{ "a11y.skipToContent": "Skip to content", "anatomy.articles": "Articles on heart anatomy and function", "anatomy.intro": "A 3D model of a normal adult heart. Rotate it, pick a structure from the list or click it on the model, make the chambers see-through or cut the heart open to look inside.", "anatomy.patientModels": "Hearts of real patients with congenital defects are separate 3D models, shown in their articles:", "anatomy.title": "Heart anatomy", "articles.showOnModel": "show on the 3D model", "articles.type.anatomy": "Anatomy", "articles.type.diagnostic": "Diagnostics", "articles.type.disease": "Diseases", "articles.type.treatment": "Treatment", "catalog.filter.empty": "Nothing found in this section.", "catalog.filter.found": "Articles found: {count}", "catalog.filter.label": "Find a disease", "catalog.filter.searchAll": "Search the whole atlas", "catalog.group.arteries": "Aorta and arteries", "catalog.group.congenital": "Congenital heart defects", "catalog.group.coronary": "Coronary arteries", "catalog.group.inflammation": "Inflammation, pericardium and tumours", "catalog.group.myocardium": "Heart failure and cardiomyopathies", "catalog.group.other": "Other", "catalog.group.pulmonary": "Pulmonary circulation", "catalog.group.rhythm": "Rhythm and conduction", "catalog.group.risk-factors": "Blood pressure and cholesterol", "catalog.group.valves": "Valves", "catalog.group.veins": "Veins and blood clots", "catalog.groups": "Disease groups", "congenital.signsNote": "The features are named as in the sources of the article; they are not marked on the model.", "congenital.source": "Model record in the NIH 3D Heart Library", "congenital.tetralogy-of-fallot.caption": "The heart of a patient with tetralogy of Fallot, a model built from MRI scans in the NIH 3D Heart Library. It is one person's heart: in other patients the shape and size differ. NIH did not take part in Heart Atlas and does not endorse it.", "congenital.tetralogy-of-fallot.ghost": "See-through muscle", "congenital.tetralogy-of-fallot.posterAlt": "The heart of a patient with tetralogy of Fallot, cut from the front: heart muscle and the blood inside the chambers and vessels", "congenital.tetralogy-of-fallot.sign1": "Ventricular septal defect", "congenital.tetralogy-of-fallot.sign2": "Right ventricular outflow tract obstruction and pulmonary valve stenosis", "congenital.tetralogy-of-fallot.sign3": "Overriding aorta", "congenital.tetralogy-of-fallot.sign4": "Right ventricular hypertrophy", "congenital.tetralogy-of-fallot.signs": "Four features of tetralogy of Fallot", "congenital.transposition-of-the-great-arteries.caption": "The heart of a child with transposition of the great arteries before surgery: a model of the blood in the chambers and vessels from the NIH 3D Heart Library. Blue is the blood of the systemic circulation (venae cavae, right atrium and ventricle, aorta), red the blood of the pulmonary circulation (pulmonary veins, left atrium and ventricle, pulmonary artery). The model is enlarged. It is one person's heart: in other patients the shape and size differ. NIH did not take part in Heart Atlas and does not endorse it.", "congenital.transposition-of-the-great-arteries.ghost": "See-through systemic circulation", "congenital.transposition-of-the-great-arteries.posterAlt": "The heart of a child with transposition of the great arteries, from the front: the blue systemic circulation with the aorta rising from the right ventricle, and the red pulmonary circulation behind it", "congenital.transposition-of-the-great-arteries.sign1": "Ventriculo-arterial discordance: the aorta originates from the right ventricle, the pulmonary artery from the left ventricle", "congenital.transposition-of-the-great-arteries.sign2": "Independent, parallel pulmonary and systemic circulations", "congenital.transposition-of-the-great-arteries.signs": "Two features of transposition of the great arteries", "diagram.abdominal-aortic-aneurysm.title": "Diagram of the abdominal aorta with the renal and iliac arteries: normally the aorta below the renal arteries is on average 18–22 mm across; in an abdominal aortic aneurysm this segment usually widens all round to 3 cm or more, and a blood clot often lines its wall from inside", "diagram.acute-limb-ischemia.title": "Diagram of the main artery of the leg, which divides into the lower leg arteries below the knee: normally blood flows through them to the foot and there is a pulse on the foot; in acute limb ischaemia an embolus is stuck where the artery branches, there is no blood flow below it, no pulse on the foot, and the foot is pale and cold", "diagram.acute-rheumatic-fever.title": "Diagram of a section through the heart wall next to the mitral valve: endocardium, heart muscle and pericardium; normally the valve leaflet is thin and the layers of the pericardium lie close together; in acute rheumatic carditis the leaflet is swollen with nodules along its edge, there are foci of inflammation in the heart muscle and a thin layer of fluid in the pericardium; fused leaflets and valve narrowing are not shown", "diagram.alcoholic-cardiomyopathy.title": "Diagram of the size of the left ventricle and how strongly it contracts, normally and in alcoholic cardiomyopathy: normally the ventricle is of usual size and contracts strongly; in the disease it is dilated and contracts weakly", "diagram.aortic-dissection.title": "Diagram of the aorta cut lengthwise: normally the three-layer wall is intact and blood flows in one lumen; in aortic dissection blood passes through an intimal tear into the middle layer of the wall, and a flap of intima separates the true lumen from the false lumen", "diagram.aortic-regurgitation.title": "Diagram of the left heart in diastole, while the left ventricle fills from the left atrium: normally the aortic valve leaflets are closed; in aortic regurgitation they do not close and blood flows back from the aorta into the left ventricle", "diagram.aortic-stenosis.title": "Diagram of the aortic valve: normally, in aortic stenosis and after the valve is replaced with a prosthesis", "diagram.aortopulmonary-window.title": "Diagram of the ventricles, aorta and pulmonary artery, normally and with an isolated aortopulmonary window (type I, one of the variants): normally the aorta and pulmonary artery are separate vessels, each with its own valve, and the wall between them is intact; with the defect there is a window in this wall just above the valves, some blood from the aorta flows through it into the pulmonary artery, too much blood goes to the lungs, the pulmonary artery and left ventricle are dilated, while the valves stay separate and the ventricular septum is intact", "diagram.arrhythmogenic-right-ventricular-cardiomyopathy.title": "Diagram of the right and left ventricles in section and of the right ventricular wall tissue: normally the right ventricular wall is heart muscle whose cells are held together by desmosomes; in late-stage arrhythmogenic right ventricular cardiomyopathy the right ventricle is dilated, its wall is thinner, and in the outflow part, the inflow part and at the apex the muscle is replaced by fatty and fibrous tissue", "diagram.athletes-heart.title": "Diagram of the heart in section: in an untrained person the chambers and walls are of usual size and the pulse is normal; in a trained athlete all four chambers are slightly larger, the walls are slightly and evenly thicker and the pulse at rest is slower, which is an adaptation to training, not a disease", "diagram.atrial-fibrillation.title": "Diagram of the electrical impulse in the heart in normal sinus rhythm and in atrial fibrillation", "diagram.atrial-flutter.title": "Diagram of the atria and ventricles: normally the impulse from the sinus node spreads over the atria and passes through the AV node to the ventricles; in typical atrial flutter the impulse runs in a large circle in the right atrium around the ring of the tricuspid valve, counterclockwise, through the isthmus between the inferior vena cava and the valve, and usually every second impulse reaches the ventricles", "diagram.atrial-septal-defect.title": "Diagram of the heart chambers: normal, with an atrial septal defect and after the defect is closed", "diagram.atrioventricular-septal-defect.title": "Diagram of the four heart chambers normally and in the complete form of atrioventricular septal defect: normally the right and left halves of the heart are separate and blood flows from the atria into the ventricles through two separate valves, the tricuspid and the mitral; in the complete form there is one large defect in the centre of the heart directly above and below a common valve through which both atria connect with the ventricles, blood shunts from left to right at the atrial and the ventricular level, and all four chambers are enlarged", "diagram.av-block.title": "Diagram of impulses travelling from the sinus node through the atria and the atrioventricular node to the ventricles: normally every impulse gets through; in second-degree atrioventricular block one impulse is blocked and the ventricles skip a beat", "diagram.bicuspid-aortic-valve.title": "Diagram of the closed aortic valve seen from the aorta: normally the valve has three cusps that meet in the centre; a bicuspid aortic valve has two cusps, a smaller one and a larger one formed by two fused cusps, which carries a fusion line; the valve is not drawn narrowed", "diagram.blood-flow.title": "Diagram of blood flow through the heart, lungs and body", "diagram.brugada-syndrome.title": "ECG diagram of the right precordial leads V1 and V2: normally the ST segment after the QRS complex runs along the baseline; in the type 1 Brugada pattern the J point and the ST segment are raised, and the coved ST segment descends into an inverted T wave", "diagram.bundle-branch-block.title": "Diagram of the electrical impulse from the sinus node through the atria, the AV node and the bundle of His to the ventricles, with the ECG of one beat: normally the impulse travels down the right and left bundle branches, both ventricles are activated at the same time and the QRS complex is narrow; in right bundle branch block conduction along that branch is interrupted and the right ventricle is activated later; in left bundle branch block the left ventricle is activated later; with a block the QRS is wide", "diagram.cancer-therapy-related-cardiac-dysfunction.title": "Long-axis diagram of the left ventricle before and after contraction: before cancer treatment all the walls contract well and the cavity becomes much smaller; with cardiotoxicity the same ventricle contracts more weakly, and a dashed outline shows how it contracted before treatment: doctors compare new results with this baseline", "diagram.cardiac-amyloidosis.title": "Diagram of the heart cut through all four chambers while the ventricles fill: normally the ventricular walls are of normal thickness and the valves and the septum between the atria are thin; in cardiac amyloidosis there are amyloid deposits in the walls; the walls of both ventricles, the valves and the septum between the atria are thickened, there is a little fluid in the pericardium and the left atrium is enlarged", "diagram.cardiac-myxoma.title": "Diagram