, the average mortality rate

1 890 R




A brief guide to key issues in diagnosing diseases of internal organs. All sections are presented in the form of visual material - brief structural logical diagrams (algorithms). The content of the book is subject to a single scheme, which greatly facilitates the ability to quickly work with the book and quickly search for a symptom or syndrome.

539 R




The basic principles of transthoracic ultrasound examination of the main coronary arteries are outlined, including methodological and technical features of visualization, the parameters of laminar, turbulent and collateral coronary blood flow, assessment methods and algorithms for diagnosing coronary stenoses and occlusions are discussed.

1 890 R




One page covers only one cardiac problem: disease, syndrome and other necessary information. Graphic explanations are given for each topic: diagrams, drawings, tables. The book contains a lot of visual material. Diseases, syndromes and conditions are considered traditionally: definition, patient complaints, objective data, examination plan, differential diagnosis and treatment. All topics are reviewed taking into account regulatory requirements, clinical guidelines and standards of care

589 R




The manual provides data on the chemical structure, pharmacological properties, mechanism of action, indications and contraindications for use, doses, side effects and other information about drugs necessary for rational therapy. For a wide range of medical professionals.

2 600 R




The main pathogenetic mechanisms of kidney damage in acute situations associated with various exposures are presented. Clinical variants of AKI and approaches to clinical diagnosis are reviewed in detail. Particular attention is paid to the role of biomarkers of acute kidney injury in the diagnosis and assessment of the clinical prognosis of AKI.

2 299 R




The guide is devoted to the differential diagnosis of pathologies that are accompanied by pain in the chest area. Pain syndromes with the specified localization, as well as their causes and the sequence of diagnostic measures are described in a structured, systemic form.

1 699 R




They give detailed recommendations on nutrition and physical activity of patients, highlight the features of type 1 diabetes mellitus in childhood and adolescence, as well as latent autoimmune diabetes in adults. The publication presents the possibilities and prospects of modern methods of treating diabetes mellitus, including cellular, transplantation and molecular genetic technologies.

2 390 R




The most modern ideas about the etiology, pathogenesis, genetic mediation, diagnosis, prevention and treatment of type 2 diabetes mellitus are summarized. The algorithms for medical care for patients with type 2 diabetes presented in the book are based on modern international and national standards.

2 390 R




Modern views on the etiology and pathogenetic mechanisms of atrioventricular blocks and their classification are presented. Clinical cases are illustrated with electrocardiograms and their detailed analysis. Practical recommendations for the comprehensive diagnosis and management of patients with AV conduction disorders are also provided from the perspective of modern ideas on this problem and our own experience.

1 890 R




The book covers general and specific issues of cardiology, contains information about physiology, diagnostic methods, principles of treatment of diseases of the cardiovascular system, and provides characteristics of drugs used in cardiological practice. New chapters are devoted to modern diagnostic methods, including molecular genetic and cellular ones, medical and social examination and rehabilitation in cardiology, psychological factors influencing the development of cardiovascular diseases, as well as the state of the cardiovascular system during pregnancy and sports.

4 199 R




Guide to echocardiography. The book is intended both for those cardiologists who are just beginning to master echocardiography, and for those who have been doing it for a long time. Echocardiographic studies at the most modern level - as they are done in the Echocardiography Laboratory of the University of California, San Francisco.

3 090 R




The book covers all the main sections of cardiology - modern issues of diagnosis and treatment of coronary heart disease, congenital and acquired heart defects, non-coronary myocardial diseases, cardiac rhythm and conduction disorders, heart failure, arterial hypertension - and related disciplines (rehabilitation, diet therapy, etc.).

3 490 R




Unified electrocardiographic conclusions and corresponding signs that help the correct interpretation of electrocardiograms are presented. Illustrative material has been expanded. Materials on cardiac pacing issues have been added.

1 150 R




General issues of ultrasound examination and specific aspects of the use of TPE intraoperatively for all types of cardiac surgery and in intensive care are discussed, and the problems of studying prosthetic heart valves, thoracic aorta, heart tumors and searching for cardiac sources of embolism are separately highlighted.