of the heart cut through all four chambers while the ventricles fill: normally the mitral valve is open and blood flows freely from the left atrium into the left ventricle; with a myxoma a rounded lobular tumour hangs in the left atrium on a stalk attached to the interatrial septum, swings with the blood flow, drops into the opening of the mitral valve and obstructs blood flow into the left ventricle", "diagram.cardiac-sarcoidosis.title": "Diagram of a four-chamber section of the heart with the conduction system: normally the impulse from the sinus node travels over the atria, through the atrioventricular node, the bundle of His and its branches to the ventricles; in cardiac sarcoidosis there are foci (granulomas) in the heart muscle (their places in the diagram are an example): in the interventricular septum at the bundle of His, where the impulse stops, and in the walls of the left and right ventricles", "diagram.cardiac-tamponade.title": "Diagram of the heart cut through all four chambers inside the pericardium while the ventricles fill: normally a thin layer of fluid lies between the layers of the pericardium and the chambers fill freely; in cardiac tamponade a layer of fluid or blood surrounds the heart, which is not enlarged, and presses on it, the right atrium and right ventricle are compressed, and all chambers are smaller because they fill less", "diagram.cardiogenic-shock.title": "Diagram of a person with the heart, the aorta, the lungs and the organs: normally the heart pumps out enough blood and thick arrows carry it to the brain, the skin and the kidneys; in cardiogenic shock there is an infarct zone in the left ventricle, the heart pumps out too little blood, the arrows to the organs are thin, and confusion, cold clammy skin, little urine and congestion in the lungs are marked", "diagram.carotid-artery-stenosis.title": "Diagram of the carotid artery in the neck and where it divides: normally the internal carotid artery, which carries blood to the brain, has a wide, smooth lumen; in carotid stenosis plaques at the bifurcation narrow the start of the internal carotid artery, and a fragment may break off a plaque and travel with the blood to the brain", "diagram.catecholaminergic-polymorphic-ventricular-tachycardia.title": "Diagram of the electrical impulse path from the sinus node through the atria and the AV node to the ventricles, with a ventricular cell close up: at rest the impulse takes its usual route, the rhythm is regular and the calcium stays in the cell's internal store; during exertion or emotion stress hormones reach the heart, the store leaks extra calcium and extra impulses start from several points in the ventricles, while the structure of the heart does not change", "diagram.chagas-cardiomyopathy.title": "Diagram of a section of the heart with the conduction system: normally all chambers are of normal size and the impulse travels through the bundle of His, the right bundle branch and the fascicles of the left bundle branch; in Chagas cardiomyopathy all chambers are enlarged, there is an aneurysm at the apex of the left ventricle, and conduction is blocked in the right bundle branch and the left anterior fascicle", "diagram.chronic-kidney-disease-and-heart.title": "Diagram of the heart and a kidney joined by an artery: normally blood from the heart reaches the kidney, and the kidney passes waste, extra salt, water and potassium out in the urine; in chronic kidney disease the kidneys filter less well, salt and water retention raises blood pressure and the risk of heart failure, blood potassium rises and increases the risk of heart rhythm disorders, the risk of atherosclerosis is higher, and heart and blood vessel disease in turn harms the kidneys", "diagram.chronic-thromboembolic-pulmonary-hypertension.title": "Diagram of the right ventricle and the pulmonary artery with its branches in the lung: normally all branches are open and the right ventricle is of normal size; in chronic thromboembolic pulmonary hypertension organised fibrotic material narrows some branches with a ring-like narrowing or a web and blocks one branch completely, less blood reaches the lung beyond it, the open branches are overfilled, and the right ventricle has a thickened wall and a dilated cavity", "diagram.coarctation-of-the-aorta.title": "Diagram of the left ventricle, the aortic arch with its branches to the head and arms, and the descending aorta: normally, in coarctation of the aorta and after it is repaired. In coarctation there is a narrowing just past the left subclavian artery, high pressure above the narrowing, less blood flow below it and a thickened left ventricular wall; after repair blood flows freely down the aorta again", "diagram.conduction-system.title": "Diagram of the conduction system: the impulse from the sinoatrial node to the Purkinje fibres", "diagram.congenitally-corrected-transposition.title": "Diagram of the circulation, normally and in congenitally corrected transposition of the great arteries: normally the right atrium connects through the tricuspid valve to the right ventricle and the left atrium through the mitral valve to the left ventricle; in corrected transposition the ventricles have swapped places together with their valves, yet venous blood still goes to the lungs and arterial blood to the body; the right ventricle pumps blood into the aorta, which lies in front and to the left, and blood often leaks back through the tricuspid valve into the left atrium", "diagram.constrictive-pericarditis.title": "Diagram of the heart cut through all four chambers inside the pericardium while the ventricles fill: normally the pericardium is thin with a narrow cavity under it and the chambers fill freely; in constrictive pericarditis the pericardium is thick and stiff with patches of calcium and no wide layer of fluid under it, the atria are enlarged, and the ventricles are of normal size but fill less", "diagram.cor-triatriatum.title": "Diagram of the left atrium and left ventricle while the ventricle fills: normally the left atrium is one chamber, the pulmonary veins drain into it and blood flows freely through the mitral valve into the left ventricle; in cor triatriatum a membrane divides the left atrium into an upper and a lower chamber, the pulmonary veins drain into the upper chamber, blood passes into the lower one through a narrow opening in the membrane, the pulmonary veins are not dilated, and the mitral valve in the diagram is unchanged", "diagram.coronary-arteries.title": "Diagram of the coronary arteries, front view of the heart", "diagram.coronary-artery-anomalies.title": "Diagram of the heart from the front with the roots of the aorta and the pulmonary trunk and the coronary arteries: normally both coronary arteries start from the aorta and none from the pulmonary trunk; in anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA) the right coronary artery is wide and tortuous, blood from it reaches the left coronary artery through collaterals and flows back into the pulmonary trunk, and the anterior wall of the left ventricle gets too little blood and oxygen", "diagram.coronary-heart-disease.title": "Diagram of a coronary artery supplying the heart muscle: normal, and narrowed by plaques with one branch blocked by a blood clot", "diagram.coronary-microvascular-dysfunction.title": "Diagram in two halves: a large coronary artery on the surface of the heart and the small vessels it sends into the heart muscle; normally the small vessels widen with exercise and blood flows freely into the muscle; in angina with no obstructive coronary arteries the large artery is not narrowed by a plaque, and two mechanisms are shown: on the left, in microvascular angina, the small vessels do not widen with exercise; on the right, in vasospastic angina, a short segment of the large artery is narrowed for a while by a spasm; in both cases the muscle gets less blood", "diagram.deep-vein-thrombosis.title": "Diagram of part of the lower leg with a deep vein in longitudinal section: normally blood flows up the vein towards the heart through open valves; in deep vein thrombosis a clot starts at a valve and grows up the vein, blood flow below it is slowed, the leg below the clot swells, and a piece of the clot can break off and travel to the lungs (pulmonary embolism)", "diagram.diabetes-and-heart.title": "Diagram of a coronary artery cut lengthwise: normally the wall is smooth and blood flows freely; in diabetes plaques form in the wall and narrow the lumen", "diagram.dilated-cardiomyopathy.title": "Diagram of the size of the left ventricle and how much it contracts, normally and in dilated cardiomyopathy", "diagram.double-chambered-right-ventricle.title": "Diagram of the right ventricle, its outflow tract and the pulmonary trunk in systole: normally the right ventricle is one cavity with a thin wall, and blood flows evenly through the outflow tract and the open pulmonary valve; in double-chambered right ventricle, muscle bands in the middle of the cavity leave a narrow passage: below them is a high-pressure chamber with a thick wall, above them the outflow tract with low pressure and a thin wall, and the pulmonary valve in the diagram is drawn as normal", "diagram.double-outlet-right-ventricle.title": "Diagram of the ventricles and the vessels leaving them, normally and in double outlet right ventricle (one of the variants, with the defect below the aorta and no narrowing on the way into the pulmonary artery): normally the pulmonary artery leaves the right ventricle and the aorta leaves the left; in this condition both vessels leave the right ventricle, the left ventricle empties only through a ventricular septal defect, and mixed blood goes into both the aorta and the pulmonary artery, with too much blood going to the lungs", "diagram.dyslipidemia.title": "Diagram of an artery cut lengthwise: normally LDL particles pass along the lumen with the blood; with high LDL cholesterol there are more of them, they are retained in the wall and form an early plaque", "diagram.early-repolarization-syndrome.title": "ECG complex diagram: normally the J point, where the QRS complex turns into the ST segment, lies on the baseline and the ST segment runs along it; in the early repolarisation pattern the J point is raised above the baseline and there is a notch at the end of the QRS complex, with the normal ST segment and T wave shown dashed; in a person without symptoms and without sudden deaths in the family this pattern is most often a harmless finding", "diagram.ebstein-anomaly.title": "Diagram of the right heart: normally the tricuspid valve leaflets attach to the annulus between the right atrium and the right ventricle; in Ebstein anomaly the anterior leaflet is enlarged and sail-like, the septal leaflet is stuck to the septum and displaced towards the apex, the part of the ventricle between the annulus and the leaflets is atrialised, the functional ventricle is smaller, blood flows back through the valve, and the right atrium is drawn larger", "diagram.eisenmenger-syndrome.title": "Diagram of the ventricles, the pulmonary artery, the aorta and small lung arteries in cross-section: normally the septum between the ventricles is intact, there is no shunt, and the walls of the small lung arteries are thin; in Eisenmenger syndrome there is a large defect in the septum, the pressure in the pulmonary artery is high, the walls of the small lung arteries are thickened, blood crosses the defect from right to left, and mixed blood enters the aorta", "diagram.extrasystole.title": "Diagram of the electrical impulse path from the sinus node through the atria to the ventricles, with an ECG strip: normally every beat starts in the sinus node and every QRS complex has a P wave before it; in a ventricular premature beat an extra impulse starts early in a focus in a ventricle, and on the ECG it is an early, wide QRS complex without a P wave, followed by a pause", "diagram.fabry-disease.title": "Diagram of a small area of the left ventricular wall seen close up, outer surface at the top and cavity at the bottom: normally the wall has its usual thickness and nothing builds up in the lysosomes of the muscle cells; in Fabry disease the wall is thicker, the muscle cells are larger, small deposits lie inside their lysosomes, and there are patches of fibrous tissue between the cells", "diagram.familial-hypercholesterolemia.title": "Diagram of a liver cell with blood above it: normally LDL receptors on the cell surface take up LDL particles and carry them into the cell, and there are few particles in the blood; in familial hypercholesterolaemia the receptors do not work or work less well, the cell takes up fewer particles, and many LDL particles stay in the blood", "diagram.fibromuscular-dysplasia.title": "Diagram of a segment of an artery cut lengthwise: normally the lumen is even all along; in multifocal fibromuscular dysplasia narrowings alternate with widenings in the middle and far parts of the artery like a string of beads, and the initial part of the artery is usually unchanged; there is no plaque", "diagram.focal-atrial-tachycardia.title": "Diagram of the electrical impulse path from the atria through the AV node to the ventricles: normally the sinus node sets the rhythm; in focal atrial tachycardia a focus in an atrium fires fast, the wave spreads from it in all directions, and the ventricles usually beat fast and regularly", "diagram.giant-cell-arteritis.title": "Diagram of the head from the side with the temporal artery and its enlarged cross-section: normally the artery wall is not thickened, the lumen is wide and blood flows freely to the scalp; in giant cell arteritis, in inflamed segments that alternate with unaffected ones, the wall is thickened, the lumen is narrowed and blood flow is reduced", "diagram.heart-chambers.title": "Diagram of the four heart chambers in diastole and systole", "diagram.heart-failure.title": "Diagram of how strongly the ventricles contract and how much blood they eject, normally and in heart failure", "diagram.heart-valves.title": "Diagram of the four heart valves in diastole and systole", "diagram.holter-monitor.title": "Diagram of Holter monitoring: a recorder worn on the body and the ECG recording", "diagram.hypertension-in-pregnancy.title": "Diagram of a section through the uterine wall with the placenta lying on it: normally the spiral arteries in the wall are wide and plenty of the mother's blood reaches the placenta; in pre-eclampsia the spiral arteries are narrow and the placenta gets little blood, substances from the placenta damage the mother's blood vessels, her blood pressure rises, and her kidneys, liver and brain can be harmed", "diagram.hypertension.title": "Diagram of an artery and the left ventricle with normal and high blood pressure", "diagram.hypertensive-crisis.title": "Diagram of a person with the heart, the aorta and the target organs: normally blood pressure is in the usual range and the organs are not damaged; in a hypertensive crisis blood pressure rises sharply and acute damage to the brain, eyes, heart, aorta and kidneys is marked", "diagram.hypertensive-heart-disease.title": "Diagram of the left atrium and the left ventricle: normally the ventricle wall is of usual thickness, the atrium is of usual size and blood fills the ventricle easily; in hypertensive heart disease the ventricle wall is thickened all around and stiffer, the ventricle fills less easily and the left atrium is enlarged", "diagram.hypertrophic-cardiomyopathy.title": "Diagram of the left ventricle and its outflow into the aorta, normally and in hypertrophic cardiomyopathy with a thickened septum", "diagram.hypoplastic-left-heart-syndrome.title": "Diagram of the circulation, normally and in hypoplastic left heart syndrome: normally blood passes through the lungs and the body in turn; in the defect the mitral and aortic valves are closed, the left ventricle is small, the ascending aorta and the aortic arch are narrow, blood from the left atrium crosses an atrial communication into the right atrium and mixes there with venous blood, and the right ventricle pumps the mixed blood into the pulmonary artery and through a patent ductus arteriosus into the aorta and on to the body", "diagram.hypothyroid-heart-disease.title": "Diagram of the thyroid gland and the heart in the pericardium: normally the gland releases the usual amount of hormones, the heart beats at its usual rhythm and there is only a little fluid in the pericardial cavity; in hypothyroidism there is too little hormone, the pulse slows, and fluid may collect in the pericardium", "diagram.inappropriate-sinus-tachycardia.title": "A schematic heart-rate curve over a day with a line at 100 beats per minute, and a heart with its sinus node: normally the rate at rest is below the line and goes above it only with exercise, then falls gradually; in inappropriate sinus tachycardia the rate is above the line already at rest and rises sharply with light exercise, the rises and falls are gradual, and the sinus node still sets the rhythm, as it does normally", "diagram.infective-endocarditis.title": "Diagram of a heart valve: normal, and in infective endocarditis with a vegetation, a damaged leaflet, backflow and a fragment breaking off", "diagram.interrupted-aortic-arch.title": "Diagram of the ventricles, the aorta with its arch and branches, and the pulmonary artery, normally and with an interrupted aortic arch: normally the arch is continuous; with an interrupted arch (type B) the arch is broken between the left common carotid and the left subclavian artery, blood reaches the descending aorta and the left subclavian artery from the pulmonary artery through the patent ductus arteriosus, blood crosses a ventricular septal defect from the left ventricle to the right one, and too much blood goes to the lungs", "diagram.intramural-hematoma.title": "Cross-section of the aorta: normally a wall of three layers, the intima, media and adventitia, surrounds one round lumen; in intramural haematoma, clotted blood collects in the media and thickens the wall in a crescent with no blood flow; no intimal tear or flap is seen, and the aortic lumen looks almost normal", "diagram.kawasaki-disease.title": "Diagram of the heart from the front with the coronary arteries: normally the artery wall does not bulge anywhere; in Kawasaki disease a coronary artery aneurysm may form, a part where the wall bulges out and the artery widens; as an example, the aneurysm is shown on the right coronary artery", "diagram.label.abdominal-aorta": "Abdominal aorta", "diagram.label.abdominal-organs": "Abdominal organs", "diagram.label.above-the-valve": "above the valve", "diagram.label.accessory-pathway": "Accessory pathway", "diagram.label.activated-later": "Activated later", "diagram.label.activeHormone": "active hormone", "diagram.label.adaptation-not-disease": "An adaptation to training, not a disease", "diagram.label.adenoma-makes-aldosterone-without-signal": "An adenoma makes aldosterone without a signal", "diagram.label.adrenal-gland": "Adrenal gland", "diagram.label.adrenaline-released-as-needed": "Adrenaline is released as needed, for example under stress", "diagram.label.adventitia": "Adventitia", "diagram.label.aldosterone": "Aldosterone", "diagram.label.all-chambers-dilated": "All chambers enlarged", "diagram.label.all-chambers-slightly-larger": "All four chambers slightly larger", "diagram.label.all-walls-contract": "All walls contract", "diagram.label.amyloid-deposits": "Amyloid deposits", "diagram.label.and-or": "and/or", "diagram.label.aneurysm": "Aneurysm", "diagram.label.aneurysm-diameter": "3 cm or more", "diagram.label.anterior-wall": "Anterior wall", "diagram.label.aorta": "Aorta", "diagram.label.aorta-anterior-left": "Aorta: in front and to the left", "diagram.label.aorta-dissection": "Aorta: dissection", "diagram.label.aorta-normal-diameter": "18–22 mm", "diagram.label.aortic-arch": "Aortic arch", "diagram.label.aortic-lumen": "Aortic lumen", "diagram.label.aortic-narrowing": "Aortic narrowing", "diagram.label.aortic-root": "Aortic root", "diagram.label.aortic-root-dilated": "Dilated aortic root", "diagram.label.aortic-valve": "Aortic valve", "diagram.label.aorticValve": "Aortic", "diagram.label.aortopulmonary-window": "Aortopulmonary window", "diagram.label.apex-mid-not-contracting": "Apex and mid walls do not contract", "diagram.label.arch-interruption": "Arch interruption", "diagram.label.arm-working-needs-more-blood": "The arm is working and needs more blood", "diagram.label.artery": "Artery", "diagram.label.artery-compressed-arm-pale-cool": "Artery compressed: arm pale and cool", "diagram.label.artery-without-narrowing": "Artery not narrowed", "diagram.label.ascending-aorta": "Ascending aorta", "diagram.label.at-artery-branching": "where the artery branches", "diagram.label.at-rest": "At rest", "diagram.label.atherosclerosis-risk-higher": "Higher risk of atherosclerosis", "diagram.label.athletes-heart": "Heart of a trained athlete", "diagram.label.atria": "Atria", "diagram.label.atria-about-300": "Atria: about 300 per minute", "diagram.label.atria-enlarged": "Enlarged atria", "diagram.label.atria-may-fibrillate": "The atria may go into fibrillation", "diagram.label.atrial-communication": "Atrial communication", "diagram.label.atrial-focus": "Focus in an atrium", "diagram.label.atrialized-rv": "Atrialised part of RV", "diagram.label.attack-cold-or-emotion": "Attack: cold or emotional stress", "diagram.label.av-node": "AV node", "diagram.label.av-node-and-below": "AV node and below", "diagram.label.avNode": "Atrioventricular node", "diagram.label.back": "Back", "diagram.label.back-of-brain-may-get-too-little-blood": "The back of the brain may get too little blood", "diagram.label.backflow": "Backflow", "diagram.label.backflow-often": "Backflow (common)", "diagram.label.backflow-sometimes": "Sometimes: backflow", "diagram.label.base-contracts-strongly": "Base contracts strongly", "diagram.label.basilar-artery": "Basilar artery", "diagram.label.before-contraction": "Before contraction", "diagram.label.between-attacks": "Between attacks", "diagram.label.blocked-branch": "Branch blocked", "diagram.label.blocked-origin": "Blocked origin", "diagram.label.blood": "Blood", "diagram.label.blood-flows-down-to-arm": "Blood flows down to the arm", "diagram.label.blood-lipids-disturbed": "Blood lipids disturbed", "diagram.label.blood-lipids-normal": "Blood