3 699 R




Dedicated to the pathogenesis, etiology, diagnosis and treatment of polycystic ovary syndrome (PCOS), as the most common endocrine disease in women of reproductive age. A detailed description of the features of the physiology of the female reproductive system is given. Considerable attention is paid to the differential diagnosis of PCOS and morphological changes in the ovaries.

1 150 R




All issues of postoperative management of patients are covered, depending on the type of surgical intervention, modern methods of pharmacological treatment and mechanical support of the heart in heart failure, cardiogenic shock and other critical situations are presented. The book includes sections concerning anesthesiological features of operations during heart transplantation, chronic pulmonary embolism and new surgical technologies. The list of references has been supplemented with new publications.

2 200 R




Along with coverage of traditional issues of emergency cardiology - acute coronary syndrome, diagnosis and treatment of arrhythmias, cardiogenic shock, pulmonary embolism, etc. - separate chapters are presented on implantable devices, echocardiography in emergency conditions, cardiac arrhythmias in children, diagnosis and treatment of panic disorders .

1 890 R




A series of clinical problems are presented, based on real-life cases. The range of proposed tasks covers the main areas of cardiology (coronary heart disease, rhythm and conduction disorders, etc.), including complex issues on permanent cardiac pacing.

1 100 R




We showed the most common errors in the interpretation of Holter registration and analyzed the reasons for their occurrence. Separate chapters of the book are also devoted to normal indicators of Holter monitoring and principles of drawing up a conclusion.

1 690 R




519 R




The guidelines describe almost all congenital heart defects that can be diagnosed in the fetus, as well as treatment of fetal arrhythmias and screening ultrasound examinations in the first trimester of pregnancy. A separate chapter is devoted to an overview of the likely outcomes of each of the congenital heart defects. The data are based on a study of nearly 4,000 fetuses with heart abnormalities.

3 520 R




Issues related to modern principles of diagnosis, features of the clinical course, treatment and prevention of the most common diseases of internal organs in obstetric practice are considered.

1 240 R




The book covers in detail the principles of conducting invasive electrophysiological studies for various types of supraventricular and ventricular arrhythmias, presents the mechanisms of arrhythmias and diagnostic maneuvers used for supraventricular tachyarrhythmias, including incisional postoperative tachycardias.

1 199 R




425 R




This publication is a guide for cardiologists, therapists, local and family doctors, ambulance and emergency medical care specialists, doctors studying in the postgraduate education system, senior students of medical universities.

1 399 R




Heart rhythm disorders and conduction disorders. Causes, mechanisms, electrocardiographic and electrophysiological diagnostics, clinic, treatment. Guide for doctors.

2 599 R




Electrocardiograms of patients with myocardial infarction complicated by various cardiac rhythm and conduction disorders. Next to each electrocardiogram, a detailed description of the changes and a possible algorithm for the doctor’s further actions for effective differential diagnosis of existing ECG changes and treatment tactics for patients are given.

1 880 R




A description of instrumental diagnostic methods for studying the heart and blood vessels is presented: electrocardiographic, ultrasound, X-ray and radionuclide. Approaches to assessing drug and surgical treatment of angina, stratifying the risk of complications and determining the prognosis of patients are shown.

1 740 R




Heart rate and conduction analysis. Assessing the regularity of heartbeats. Heart rate calculation. Determining the source of excitation. Assessment of the cardiac conduction system.

250 R




Its main goal is to help the practicing physician quickly determine and, if necessary, flexibly change the optimal treatment strategy for patients with chronic heart failure, depending on the clinical situation, taking into account current Russian and international recommendations.

2 360 R




The features of performing cardiac MRI in children of different age groups are discussed in detail. MRI scans of the normal anatomy of the heart and mediastinum in infants are presented. Atlas on the clinical use of magnetic resonance imaging for diagnosing the anatomy of congenital heart defects in children.

1 484 R




Modern diagnostic methods for assessing pulmonary hypertension, such as right heart catheterization, echocardiography, image diagnostic methods, and others, are described in detail. Separate chapters are devoted to various forms of pulmonary hypertension - idiopathic, chronic thromboembolic

2 190 R




The book is devoted to CT diagnostics of diseases of the cardiovascular system. Coronary heart disease and coronary artery anomalies. Cardiac arrhythmias. Valve pathology. Aortic diseases. Peripheral arterial diseases.