lipids normal", "diagram.label.blood-oxygen": "Oxygen in the blood", "diagram.label.blood-oxygen-falls": "Less oxygen in the blood", "diagram.label.blood-potassium-rises-rhythm-disorder-risk": "Blood potassium rises: risk of heart rhythm disorders", "diagram.label.blood-pressure-normal": "Blood pressure normal", "diagram.label.blood-pressure-raised": "Blood pressure raised", "diagram.label.blood-pressure-rises-sharply": "Sharp rise in blood pressure", "diagram.label.blood-pressure-usual-range": "Blood pressure in the usual range", "diagram.label.blood-pumped-out": "Blood is pumped out", "diagram.label.blood-reaches-fingertip": "Blood reaches the fingertip", "diagram.label.body": "Body", "diagram.label.brachial-plexus-nerves": "Brachial plexus (nerves)", "diagram.label.brachiocephalic-trunk": "Brachiocephalic trunk", "diagram.label.brain": "Brain", "diagram.label.brain-swelling-stroke": "Brain: swelling (encephalopathy), stroke", "diagram.label.branches": "Bundle branches", "diagram.label.breathing-efforts-continue": "Efforts to breathe in continue", "diagram.label.brief-awakening": "The pause ends with a brief awakening", "diagram.label.button": "Button pressed", "diagram.label.calcification-not-always": "Calcification (not always)", "diagram.label.calcified-leaflets": "Calcified leaflets", "diagram.label.calcium": "Calcium", "diagram.label.calcium-leak": "Calcium leak", "diagram.label.calcium-store": "Calcium store", "diagram.label.calf-muscle": "Calf muscle", "diagram.label.calf-pain-walking": "Calf: pain on walking", "diagram.label.calm-heart-rate-at-rest": "Calm heart rate at rest", "diagram.label.carotid-bifurcation": "Carotid bifurcation", "diagram.label.celiac-trunk": "Coeliac trunk", "diagram.label.chambers-normal-size": "Chambers of normal size", "diagram.label.chordae": "Chordae", "diagram.label.chronic-form-plaques-narrow-arteries": "Chronic form: plaques narrow the arteries", "diagram.label.clavicle": "Collarbone", "diagram.label.cleavage": "cleavage", "diagram.label.close-up": "A small area, close up", "diagram.label.closed-defect": "Closed defect", "diagram.label.closed-duct": "Closed duct", "diagram.label.clot": "Blood clot", "diagram.label.clot-may-come-from-heart-in-af": "May come from the heart in atrial fibrillation", "diagram.label.clot-on-plaque": "Clot on a plaque", "diagram.label.cold-bluish-toes": "Cold, bluish toes", "diagram.label.cold-clammy-skin": "Cold, clammy skin", "diagram.label.collateral-vessels": "Collateral vessels", "diagram.label.collaterals": "Collaterals", "diagram.label.common-av-valve": "Common AV valve", "diagram.label.common-trunk": "Common trunk", "diagram.label.common-ventricle": "Common ventricle", "diagram.label.compact-wall": "Dense (compact) wall", "diagram.label.compressed-lumen": "Compressed lumen", "diagram.label.compression": "Compression", "diagram.label.conduction-block": "Conduction block", "diagram.label.conduction-interrupted": "Conduction interrupted", "diagram.label.confusion": "Confusion", "diagram.label.connecting-vein": "Connecting vein", "diagram.label.contracted": "After contraction", "diagram.label.contracted-before-treatment": "After contraction, before treatment", "diagram.label.contracted-now": "After contraction, now", "diagram.label.corkscrew-collateral-vessels": "Corkscrew collateral vessels", "diagram.label.coronary-artery": "Coronary artery", "diagram.label.coved-st": "Coved ST elevation", "diagram.label.cusps-apart": "Cusps do not meet", "diagram.label.cyanosis": "Cyanosis", "diagram.label.damaged-leaflet": "Damaged leaflet", "diagram.label.deep-recesses": "Deep recesses between trabeculae", "diagram.label.deep-vein-spread-risk": "Risk of the clot spreading into the deep vein", "diagram.label.defect": "Defect", "diagram.label.defect-below-aorta": "Defect below the aorta", "diagram.label.delta-wave": "Delta wave", "diagram.label.descending-aorta": "Descending aorta", "diagram.label.desmosomes": "Desmosomes", "diagram.label.diagonal": "Diagonal branch", "diagram.label.diary": "Diary:", "diagram.label.diaryEntry": "\"14:20 — palpitations\"", "diagram.label.dilated-tortuous-vein": "Vein widened and twisted", "diagram.label.displaced-septal-leaflet": "Displaced septal leaflet", "diagram.label.distance-between-layers": "Distance between the layers", "diagram.label.dizziness-with-arm-work": "Dizziness when the arm works", "diagram.label.domed-valve": "Fused leaflets: a dome with a narrow opening", "diagram.label.early-plaque": "Early plaque", "diagram.label.ecg": "ECG", "diagram.label.ecgRecord": "ECG recording", "diagram.label.edema": "Swelling", "diagram.label.effusion": "Effusion", "diagram.label.elastic-walls": "Elastic walls", "diagram.label.electrodes": "Electrodes", "diagram.label.embolus": "Embolus", "diagram.label.endocardium": "Endocardium", "diagram.label.enlarged-muscle-cells": "Enlarged muscle cells", "diagram.label.enough-blood-to-brain": "The brain gets enough blood", "diagram.label.enough-fluid-less-renin-less-aldosterone": "Enough fluid: less renin and less aldosterone", "diagram.label.esophagus": "Oesophagus", "diagram.label.even-lumen": "Even lumen", "diagram.label.every-second-impulse": "Every second impulse: about 150 per minute", "diagram.label.excess-fat-inside-abdomen": "Excess fat inside the abdomen", "diagram.label.excess-thyroid-hormones": "Too much thyroid hormone", "diagram.label.exercise": "Exercise", "diagram.label.exertion-or-emotion": "Exertion or emotion", "diagram.label.extra-ventricular-impulses": "Extra impulses in the ventricles", "diagram.label.eye": "Eye", "diagram.label.eye-retinal-bleeding-swollen-optic-disc": "Eye: bleeding in the retina, swelling of the optic disc", "diagram.label.false-lumen": "False lumen", "diagram.label.fast-heart-rate-at-rest": "Heart rate already fast at rest", "diagram.label.fast-jet": "Fast jet", "diagram.label.fast-pathway": "Fast pathway", "diagram.label.fast-regular-rhythm": "Fast, regular rhythm", "diagram.label.fatty-tissue": "Fatty tissue", "diagram.label.femoral-artery": "Femoral artery", "diagram.label.fibromuscular-dysplasia-string-of-beads": "Another cause, fibromuscular dysplasia: a “string of beads” in the middle and far parts of the artery", "diagram.label.fibrotic-material": "Fibrotic material", "diagram.label.fibrous-tissue": "Fibrous tissue", "diagram.label.filling-limited": "Filling restricted", "diagram.label.finger-artery": "Finger artery", "diagram.label.fingertip-white-clear-border": "The fingertip turns white, with a clear border", "diagram.label.first-rib": "First rib", "diagram.label.fluid-may-collect-in-pericardium": "Fluid may collect in the pericardium", "diagram.label.foot-and-toe-arteries": "Foot and toe arteries", "diagram.label.fossa-ovalis": "Fossa ovalis", "diagram.label.fragile-wall": "Fragile wall", "diagram.label.fragment-may-break-off": "A fragment may break off", "diagram.label.free-commissures": "Free commissures", "diagram.label.front": "Front", "diagram.label.functional-rv": "Functional RV", "diagram.label.fused-commissures": "Fused commissures", "diagram.label.fusion-line": "Fusion line", "diagram.label.gradual-rise-and-fall": "Gradual rises and falls", "diagram.label.granulomas": "Granulomas", "diagram.label.heart": "Heart", "diagram.label.heart-af-more-damage-than-pressure-explains": "Heart: atrial fibrillation, more damage than expected at this blood pressure", "diagram.label.heart-beats-faster": "The heart beats faster", "diagram.label.heart-ischemia-acute-failure": "Heart: ischaemia, acute heart failure", "diagram.label.heart-muscle": "Heart muscle", "diagram.label.heart-pumps-enough-blood": "The heart pumps out enough blood", "diagram.label.heart-rate-over-day": "Heart rate over a day (schematic)", "diagram.label.heart-rate-rises-markedly": "Heart rate rises markedly", "diagram.label.heart-rate-rises-slightly": "Heart rate rises slightly", "diagram.label.heart-rate-rises-with-exercise": "Heart rate rises with exercise", "diagram.label.heart-rate-slows": "Heart rate slows", "diagram.label.heart-vessel-disease-harms-kidneys": "Heart and blood vessel disease harms the kidneys", "diagram.label.heart-without-extra-load": "Heart without extra load", "diagram.label.high-pressure": "High pressure", "diagram.label.higher-risk-of-heart-disease": "Higher risk of heart disease", "diagram.label.his": "Bundle of His", "diagram.label.hours": "Hours of continuous recording →", "diagram.label.iliac-arteries": "Iliac arteries", "diagram.label.impulse-blocked": "Impulse blocked", "diagram.label.inactiveFragment": "inactive fragment", "diagram.label.infarct-heart-pumps-little-blood": "Infarct zone: the heart pumps out too little blood", "diagram.label.infarct-zone": "Infarct zone", "diagram.label.inferior-mesenteric-artery": "Inferior mesenteric artery", "diagram.label.inferior-wall": "Inferior wall", "diagram.label.inflamed-pericardium": "Inflamed pericardium", "diagram.label.inflamed-segments": "Inflamed segments", "diagram.label.inflammation-around-vein": "Inflammation around the vein", "diagram.label.inflammation-foci": "Foci of inflammation", "diagram.label.initial-part": "Initial part", "diagram.label.inner-pericardial-layer": "Inner layer of the pericardium", "diagram.label.intact-septum": "Intact septum", "diagram.label.interatrial-septum": "Interatrial septum", "diagram.label.internal-carotid-artery": "Internal carotid artery", "diagram.label.intestine": "Intestine", "diagram.label.intima": "Intima", "diagram.label.intimal-tear": "Intimal tear", "diagram.label.inverted-t": "Inverted T wave", "diagram.label.isthmus": "Isthmus", "diagram.label.ivc": "Inferior vena cava", "diagram.label.j-point": "J point", "diagram.label.j-point-on-baseline": "J point on the baseline", "diagram.label.j-point-raised": "J point raised", "diagram.label.junction": "Junction", "diagram.label.kidney": "Kidney", "diagram.label.kidney-beyond-narrowing-smaller": "The kidney beyond the narrowing is smaller", "diagram.label.kidney-keeps-sodium-water-removes-potassium": "The kidney keeps sodium and water and removes potassium", "diagram.label.kidney-releases-renin-pressure-rises": "The kidney releases renin, and blood pressure rises", "diagram.label.kidneys": "Kidneys", "diagram.label.kidneys-acute-injury": "Kidneys: acute injury", "diagram.label.kidneys-filter-blood-waste-salt-water-potassium-in-urine": "Kidneys filter the blood: waste, extra salt, water and potassium leave in the urine", "diagram.label.kidneys-filter-less-well-less-waste-potassium-in-urine": "Kidneys filter less well: less waste and potassium leave in the urine", "diagram.label.kidneys-little-urine": "Kidneys: little urine", "diagram.label.knee": "Knee", "diagram.label.la": "LA", "diagram.label.la-dilated": "Enlarged LA", "diagram.label.la-enlarged": "LA enlarged in severe regurgitation", "diagram.label.la-enlarged-contracts-harder": "LA enlarged, contracts harder", "diagram.label.la-usual-size": "LA of usual size", "diagram.label.lad": "Anterior interventricular", "diagram.label.larger-cusp": "Larger cusp", "diagram.label.lca": "Left coronary", "diagram.label.lcx": "Circumflex", "diagram.label.ldl-particles": "LDL particles", "diagram.label.ldl-receptor": "LDL receptor", "diagram.label.leaflets": "Valve leaflets", "diagram.label.leaflets-closed": "Leaflets closed", "diagram.label.leaflets-fused": "Thickened, fused leaflets", "diagram.label.leaflets-gap": "Leaflets do not close", "diagram.label.leaflets-open": "Leaflets open wide", "diagram.label.left-anterior-fascicle": "Left anterior fascicle", "diagram.label.left-aortic-arch": "Left aortic arch", "diagram.label.left-arm": "Left arm", "diagram.label.left-bundle-branch": "Left bundle branch", "diagram.label.left-common-carotid": "Left common carotid artery", "diagram.label.left-subclavian": "Left subclavian artery", "diagram.label.left-ventricle": "Left ventricle", "diagram.label.leg-vein": "Deep leg vein", "diagram.label.ligamentum-arteriosum": "Ligamentum arteriosum", "diagram.label.light-exercise": "Light exercise", "diagram.label.lightheaded-dizzy": "Light-headedness, dizziness", "diagram.label.lightheaded-sometimes-faint": "Light-headedness, sometimes fainting", "diagram.label.lightheaded-weak": "Light-headedness, weakness", "diagram.label.line-100-per-minute": "100 per minute", "diagram.label.liver-cell": "Liver cell", "diagram.label.long-qt-interval": "Long QT interval", "diagram.label.low-blood-oxygen": "Too little blood and oxygen", "diagram.label.low-pressure": "Low pressure", "diagram.label.lower-chamber": "Lower chamber", "diagram.label.lower-leg-arteries": "Lower leg arteries", "diagram.label.lower-pressure-in-left-arm": "Blood pressure is lower in the left arm", "diagram.label.lpa-particles": "Lp(a) particles", "diagram.label.lumen-nearly-normal": "Lumen almost normal", "diagram.label.lung-congestion": "Congestion in the lungs", "diagram.label.lungs": "Lungs", "diagram.label.lv": "LV", "diagram.label.lv-apex": "LV apex", "diagram.label.lv-apical-aneurysm": "LV apical aneurysm", "diagram.label.lv-base": "LV base", "diagram.label.lv-cavity": "LV cavity", "diagram.label.lv-cross-section": "LV cross-section", "diagram.label.lv-dilated": "Dilated LV", "diagram.label.lv-dilated-contracts-weakly": "LV dilated, contracts weakly", "diagram.label.lv-fills-easily": "LV fills easily", "diagram.label.lv-hypertrophy": "LV hypertrophy", "diagram.label.lv-long-axis-section": "LV long-axis section", "diagram.label.lv-normal-size-contracts-strongly": "Normal-size LV, contracts strongly", "diagram.label.lv-pumps-to-aorta": "The LV pumps blood into the aorta", "diagram.label.lv-wall": "Left ventricular wall", "diagram.label.lv-wall-thickened-all-around": "LV wall thickened all around", "diagram.label.lysosome-storage": "Deposits in lysosomes", "diagram.label.lysosomes": "Lysosomes", "diagram.label.many-chaotic-waves": "Many chaotic waves", "diagram.label.marginal": "Right marginal", "diagram.label.mean-pressure-high": "Mean > 20 mmHg", "diagram.label.mean-pressure-normal": "Mean ≤ 20 mmHg", "diagram.label.media": "Media", "diagram.label.medium-sized-artery": "Medium-sized artery", "diagram.label.membrane": "Membrane", "diagram.label.microvascular-angina": "Microvascular angina", "diagram.label.middle-and-far-parts": "Middle and far parts", "diagram.label.mitral": "Mitral", "diagram.label.mitral-prolapse": "Leaflets bulge into the left atrium", "diagram.label.mitral-valve": "Mitral valve", "diagram.label.mixed-blood": "Mixed blood", "diagram.label.more-blood-pools-in-belly-veins": "More blood pools in the belly veins", "diagram.label.more-blood-pools-in-leg-veins": "More blood pools in the leg veins", "diagram.label.more-sodium-water-pressure-higher": "More sodium and water: blood pressure is higher", "diagram.label.mother-blood-pressure-rises": "The mother's blood pressure rises", "diagram.label.mother-kidneys-liver-brain-at-risk": "The mother's kidneys, liver and brain can be harmed", "diagram.label.much-blood-to-lungs": "Too much blood to the lungs", "diagram.label.muscle": "Muscle", "diagram.label.muscle-bands": "Muscle bands", "diagram.label.muscle-cells": "Muscle cells", "diagram.label.myxoma-on-stalk": "Myxoma on a stalk", "diagram.label.narrow-aorta": "Narrow aorta", "diagram.label.narrow-arteries-little-blood-to-placenta": "Narrow arteries: the placenta gets little blood", "diagram.label.narrow-lumen": "Narrow lumen", "diagram.label.narrow-opening": "Narrow opening", "diagram.label.narrow-qrs": "Narrow QRS", "diagram.label.narrowed-origin": "Narrowed origin", "diagram.label.narrowed-outflow": "Narrowed outflow", "diagram.label.narrowing": "Narrowing", "diagram.label.nerves-compressed-pain-tingling": "Nerves compressed: pain, tingling", "diagram.label.no-blood-flow": "No blood flow", "diagram.label.no-blood-pumped-out": "No blood is pumped out", "diagram.label.no-intimal-flap": "No intimal flap", "diagram.label.no-plaques": "No plaques", "diagram.label.no-symptoms": "No symptoms", "diagram.label.normal-rhythm": "Normal rhythm", "diagram.label.normal-size": "Normal LV size", "diagram.label.normal-thickness": "Normal thickness", "diagram.label.not-dilated": "Not widened", "diagram.label.notch-at-end-of-qrs": "Notch at the end of QRS", "diagram.label.one-excitation-wave": "One excitation wave", "diagram.label.open-branches": "All branches open", "diagram.label.open-duct": "Patent ductus", "diagram.label.organ-area-dies-infarct": "Part of the organ dies (infarction)", "diagram.label.organ-tissue": "Organ tissue", "diagram.label.outer-pericardial-layer": "Outer layer of the pericardium", "diagram.label.outlet-chamber": "Outlet chamber", "diagram.label.overriding-aorta": "Overriding aorta", "diagram.label.pa-trunk-dilated": "Dilated PA trunk", "diagram.label.pale-cold-foot": "Pale, cold foot", "diagram.label.pallor": "Pallor", "diagram.label.pause": "Pause", "diagram.label.pda": "Posterior interventricular (behind, dashed)", "diagram.label.pericardial-cavity": "Pericardial cavity", "diagram.label.pericardial-fluid": "Fluid or blood", "diagram.label.pericardium": "Pericardium", "diagram.label.pharynx-collapses-no-air": "Throat collapses, no air gets through", "diagram.label.pharynx-open-air-passes": "Throat open, air gets through", "diagram.label.placenta": "Placenta", "diagram.label.placenta-substances-damage-mother-vessels": "Substances from the placenta damage the mother's blood vessels", "diagram.label.plaque": "Plaque", "diagram.label.plaques-more-often-and-earlier-in-diabetes": "In diabetes, plaques appear more often and earlier", "diagram.label.popliteal-artery": "Popliteal artery", "diagram.label.posterior-leaflet-prolapse": "Posterior leaflet bulges into the LA", "diagram.label.potassium-lost-in-urine-lower-in-blood": "Potassium is lost in urine: less of it in the blood", "diagram.label.pre-excitation": "Pre-excitation", "diagram.label.premature-beat": "Premature beat", "diagram.label.pressure": "Pressure", "diagram.label.pressure-after-standing": "Blood pressure after standing up", "diagram.label.pressure-barely-changes": "Blood pressure barely changes", "diagram.label.pressure-falls-too-far": "Blood pressure falls too far", "diagram.label.pressure-holds": "Blood pressure holds", "diagram.label.pulmonary-arteries": "Pulmonary arteries", "diagram.label.pulmonary-backflow": "Possible backflow into the RV", "diagram.label.pulmonary-trunk": "Pulmonary trunk", "diagram.label.pulmonary-valve": "Pulmonary valve", "diagram.label.pulmonary-venous-confluence": "Confluence", "diagram.label.pulmonaryArtery": "Pulmonary artery", "diagram.label.pulmonaryValve": "Pulmonary", "diagram.label.pulmonaryVeins": "Pulmonary veins", "diagram.label.pulse-absent": "No pulse", "diagram.label.pulse-may-slow": "Pulse may slow", "diagram.label.pulse-normal": "Normal pulse", "diagram.label.pulse-weak": "Weak pulse", "diagram.label.pulse-weak-or-absent": "Pulse weak or absent", "diagram.label.purkinje": "Purkinje fibres", "diagram.label.qt-interval": "QT interval", "diagram.label.ra": "RA", "diagram.label.ra-dilated": "Enlarged RA", "diagram.label.rca": "Right coronary", "diagram.label.rca-wide-tortuous": "Wide and tortuous", "diagram.label.receptor-not-working": "Receptor not working", "diagram.label.recorder": "Recorder", "diagram.label.redness": "Redness", "diagram.label.reduced-blood-flow": "Reduced blood flow", "diagram.label.renal-arteries": "Renal arteries", "diagram.label.renin": "Renin", "diagram.label.renin-suppressed": "Renin suppressed", "diagram.label.repaired-narrowing": "Repaired narrowing", "diagram.label.right-aortic-arch": "Right aortic arch", "diagram.label.right-arm": "Right arm", "diagram.label.right-bundle-branch": "Right bundle branch", "diagram.label.right-chambers-compressed": "RA and RV compressed", "diagram.label.right-subclavian": "Right subclavian artery", "diagram.label.right-upper-pulmonary-vein": "Right upper pulmonary vein", "diagram.label.right-ventricle": "Right ventricle", "diagram.label.ring-narrowing": "Ring-like narrowing", "diagram.label.root-ascending-dilated": "Aortic root and ascending aorta dilated", "diagram.label.root-ascending-graft": "Graft of the aortic root and ascending aorta", "diagram.label.rv": "RV", "diagram.label.rv-dilated": "Dilated RV", "diagram.label.rv-hypertrophy": "RV hypertrophy", "diagram.label.rv-normal-size": "Normal RV size", "diagram.label.rv-outflow-closed": "RV outflow closed", "diagram.label.rv-outflow-narrowing": "Narrowed RV outflow", "diagram.label.rv-outflow-tract": "RV outflow tract", "diagram.label.rv-outflow-widened": "Widened RV outflow", "diagram.label.rv-pumps-to-aorta": "The RV pumps blood into the aorta", "diagram.label.rv-wall-tissue": "RV wall tissue", "diagram.label.sa-node": "SA node", "diagram.label.saNode": "Sinoatrial node", "diagram.label.sail-like-leaflet": "Sail-like anterior leaflet", "diagram.label.salt-water-retained-higher-pressure-heart-failure-risk": "Salt and water retained: higher blood pressure, risk of heart failure", "diagram.label.scalene-muscles": "Scalene muscles", "diagram.label.scar": "Scar", "diagram.label.scarred-thick-wall": "Scarring: thickened wall", "diagram.label.septum": "Septum", "diagram.label.septum-primum": "Septum primum", "diagram.label.septum-secundum": "Septum secundum", "diagram.label.sharp-rise-with-light-exercise": "Sharp rise with light exercise", "diagram.label.short-blocked-segments": "Short blocked segments", "diagram.label.short-qt-interval": "Short QT interval", "diagram.label.shunt-on-straining": "May occur on straining", "diagram.label.sinus-node-sets-rhythm": "The sinus node sets the rhythm", "diagram.label.sinus-pause": "Sinus pause", "diagram.label.sinus-venosus-defect": "Sinus venosus defect", "diagram.label.sinusBranch": "Sinoatrial nodal branch", "diagram.label.skin": "Skin", "diagram.label.slow-pathway": "Slow pathway", "diagram.label.slower-resting-pulse": "Slower pulse at rest", "diagram.label.small-lung-arteries": "Small lung arteries", "diagram.label.small-lv": "Small LV", "diagram.label.small-rv": "Small RV", "diagram.label.small-vessels-do-not-widen-with-exercise": "With exercise the small vessels do not widen", "diagram.label.small-vessels-widen-with-exercise": "With exercise the small vessels widen", "diagram.label.smaller-cusp": "Smaller cusp", "diagram.label.smooth-inner-lining": "Smooth inner lining", "diagram.label.smooth-inner-surface": "Smooth inner surface", "diagram.label.some-blood-shifts-to-leg-veins": "Some blood shifts into the leg