1 700 R




Age-related features of the physiology and pathophysiology of the cardiovascular system are considered. Modern views on the diagnosis of diseases, anesthesiological and perfusion safety of the operation, and intensive care after surgery are outlined. The conditions and results of using extracorporeal support systems for the cardiovascular system and heart transplantation in children are presented.

6 100 R




The manual is devoted to the study of current problems of extracorporeal blood purification in intensive care units. The central place in the publication is occupied by the issues of epidemiology and pathogenesis, diagnosis and selection of hemocorrection methods for acute kidney injury. A large section is devoted to modern principles of extracorporeal treatment of sepsis, based on pathogenetic ideas about the mechanisms of progression of this serious disease.

4 990 R




Early diagnostic signs of emergency cardiac conditions and assessment of risk factors for their occurrence, step-by-step recommendations for providing accessible minimally sufficient emergency medical care, features of the use of medications, typical treatment errors.

1 570 R




The origin of the waves of a normal ECG and its changes are interpreted from the perspective of vector analysis. ECG changes in various diseases are presented: coronary heart disease, cardiopathy, myo- and pericarditis, pulmonary embolism, heart defects, hypertension, pathology of the kidneys, lungs, endocrine glands, electrolyte metabolism disorders

1 890 R




You will not find such a complete differential diagnostic echocardiographic series as in this publication, supported by video materials and illustrations. The book helps to systematize, classify and conduct differential echocardiographic diagnosis in a patient based on a set of signs identified during the study.

2 750 R




The criteria for a normal electrocardiogram, indicators of heart rate variability, assessment of late ventricular potentials, and features of the daily dynamics of the QT interval in CM are presented. The section on private pathology shows the diagnostic value of CM in examining patients with brady and tachyarrhythmias, syncope and other diseases.

The ECG ruler is designed to decipher an electrocardiogram taken at a speed of 50 or 25 mm/sec




The heart rate scale is synchronous with the Q-T interval scale at a speed of 50 mm/s. The number of heartbeats corresponds to two R-R intervals. Millivolt scale for determining R wave voltage. Table of P-Q and Q-T intervals per second at different heart rates. Scale for calculating the duration of the P wave, QRS complex, P-Q and Q-T intervals per second. Scale of displacement of the ST segment, values ​​of the P and T waves in mV in relation to the isoline. Einthoven's triangle for determining the deviation of the electrical axis of the heart by the angle α (alpha).

479 R




The basics of ECG are given, allowing you to independently master this research method in a short time. For students, trainee doctors, therapists, cardiologists, as well as doctors of other specialties who want to quickly acquire or refresh their knowledge of ECG.




Contains all the information necessary for a medical student and a practicing physician about modern methods of ultrasound examination of the heart, including one-dimensional and Doppler modes.

559 R




MRI semiotics of coronary heart disease with emphasis on assessing myocardial viability. The role and place of the technique in the structure of methods for examining patients with coronary artery disease is determined. The educational and methodological manual has been compiled to assist a practicing radiologist in conducting research, interpreting results and writing conclusions.

490 R




Preventive cardiology. Biological basis of vascular atherosclerosis. Mechanisms and diagnosis of systemic hypertension. Cardiovascular diseases of atherosclerotic origin. Coronary blood flow and myocardial ischemia.




Methods for assessing the patient's health status and evaluating the results of various examination methods are discussed. Several chapters discuss the pathophysiological mechanisms of the development of various cardiovascular diseases, diagnosis and treatment of acute and chronic forms of diseases.

3 590 R




It is a practical guide covering the main aspects of performing functional stress tests. The book is well illustrated: it contains clinical examples, diagrams, tables. Recommendations for test interpretation are given.

1 390 R




The textbook examines, from a modern perspective, changes in the electrocardiogram in cases of dysfunction of automaticity, excitability and conduction, in case of hypertrophy of the atria and ventricles, as well as in cases of myocardial damage of various etiologies.

1 550 R




Criteria for early diagnosis of cardio-cerebrovascular pathology have been proposed, and a classification of isolated and combined forms of damage to the heart and brain in the latent and manifest periods of arterial hypertension has been developed. Based on the proposed method of automatic dynamic manometry, the features of blood pressure variability and its regulation in children and adults were studied.

1 300 R




Recommendations for performing perfusion scintigraphy. The used radiopharmaceuticals, activity and administered doses, stress tests, principles of obtaining and methods of image reconstruction, options for normal and pathological accumulation of radiopharmaceuticals, and the sequence of drawing up conclusions are considered.

520 R




The normal and radiation anatomy of the heart is described according to computed tomography and magnetic resonance imaging. The second chapter is devoted to a description of radiation semiotics of the most common types of myocardial diseases, which presents data from CT, MRI, and radioisotope diagnostic techniques.

956 R




The method of studying the bioelectrical activity of the heart is indispensable in the diagnosis of rhythm and conduction disorders, ventricular and atrial myocardial hypertrophy, coronary heart disease, myocardial infarction and other heart diseases.

680 R




The publication contains test questions and clinical tasks with answers and explanations for self-control. The book is addressed both to doctors who are starting to conduct stress tests, and to experienced specialists who want to have the opportunity to exchange practical experience.

1 560 R




An innovative approach to ECG interpretation and a new system for step-by-step, fast and accurate ECG interpretation are proposed. The author has developed a standard sequential interpretation of the main ECG parameters (waves, intervals, position of the electrical axis of the heart, assessment of LV hypertrophy). Key positions of the ECG are clearly presented in the form of algorithms and diagrams with final access to clinical practice.

4 590 R

Assessment of ST segment elevation or depression Normally, the ST segment is located on an isoline. Normal segment elevation:

• leads from the limbs up to 1 mm,
• V1-V2 up to 3 mm,
• V5-V6 up to 2 mm.

ST segment depression:

• Normal in limb leads up to 0.5 mm
• V1-V2 ≥ 0.5 mm – deviation from the norm

ST segment elevation
↓
Limb leads	Chest leads
ST elevation ≥ 1 mm in ≥2 contiguous leads	ST elevation ≥ 2 mm in ≥2 leads
↓
Acute myocardial infarction (possible infarction with Q wave appearance)

ST segment depression ≥1.5 mm in two or more adjacent leads
↓
Test for troponin and/or MV CPK and/or myoglobin
↓
Yes	No
↓	↓
Myocardial infarction without Q wave	Myocardial ischemia

Differential diagnosis for changes in the ST segment: 1. Standard option:

1. Isolated elevation of the J point (early repolarization phenomenon): displacement of the ST segment at the J point by 1-4 mm above the isoline. Concave upward displacement of the ST segment, in the shape of a fishhook, in combination with high symmetrical T waves, predominantly in leads V2-V4.
2. Isolated J-point depression: upward elevation of the ST segment at the J-point, found in an apparently healthy person.
3. RSR` in lead V1:

• normal duration of the RSR` complex;
• amplitude of the first R wave<8 мм в отведении V1;
• amplitude R`<6 мм;
• R/S<1 во всех правых грудных отведениях.

1. Preservation of the juvenile T waveform: T wave inversion in leads V1 and V2 in an apparently healthy adult.

2. ST segment or T wave changes suspicious for acute or subacute myocardial infarction or left ventricular aneurysm:

• Horizontal or concave elevation with or without T wave inversion.
• Horizontal ST depression in combination with high T waves in leads V1-V2 (indicates posterior wall damage)

3. Changes in the ST segment and (or) T wave, in the presence of signs of acute MI, suspicious for reciprocal changes or myocardial ischemia:

• horizontal or downward ST shift with or without T wave changes in leads opposite those in which there is ST segment elevation.

4. Changes in the ST segment and (or) T wave, in the absence of signs of acute MI, suspicious for myocardial ischemia:

• horizontal or downward ST depression with or without T wave inversion in the absence of ST segment elevation.