veins", "diagram.label.spasm": "Spasm", "diagram.label.spasm-narrowed-lumen": "Spasm: the lumen is sharply narrowed", "diagram.label.spasm-narrows-artery-for-a-while": "The spasm narrows the artery for a while", "diagram.label.spiral-arteries": "Spiral arteries", "diagram.label.spongy-trabecular-layer": "Spongy layer: prominent trabeculation", "diagram.label.stands-up": "Stands up", "diagram.label.stiff-lv-fills-less-easily": "Stiff LV fills less easily", "diagram.label.stiff-walls": "Stiff walls", "diagram.label.stress-hormones": "Stress hormones", "diagram.label.string-of-beads": "“String of beads”: narrowings alternate with widenings", "diagram.label.strong-wall": "Strong wall", "diagram.label.subaortic-membrane": "Membrane below the valve", "diagram.label.subclavian-artery": "Subclavian artery", "diagram.label.subclavian-vein": "Subclavian vein", "diagram.label.sugar-metabolism-disturbed": "Sugar metabolism disturbed", "diagram.label.sugar-metabolism-normal": "Sugar metabolism normal", "diagram.label.superficial-vein": "Superficial vein", "diagram.label.superior-mesenteric-artery": "Superior mesenteric artery", "diagram.label.svc": "Superior vena cava", "diagram.label.swollen-leaflet-nodules": "Swollen leaflet, nodules on its edge", "diagram.label.syncope-trigger": "Trigger: prolonged standing, pain, fear", "diagram.label.temporal-artery": "Temporal artery", "diagram.label.temporal-artery-cross-section": "Temporal artery cross-section", "diagram.label.tendency-to-clots": "Tendency to form clots", "diagram.label.thick-leaflets": "Thickened leaflets", "diagram.label.thick-septum": "Thickened septum", "diagram.label.thick-stiff-pericardium": "Thick, stiff pericardium", "diagram.label.thick-valves": "Thickened valves", "diagram.label.thick-wall": "Thick wall", "diagram.label.thick-walls": "Thickened walls", "diagram.label.thin-compact-layer": "Thin compact layer", "diagram.label.thin-leaflet": "Thin leaflet", "diagram.label.thin-leaflets": "Thin leaflets", "diagram.label.thin-pulmonary-arteries": "Thin pulmonary arteries", "diagram.label.thin-wall": "Thin wall", "diagram.label.three-cusps": "Three cusps", "diagram.label.thyroid-enlarged": "Enlarged gland", "diagram.label.thyroid-gland": "Thyroid gland", "diagram.label.thyroid-hormones-usual-amount": "Thyroid hormones: the usual amount", "diagram.label.time": "Time →", "diagram.label.to-abdomen-and-legs": "To the abdominal organs and legs", "diagram.label.to-back-of-brain": "To the back of the brain", "diagram.label.to-brain": "To the brain", "diagram.label.to-head-and-arms": "To the head and arms", "diagram.label.to-heart": "To the heart", "diagram.label.to-lower-body": "To the lower body", "diagram.label.to-lungs-pe": "To the lungs (PE)", "diagram.label.to-scalp": "To the scalp", "diagram.label.too-little-blood-to-brain": "Too little blood reaches the brain", "diagram.label.too-little-thyroid-hormone": "Too little thyroid hormone", "diagram.label.torsades": "Torsades de pointes", "diagram.label.tortuous-arteries": "Tortuous arteries", "diagram.label.trachea": "Trachea", "diagram.label.tricuspid": "Tricuspid", "diagram.label.tricuspid-valve": "Tricuspid valve", "diagram.label.true-lumen": "True lumen", "diagram.label.truncal-valve": "One common valve", "diagram.label.tumour-releases-much-adrenaline-noradrenaline": "The tumour releases a lot of adrenaline and noradrenaline, often in surges", "diagram.label.two-separate-valves": "Two separate valves", "diagram.label.uniform-wall": "Uniform wall", "diagram.label.untrained-heart": "Heart of an untrained person", "diagram.label.upper-chamber": "Upper chamber", "diagram.label.usual-lumen": "Normal lumen", "diagram.label.usually-harmless-finding": "Most often a harmless finding", "diagram.label.uterine-wall": "Uterine wall", "diagram.label.vagus-nerve": "Vagus nerve", "diagram.label.valve-annulus": "Valve annulus", "diagram.label.valve-prosthesis": "Valve prosthesis", "diagram.label.valve-top-view": "Valve from above", "diagram.label.valve-unchanged": "Valve may be unchanged", "diagram.label.valve-ventricle-view": "Seen from the ventricle", "diagram.label.valves": "Valves", "diagram.label.valves-closed": "Closed valves", "diagram.label.valves-damaged": "Damaged valves", "diagram.label.vasospastic-angina": "Vasospastic angina", "diagram.label.vegetation": "Vegetation", "diagram.label.vein-compressed-arm-swollen-bluish": "Vein compressed: arm swollen, bluish", "diagram.label.vein-pressure-higher": "Higher pressure in the veins", "diagram.label.vein-pressure-raised": "Raised pressure in the vein", "diagram.label.venaCava": "Venae cavae", "diagram.label.ventricleCell": "Ventricular cell", "diagram.label.ventricles": "Ventricles", "diagram.label.ventricles-contract": "The ventricles contract", "diagram.label.ventricles-normal-size": "Ventricles of normal size", "diagram.label.ventricles-quiver": "The ventricles only quiver", "diagram.label.ventricles-sequential": "Ventricles activated one after the other", "diagram.label.ventricles-simultaneous": "Ventricles activated at the same time", "diagram.label.ventricles-swapped": "The ventricles have swapped places with their valves", "diagram.label.ventricular-focus": "Focus in a ventricle", "diagram.label.vertebral-arteries": "Vertebral arteries", "diagram.label.vertical-vein": "Vertical vein", "diagram.label.vessels-do-not-narrow-enough": "Blood vessels do not narrow enough", "diagram.label.vessels-narrow": "Blood vessels narrow", "diagram.label.vessels-widen-pressure-falls": "Vessels widen, pressure falls", "diagram.label.vsd-patch": "Defect closed with a patch", "diagram.label.wall": "Wall", "diagram.label.wall-damage": "Wall damage", "diagram.label.wall-hematoma": "Haematoma in the wall", "diagram.label.wall-rupture": "Wall rupture", "diagram.label.wall-slightly-thicker-evenly": "Walls slightly thicker, evenly", "diagram.label.walls-contract-weaker": "The walls contract more weakly", "diagram.label.web": "Web across the lumen", "diagram.label.whole-wall-thickness": "Through the whole wall", "diagram.label.wide-arteries-much-blood-to-placenta": "Wide arteries: plenty of blood reaches the placenta", "diagram.label.wide-lumen": "Wide lumen", "diagram.label.wide-opening": "Wide opening", "diagram.label.wide-qrs": "Wide QRS", "diagram.label.widened-pulsating-artery": "Widened pulsating artery", "diagram.left-ventricular-noncompaction.title": "Diagram of a long-axis section of the left ventricle, base at the top and apex at the bottom: normally the wall is dense (compact), and its inner surface is shown smooth as a simplification; in left ventricular noncompaction the outer compact layer is thin, and inside it lies a thick spongy layer of trabeculae with deep recesses that open into the cavity, most marked at the apex; the ventricle is the same size", "diagram.lipoprotein-a.title": "Diagram of an artery cut lengthwise: LDL particles and a few lipoprotein(a) particles pass along the lumen with the blood; with high Lp(a) there are more of these particles, they are retained in the wall and a plaque may start to grow in it", "diagram.loeys-dietz-syndrome.title": "Diagram of the left ventricle and the thoracic aorta: the root, the ascending aorta, the arch with three branches and the descending thoracic aorta. Normally the aorta is not widened anywhere, and the arch branches are drawn straight for simplicity; in Loeys–Dietz syndrome the root and the ascending aorta are widened, and arterial tortuosity is shown, as an illustration, on the arch branches; after treatment the root and the whole ascending aorta are replaced with a graft of normal width, while the tortuous branches and the rest of the aorta stay as they were", "diagram.long-qt-syndrome.title": "ECG diagram: normally the QT interval runs from the start of the QRS complex to the end of the T wave; in long QT syndrome the T wave ends later and the QT interval is longer; below, a normal rhythm and torsades de pointes ventricular tachycardia, with complexes that change around the baseline", "diagram.marfan-syndrome.title": "Diagram of the left heart and the aortic root while the left ventricle contracts: normally the mitral valve leaflets close; in Marfan syndrome the aortic root is widened, starting from the sinuses, and the mitral valve leaflets bulge back into the left atrium", "diagram.mesenteric-ischemia.title": "Side view of the abdominal aorta with the three arteries of the intestine, the coeliac trunk and the superior and inferior mesenteric arteries: normally blood flows through them to the intestine; in acute mesenteric ischaemia a clot, which may come from the heart in atrial fibrillation, blocks the superior mesenteric artery and the intestine beyond it gets no blood; a separate label shows the chronic form, in which plaques narrow the arteries of the intestine", "diagram.mitral-regurgitation.title": "Diagram of the mitral valve while the left ventricle contracts: closed normally, and in mitral regurgitation with a gap between the leaflets and blood flowing back into the left atrium, drawn larger as in severe regurgitation", "diagram.mitral-stenosis.title": "Diagram of the mitral valve while the left ventricle fills (diastole): normally the leaflets open wide and blood flows freely from the left atrium into the ventricle; in rheumatic mitral stenosis the leaflets are thickened and fused into a funnel with a narrow opening, and the left atrium is enlarged", "diagram.mitral-valve-prolapse.title": "Lengthwise diagram of the left heart while the left ventricle contracts: normally the mitral valve leaflets meet at the level of the valve annulus; in mitral valve prolapse the posterior leaflet is larger and bulges above the annulus line into the left atrium, and its chordae are longer and thinner; a dashed jet shows that the valve sometimes lets blood flow back into the atrium", "diagram.myocardial-infarction.title": "Diagram of the left ventricle in longitudinal section and the artery that runs along its inferior wall: normally blood flows through the right coronary artery to the muscle of the inferior wall; in ST-elevation myocardial infarction a clot on a plaque closes the artery completely, blood goes no further, and the part of the inferior wall beyond the blockage dies through the full thickness of the wall", "diagram.myocarditis.title": "Diagram of a cross-section of the left ventricle: a uniform wall normally, and patchy foci of inflammation in the wall in myocarditis", "diagram.natriuretic-peptides.title": "Diagram: proBNP is cleaved into the active hormone BNP and the inactive fragment NT-proBNP", "diagram.obesity-and-heart.title": "Diagram of the abdominal organs, three risk factors and the heart: normally there is no excess fat inside the abdomen, blood pressure, blood lipids and sugar metabolism are normal and the heart works without extra load; in obesity fat collects around the abdominal organs; this can raise blood pressure and disturb blood lipids and sugar metabolism, and the risk of heart disease rises", "diagram.orthostatic-hypotension.title": "Diagram of a person who stands up, with a curve of blood pressure after standing: normally some blood shifts into the leg veins, the blood vessels narrow, the heart rate rises slightly, blood pressure dips briefly and holds, and