5. Changes in the ST segment and (or) T wave associated with ventricular myocardial hypertrophy:

1. With left ventricular hypertrophy - depression of the ST segment of a convex shape with inversion of the T wave in V4-V6, often in a horizontal position of the EOS - in leads I, aVL, and in a vertical position - II, III, aVF
2. With right ventricular hypertrophy, there is depression of the ST segment of a convex shape with inversion of the T wave in V1-V3.

6. Changes in the ST segment and (or) T wave associated with intraventricular conduction disorders: QRS ≥ 120 ms +

1. With LBP blockade there is ST segment depression and T wave inversion in V4-V6.
2. With PNPG blockade, there is ST segment depression and T wave inversion in V1-V3.

7. Changes in the ST segment and (or) T wave, suspicious for the early stage of acute pericarditis: Diffuse elevation of the ST segment of a concave shape. It can be observed in all leads except aVR, but more often in I, II, V5-V6. The absence of reciprocal changes and simultaneous inversion of the T wave is a distinctive sign from MI. The T wave remains concordant with the ST shift characteristic of early pericarditis. 8. TELA 9. Acute myocarditis 10. HCM 11. Cocaine abuse 12. Non-specificchanges in the ST segment and (or) T wave:

• mild ST segment depression, or isolated T wave inversion, or other disorders that are not caused by a specific pathology.

Dynamics of the ECG segment during myocardial infarction:

1. ST depression - ischemia
2. ST elevation – damage current
3. Q wave – necrosis (infarction)

Two terms are used to describe myocardial infarction:

1. Acute ST-segment elevation MI
2. Acute MI with ST segment depression

Diagnosis criteria for acute ST-segment elevation MI (probable Q-wave infarction):

• Pathological ST segment elevation ≥ 1 mm in two or more adjacent limb leads
• Pathological ST segment elevation ≥ 2 mm in two or more precordial leads
• High R waves in leads V1 and V2 in combination with ST segment elevation in II, III, aVF or V 4R may indicate an associated posterior wall infarction. An infarction of the posterior wall is virtually always accompanied by an infarction of the inferior wall or right ventricle. Posterior MI must be confirmed with enzymes.

Additional signs confirming MI:

• The presence of reciprocal depression. Helps confirm the diagnosis of MI, but does not have diagnostic value in itself. This sign is of particular importance, because ST segment elevation may be normal if it is not accompanied by reciprocal ST depression. In acute pericarditis, ST segment depression occurs only in lead aVR and sometimes in lead V1.
• Appearance of Q waves. These waves are fully evident 2-12 hours after the onset of clinical symptoms.
• A decrease in the amplitude of the R waves in leads V2-V4, i.e. Poor rise of the R wave, especially if the R wave is present in leads V1 or V2 and disappears or decreases in V3 or V4.
• Dynamics of ST and T are observed within 10-30 hours from the onset of a heart attack

Criteria for diagnosing acute MI with ST segment depression (probable Q wave infarction): In a patient experiencing discomfort in the chest, ST segment depression ≥1.5 mm in two or more leads, as well as pathological levels of troponin and/or CK MB and/or myoglobin, allows a diagnosis of MI in the absence of the Q wave. Myocardial ischemia ST segment depression indicating ischemia must meet the following criteria:

1. Depth > 1mm.
2. Present in two or more leads.
3. Occurs in two or more consecutive QRS complexes.
4. The shape is horizontal or oblique; T wave inversion is optional.
5. Abnormal ST segment arching in leads V1-V3 or V2-V4 in combination with T wave inversion; the terminal portion of the abnormal ST segment has a typical uplifted appearance.

Nonspecific ST segment changes ST segment changes should be considered nonspecific if the following signs are present:

1. ST segment depression.
2. Isoline offset.
3. The presence or absence of T wave inversion.
4. Often associated with small flat or slightly inverted T waves.

T waves should be ≥ 0.5 mm in amplitude in leads I and II.
Causes of nonspecific changes in the ST segment:

1. Minor ST segment depression ≤ 1 mm is often observed in healthy people.
2. Incorrect application (poor contact) of electrodes.
3. Ischemia.
4. Electrolyte disturbances.
5. KMP.
6. Myocarditis.
7. Pericarditis, incl. constrictive.
8. Violation of intraventricular conduction.
9. TELA.
10. Hyperventilation.
11. Drinking cold water.
12. Arrhythmias.
13. Use of medications (drugs).
14. Alcohol abuse.

Reflects the spread of the excitation wave to the basal sections of the interventricular septum, right and left ventricles.

1. The optional negative wave following the R wave may be absent in the limb leads and V5-6.

2. If there are several teeth, it is designated S respectively,

S`, S``, S```, etc.

3. Duration less than 0.04 sec, amplitude in chest

leads is greatest in leads V1-2 and gradually decreases towards V5-6.

ST segment

Corresponds to the period when both ventricles are completely covered by excitation, measured from the end of S to the beginning of T (or from the end of R in the absence of an S wave).

1. The duration of ST depends on the pulse rate.

2. Normally, the ST segment is located on the isoline, ST depression

no more than 0.5 mm (0.05 mV) is allowed in leads V2-3 and no more than 1 mm (0.1 mV) in other leads.

3. Its rise should not exceed 1 mm in all leads except V2-3.

4. In leads V2-3, ST segment elevation ≥2 mm (0.2 mV) should be considered pathological in persons over 40 years old, in persons under 40

years ≥2.5 mm (0.25 mV) in men and ≥1.5 (0.15 mV) in women, respectively.

T wave

Reflects the processes of ventricular repolarization. This is the most labile tooth.

1. Normally, the T wave is positive in those leads where the QRS complex is represented predominantly by the R wave.

2. With a normal position of the heart, the T wave is positive in leads I, II, III, aVL and aVF, negative in lead aVR.

3. T III can be reduced, isoelectric, slightly negative when the electrical axis of the heart deviates to the left.

4. In lead V 1, the T wave with the same frequency can be negative, isoelectric, positive or

biphasic, in lead V2 it is often positive, in leads V3-6 it is always positive.

In a qualitative description, a low T wave should be identified if its amplitude is less than 10% of the amplitude of the R wave in a given lead; flattened with an amplitude from -0.1 to 0.1 mV; inverted T wave in leads I, II, aVL, V2 -V6, if its amplitude is from -0.1 to -0.5 mV; negative at an amplitude of -0.5 mV or more.

QT interval (QRST)

Reflects the electrical systole of the heart. Measured from the beginning of the Q wave (or R if there is no Q) to the end of the T wave.

1. The duration depends on gender, age, and rhythm frequency. Normal QT value (corrected QT; QTc)

2. Normal QT values ​​range between 0.39–0.45 sec.

3. If measurements are made in different leads, as a basis

the highest value is taken (usually in leads V2 - V3).

4. QT interval prolongation is considered to be 0.46 seconds or more in women, 0.45 seconds or more in men, and shortening is 0.39 seconds or less.

U wave

An unstable, small amplitude (1–3 mm or up to 11% of the amplitude of the T wave) wave, concordant (unidirectional) to the T wave, following it after 0.02–0.04 sec. Most pronounced in leads V2-V3, more often with bradycardia. Clinical significance is unclear.

TR segment

Reflects the diastole phase of the heart. Measured from the end of the T wave (U) to the beginning of the P wave.

1. Located on an isoline, the duration depends on the rhythm frequency.

2. With tachycardia, the duration of the TR segment decreases, with bradycardia it increases.

RR interval

Characterizes the duration of a complete cardiac cycle - systole and diastole.

1. To determine your heart rate, divide 60 by the RR value expressed in seconds.

IN in cases where the rhythm frequency in one patient differs in a short period of time (for example, with atrial fibrillation),

the maximum and minimum rhythm frequencies should be determined from the largest and smallest RR values, or the average rhythm frequency should be calculated from 10 consecutive RRs.

If the reader thinks that electrocardiograph can clearly record the absence of electrical currents in the heart (the so-called zero potential level), then he is mistaken. There are many extraneous currents in the body, such as skin potentials or potentials arising from different concentrations of ions in different body fluids. Consequently, when applying electrodes to two limbs, extraneous currents of this kind do not make it possible to clearly record the zero (isoelectric) level on the electrocardiogram. For this reason, to determine the zero potential level, it is necessary to perform the following procedure: first of all, find the point on the electrocardiogram that corresponds to the complete completion of ventricular depolarization, i.e. completion of the QRS complex. From this moment, all parts of the ventricles are depolarized, including damaged and normally functioning areas of the myocardium; there are no electrical currents in the heart and surrounding tissues; At this moment, a zero potential is recorded on the electrocardiogram. This point is known as the J-point of the electrocardiogram.