the brain gets enough blood; in orthostatic hypotension the blood vessels do not narrow enough, more blood pools in the leg veins, blood pressure falls too far and stays lower, too little blood reaches the brain, and light-headedness and dizziness appear", "diagram.partial-anomalous-pulmonary-venous-return.title": "Diagram of the circulation, normally and in partial anomalous pulmonary venous return: normally the four pulmonary veins carry blood from the lungs into the left atrium; in the defect (one variant is shown) the right upper pulmonary vein drains into the superior vena cava close to where it joins the right atrium, there is a sinus venosus defect high in the septum between the atria, blood passes through it from left to right, the right atrium and right ventricle are enlarged, and the other three pulmonary veins drain into the left atrium as usual", "diagram.patent-ductus-arteriosus.title": "Diagram of the aorta and pulmonary artery: normally, with a patent ductus arteriosus and after it is closed. Normally the duct has closed and become the ligamentum arteriosum; when it stays open, blood flows through it from the aorta into the pulmonary artery; after it is closed, blood no longer flows through it", "diagram.patent-foramen-ovale.title": "Diagram of the atria: normally the septum between the atria is whole, with the fossa ovalis on it; with a patent foramen ovale the two parts of the septum have not fused and overlap, with a narrow slanted slit between them through which a little blood may pass from the right atrium to the left on straining", "diagram.pause": "Pause", "diagram.pericardial-effusion.title": "Diagram of the heart inside the pericardium: normally a thin layer of fluid lies between the inner and outer layers of the pericardium; with an effusion a wide layer of fluid surrounds the heart between the layers, while the heart itself is of normal size and not compressed; an arrow shows the distance between the layers, by which the size of the effusion is judged", "diagram.pericarditis.title": "Diagram of the heart inside the pericardium: normal, and with inflamed pericardial layers and fluid between them", "diagram.peripheral-artery-disease.title": "Diagram of the main artery of the leg from the femoral artery through the popliteal artery and the lower leg arteries to the foot: normally the lumen is open and blood reaches the foot freely; in lower extremity peripheral artery disease a plaque narrows the femoral–popliteal segment, less blood passes below the narrowing, thin collateral vessels run around it, and the calf is marked as the place of pain on walking", "diagram.pheochromocytoma.title": "Diagram of a kidney with its adrenal gland, the heart and an artery: normally the adrenal gland releases adrenaline as needed, the heart beats calmly and blood pressure is in the usual range; in phaeochromocytoma a tumour of the adrenal gland releases a lot of adrenaline and noradrenaline, often in surges, the heart beats faster and blood pressure is high", "diagram.polyarteritis-nodosa.title": "Diagram of a medium-sized artery that branches and carries blood to an organ: normally the walls are smooth, all branches are open and blood reaches the whole organ; in polyarteritis nodosa inflamed segments with a thick wall and a narrow lumen are seen where the artery branches, on one branch small aneurysms alternate with narrowings, and another branch is closed by a blood clot, so the part of the organ beyond it dies (infarction)", "diagram.popliteal-artery-aneurysm.title": "Side view of the leg: at the level of the knee the femoral artery continues as the popliteal artery, and below the knee blood flows through the lower leg arteries to the foot; in a popliteal artery aneurysm this segment of the artery at the knee is widened and pulsates, and a blood clot can form in the aneurysm", "diagram.post-thrombotic-syndrome.title": "Diagram of part of the leg with a deep vein in longitudinal section: normally the vein wall is thin and the valves let blood pass only upwards, towards the heart; in post-thrombotic syndrome the vein wall is thickened by scarring after the clot, the lumen is narrowed in places, the valves are damaged and blood flows back down the vein; pressure in the vein is raised and the ankle is swollen", "diagram.postural-orthostatic-tachycardia-syndrome.title": "Diagram of a person who has stood up: normally some blood shifts into the leg veins, the heart rate rises slightly, blood pressure holds and there are no symptoms; in postural orthostatic tachycardia syndrome more blood pools in the veins of the legs and belly, the heart rate rises markedly, blood pressure barely changes, and light-headedness and weakness appear", "diagram.primary-aldosteronism.title": "Diagram of a kidney and its adrenal gland: normally the kidney releases renin, renin makes the adrenal gland release aldosterone, aldosterone makes the kidney keep sodium and water and remove potassium, and when there is enough fluid renin and aldosterone fall; in primary aldosteronism an adenoma of the adrenal gland makes aldosterone without a signal, renin is suppressed, blood pressure is higher, blood potassium is lower, and the heart suffers: atrial fibrillation and more damage than the blood pressure would explain", "diagram.pulmonary-atresia-with-intact-ventricular-septum.title": "Diagram of the ventricles, pulmonary artery and aorta in a normal heart and in pulmonary atresia with intact ventricular septum (one variant): normally blood goes from the right ventricle into the pulmonary artery and along its branches to the lungs, and from the left ventricle into the aorta; in the defect the outflow from the right ventricle into the pulmonary artery is closed, the right ventricle is small, the septum between the ventricles is intact, and blood reaches the pulmonary artery from the aorta through the open arterial duct", "diagram.pulmonary-atresia-with-ventricular-septal-defect.title": "Diagram of the ventricles, pulmonary arteries and aorta, normally and in pulmonary atresia with ventricular septal defect (one of the variants): normally blood goes from the right ventricle into the pulmonary artery and through its branches to the lungs, and from the left ventricle into the aorta; with the defect, the right ventricular outflow ends blindly, the pulmonary arteries are thin, there is a large septal defect under the aorta, the aorta is shifted and sits over it, the right ventricular wall is thickened, blood from both ventricles mixes and goes into the aorta, and from there reaches the pulmonary arteries through the open arterial duct and collateral vessels from the aorta", "diagram.pulmonary-embolism.title": "Diagram of venous blood flowing from a leg vein through the right side of the heart into the pulmonary artery branches: normal, and in pulmonary embolism with a clot in a leg vein and an embolus blocking one branch", "diagram.pulmonary-hypertension.title": "Diagram of the right ventricle, the pulmonary artery and small lung arteries in cross-section: normally the small arteries have a thin wall and a wide lumen, and the mean pulmonary artery pressure is 20 mmHg or less; in pulmonary arterial hypertension the walls of the small arteries are thickened, the lumen is narrowed, the mean pulmonary artery pressure is above 20 mmHg, and the right ventricle has a thickened wall and a dilated cavity", "diagram.pulmonary-regurgitation.title": "Diagram of the right ventricle, the pulmonary valve and the pulmonary artery in diastole, while the right ventricle relaxes: normally the valve leaflets are closed and no blood returns to the ventricle; in pulmonary regurgitation the leaflets do not close, some blood flows back from the pulmonary artery into the right ventricle, and with severe long-standing regurgitation the ventricle dilates", "diagram.pulmonary-valve-stenosis.title": "Diagram of the right ventricle, the pulmonary valve and the pulmonary trunk: normally the valve leaflets are thin and open wide, and blood flows freely from the right ventricle into the pulmonary artery; in typical valvular stenosis the leaflets are fused into a dome with a narrow opening, blood passes through it as a fast turbulent jet, the right ventricular wall is thickened and the pulmonary trunk beyond the valve is dilated", "diagram.raynaud-phenomenon.title": "Diagram of a finger and its small artery: between attacks the artery has its normal lumen and blood reaches the fingertip; during an attack of Raynaud phenomenon, brought on by cold or emotional stress, the artery is sharply narrowed by spasm, the fingertip turns white with a clear border, and the colour may change from pallor to cyanosis and redness", "diagram.renal-artery-stenosis.title": "Diagram of the abdominal aorta with the renal arteries and kidneys: normally the lumen of both arteries is even and the kidneys are the same size; with stenosis an atherosclerotic plaque at the origin of one renal artery narrows it, the kidney beyond the narrowing is smaller and releases renin, and blood pressure rises; another cause is shown separately: fibromuscular dysplasia, in which narrowings of the artery alternate with widenings like a string of beads", "diagram.restrictive-cardiomyopathy.title": "Diagram of the four heart chambers while the ventricles fill: normally the elastic ventricular walls stretch and the ventricles fill easily with blood from the atria; in restrictive cardiomyopathy the stiff walls hardly stretch, the ventricles of normal size fill less well, and both atria are enlarged", "diagram.rheumatic-heart-disease.title": "Diagram of the mitral valve seen from the left ventricle while it fills (diastole): normally the leaflets are thin, the commissures are free and the opening is wide; in rheumatic disease the leaflets are thickened, both commissures are fused and only a small oval opening remains; the heart chambers and blood flow are not shown", "diagram.schematic": "Simplified diagram, not to scale.", "diagram.short-qt-syndrome.title": "ECG diagram: normally the QT interval runs from the start of the QRS complex to the end of the T wave; in short QT syndrome the T wave moves closer to QRS and ends earlier, so the QT interval is shorter; a dashed line shows where the normal T wave ends", "diagram.sick-sinus-syndrome.title": "Diagram of sinus node impulses travelling through the atria and the atrioventricular node to the ventricles: normally the sinus node fires regularly; in sick sinus syndrome two impulses in a row are missing and a pause follows; in the diagram neither the atria nor the ventricles are activated during the pause, and the beats from lower pacemakers that usually appear in a pause are not shown", "diagram.single-ventricle.title": "Diagram of the circulation, normally and in single ventricle: normally the heart has four chambers and blood passes through the lungs and the body in turn; for the defect, one of its variants is shown, double-inlet left ventricle: both atria open into one large ventricle, the second ventricle remains a small outlet chamber joined to the main one by an opening, blood from the lungs and from the body mixes, and the mixed blood leaves into the pulmonary artery from the main ventricle and