J-point is used for potential analysis damage and the damage currents caused by it. To do this, a horizontal line is drawn in each lead on the electrocardiogram, passing through the J-point. This horizontal line indicates the zero potential level, the deviation from which due to the occurrence of fault currents can be measured.

Using the J-Point to construct the damage potential vector. The figure shows electrocardiograms (leads I and III) of a pathologically altered heart. Damage potentials are visible in both leads. In other words, the level of location of the J-point on the presented electrocardiograms does not coincide with the level of the T-P segment. The horizontal line passing through the J-point represents the zero level of cardiac potential. The damage potential in each lead is the difference between the zero level and the beginning of the P wave, expressed in millivolts. In lead I, a positive damage potential is recorded, because the T-P segment shifts upward from the zero level. In lead III, a negative damage potential is recorded, because the T-P segment shifts downward from the zero level.

In the lower part of the figure, the magnitude of the damage potential is plotted by corresponding semiaxis of leads I and III. Then, according to the rules of vector analysis outlined earlier, the resulting vector of ventricular damage potential is determined. In this case, the resulting vector is directed from right to left and upward. Its direction is determined by the angle -30°. If you mentally place the found vector on the surface of the ventricles of the heart, its negative end will indicate the localization of a permanently depolarized damaged zone of the myocardium. In this case, this is the lateral wall of the right ventricle.
Of course, such an analysis is a complex procedure.

Training video for assessing the QRS complex on an ECG in normal and pathological conditions

If you have problems watching, download the video from the page

Potential for damage in coronary circulatory disorders

Insufficient blood supply to the heart muscle leads to a decrease in metabolic rate for three reasons: (1) decreased oxygen delivery; (2) accumulation of excess carbon dioxide; (3) decreased nutrient delivery. Under these conditions, cells often survive, but the process of repolarization of cell membranes is disrupted. As long as ischemia continues, the damage current continues to flow in the diastolic period (T-P segment) of each cardiac cycle.

Severe myocardial ischemia, which develops as a result of occlusion of the coronary arteries, leads to the formation of powerful damage currents between the affected area and the rest of the myocardium during the T-P interval. Therefore, one of the most important electrocardiographic signs of acute coronary thrombosis is the pronounced damage potential.

Observed in chronic ischemic heart disease. A - horizontal; B - oblique descending; B - with an arc facing upward; G - oblique ascending; D - trough-shaped; E - ST segment elevation.

1. Horizontal displacement of the ST segment. It is characterized by a decrease in the ST segment below the isoline with its horizontal location. The ST segment turns into a positive biphasic (- +) smoothed or into a negative T wave.
2. Oblique downward displacement of the ST segment (from R to T). As you move away from the QRS complex, the degree of ST segment displacement downward from the isoline gradually increases. The ST segment becomes negative, biphasic (+) smoothed, or positive T.
3. Displacement of the ST segment downward from the isoline with the arc facing upward with its convexity. Depression of the ST segment is not expressed equally throughout its entire length, but has the shape of an arc, the convexity of which is directed upward. The ST segment becomes positive, biphasic (+), flattened or negative T wave.
4. Oblique upward displacement of the ST segment (from S to T). The greatest depression of the ST segment is observed immediately after the end of the QRS complex. Following this, the ST segment gradually rises to the isoline and usually turns into a positive or smoothed T wave.
5. Trough-shaped displacement of the ST segment. This type of ST segment displacement has the shape of an arc, the convexity of which is directed downward. It is also observed during treatment with cardiac glycosides. The ST segment turns into a smoothed biphasic (- +) or positive T wave.

For chronic coronary heart disease, the first two types of ST segment displacement are most specific, i.e. horizontal and oblique downward.

“Guide to electrocardiography”, V.N. Orlov