into the aorta from the outlet chamber", "diagram.sleep-apnea-and-heart.title": "Diagram of a sleeping person's airway and heart: normally the throat stays open during sleep, air reaches the lungs and the heart beats at its usual rhythm; in obstructive sleep apnoea the throat collapses and no air gets through although the efforts to breathe in continue, the oxygen in the blood falls, the pause usually ends with a brief awakening, and the pulse may slow", "diagram.smoking-and-heart.title": "Diagram of a coronary artery cut lengthwise: normally the inner lining of the wall is smooth and whole and blood flows freely; with smoking the inner lining is damaged, there is a plaque in the wall with a clot on it, and blood passes in a thin stream", "diagram.spontaneous-coronary-artery-dissection.title": "Diagram of a coronary artery cut across: normally the lumen is wide, lined by the intima, with the media deeper in the wall; in spontaneous dissection blood collects inside the wall (a haematoma, or false lumen) and compresses and narrows the true lumen; the narrowing is not caused by a plaque", "diagram.state": "Show", "diagram.state.athlete": "Athlete's heart", "diagram.state.diastole": "Diastole", "diagram.state.disease": "Disease", "diagram.state.lbbb": "Left bundle branch block", "diagram.state.normal": "Normal", "diagram.state.rbbb": "Right bundle branch block", "diagram.state.recording": "Recording", "diagram.state.scheme": "Diagram", "diagram.state.symptom": "Symptom", "diagram.state.systole": "Systole", "diagram.state.treated": "After treatment", "diagram.subaortic-stenosis.title": "Diagram of the left ventricle, its outflow and the aorta in systole: normally the outflow of the left ventricle below the aortic valve is free, the valve leaflets are open and blood flows evenly into the aorta; in subaortic stenosis a membrane with a narrow opening sits below an ordinary aortic valve, and blood passes through the opening as a fast jet", "diagram.subclavian-artery-stenosis.title": "Diagram of the aortic arch, the subclavian and vertebral arteries: normally both vertebral arteries carry blood up to the brain and the subclavian arteries carry blood to the arms; in stenosis a plaque narrows the start of the left subclavian artery before the vertebral artery branches off, and when the left arm works, blood in the left vertebral artery flows down to the arm; blood pressure is lower in the left arm", "diagram.superficial-thrombophlebitis.title": "Diagram of part of the leg in longitudinal section: a superficial vein in the fat under the skin and a deep vein in the muscle; near the top the superficial vein joins the deep vein (the junction). Normally blood flows up both veins towards the heart. In superficial thrombophlebitis a segment of the superficial vein is blocked by a blood clot and the fat and skin around it are inflamed; the deep vein is not affected, and a dashed arrow shows the risk of the clot spreading through the junction into the deep vein", "diagram.supravalvular-aortic-stenosis.title": "Diagram of the left ventricle, aortic valve, aorta and coronary arteries in systole, normally and in supravalvular aortic stenosis: in the disease the aorta is pinched into an hourglass just above the valve, the valve is shown unchanged and open, the coronary arteries arise below the narrowing where the pressure is high, and the aorta above the narrowing is not widened", "diagram.supraventricular-tachycardia.title": "Diagram of the electrical impulse path from the atria through the AV node to the ventricles: normally the impulse passes once, in one direction; in AV nodal re-entrant tachycardia an early impulse goes down the slow pathway, returns up the fast pathway and keeps circling, so the ventricles beat fast and regularly", "diagram.takayasu-arteritis.title": "Diagram of the aortic arch and its three branches, front view: normally the origins of the branches are not narrowed and the pulse is normal in both arms; in Takayasu arteritis the wall of the aorta and of the branch origins is thickened, and the branch origins may narrow or close; as an example, the origin of the brachiocephalic trunk is shown narrowed and the origin of the left subclavian artery blocked, so less blood reaches the arms and the pulse in them is weak or absent", "diagram.takotsubo-syndrome.title": "Diagram of the left ventricle in a long-axis view, base at the top and apex at the bottom; the solid outline is the ventricle before contraction, the dashed one at the end of contraction: normally all walls, the apex included, contract evenly and the cavity shrinks along its whole length; in takotsubo syndrome the base contracts strongly and forms a narrow neck, while the apex and mid walls do not contract, so the cavity stays round at the bottom, like an octopus trap", "diagram.tetralogy-of-fallot.title": "Diagram of the ventricles, pulmonary artery and aorta, normally, in tetralogy of Fallot and after complete repair: in tetralogy, a ventricular septal defect, a narrowed right ventricular outflow tract, an aorta overriding the defect and a thickened right ventricular wall; after repair, the defect is closed with a patch, the right ventricular outflow is widened and blood may leak back from the pulmonary artery into the right ventricle", "diagram.thoracic-aortic-aneurysm.title": "Diagram of the left ventricle and the thoracic aorta: the root, the ascending aorta, the arch with its branches and the descending thoracic aorta. Normally the aorta is not widened anywhere; in the example of a thoracic aortic aneurysm the tubular part of the ascending aorta above the root is widened, while the root and the rest of the aorta are of normal size", "diagram.thoracic-outlet-syndrome.title": "Diagram of the passage from the neck to the arm, front view: the nerves of the brachial plexus, the subclavian artery and the subclavian vein run to the arm past the collarbone, the first rib and the scalene muscles; in thoracic outlet syndrome the nerves (pain and tingling), the artery (the arm is pale and cool) or the vein (the arm swells and turns bluish) are compressed; all three sites of compression are shown together for clarity", "diagram.thromboangiitis-obliterans.title": "Diagram of the arteries of the lower leg and foot down to the toes: normally the lumen is open and blood reaches the toes; in thromboangiitis obliterans the small and medium-sized arteries of the lower leg and foot have several short blocked segments with thin tortuous corkscrew collateral vessels around them, there are no plaques, little blood passes below the blocks, and the toes are cold and bluish", "diagram.thyrotoxic-heart-disease.title": "Diagram of the thyroid gland and the heart: normally a gland of usual size releases the usual amount of hormones and the heart beats at its usual rhythm; in thyrotoxicosis the gland is enlarged and releases too much hormone, the heart beats faster, and the atria may go into fibrillation", "diagram.total-anomalous-pulmonary-venous-return.title": "Diagram of the circulation, normally and in total anomalous pulmonary venous return: normally the four pulmonary veins carry blood from the lungs into the left atrium; in the defect (the supracardiac type is shown) the pulmonary veins join a confluence behind the heart, the blood rises through a vertical vein into the superior vena cava and reaches the right atrium, mixes there with oxygen-poor blood and passes into the left side of the heart only through the opening between the atria, and the right atrium and right ventricle are enlarged", "diagram.transposition-of-the-great-arteries.title": "Diagram of the circulation, normally and in transposition of the great arteries: normally blood passes through the lungs and the body in turn; in transposition the aorta arises from the right ventricle and the pulmonary artery from the left, so each circuit loops back on itself, and a little blood mixes through an atrial communication and a patent ductus arteriosus", "diagram.tricuspid-regurgitation.title": "Diagram of the right heart while the right ventricle contracts: normally the tricuspid valve leaflets are closed and blood leaves the ventricle into the pulmonary artery; in tricuspid regurgitation the leaflets do not close, some blood flows back into the right atrium, and the atrium is drawn larger", "diagram.tricuspid-stenosis.title": "Diagram of the right heart while the right ventricle fills (diastole): normally blood reaches the right atrium through the superior vena cava, the thin tricuspid valve leaflets open wide and blood flows freely into the right ventricle; in tricuspid stenosis the leaflets are thickened, the valve opening is narrow, the right atrium is enlarged, the superior vena cava is wider, pressure in the veins is higher, and the right ventricle is small", "diagram.truncus-arteriosus.title": "Diagram of the ventricles and the vessels leaving them, normally and in truncus arteriosus (type I, one of the variants): normally the pulmonary artery leaves the right ventricle and divides into two branches, and the aorta leaves the left ventricle, each vessel with its own valve; with the defect, a single common trunk with one valve leaves the heart above a ventricular septal defect, both ventricles pump blood into it, a pulmonary artery leaves the trunk and divides into two branches, and mixed blood goes both to the body and to the lungs, with too much blood going to the lungs", "diagram.varicose-veins.title": "Diagram of part of the leg in longitudinal section: a superficial vein under the skin, a deep vein in the muscle and a short connecting vein between them. Normally the superficial vein is narrow, the cusps of its valves meet, and blood flows up it towards the heart and through the connecting vein into the deep vein. In varicose veins the superficial vein is widened and twisted, the cusps of its valves do not meet, and blood flows back down it (reflux); the deep vein is unchanged", "diagram.vascular-ehlers-danlos-syndrome.title": "Diagram of a segment of an artery cut lengthwise: normally the wall is strong and intact and blood flows along the lumen; in vascular Ehlers-Danlos syndrome the wall is fragile and can rupture even when the artery is not widened: the artery keeps its width, and blood escapes through a tear in the wall", "diagram.vascular-rings.title": "Diagram of a cross-section of the chest at the level of the aortic arch with the trachea and oesophagus, normally and with a double aortic arch: normally a single aortic arch runs from the ascending to the descending aorta beside the trachea and oesophagus and does not encircle them; with a double aortic arch both arches persist, the right (usually larger) and the left, form a complete ring around the trachea and oesophagus and squeeze them from both sides", "diagram.vasovagal-syncope.title": "Diagram of a standing person: normally blood pressure holds, the heart beats at its usual rhythm, blood returns through the leg veins to the heart, and the brain gets enough blood; in vasovagal syncope a trigger such as prolonged standing, pain or fear acts through the vagus nerve to widen the blood vessels and/or slow the heart rate, the leg veins are wider, blood pressure falls, less blood reaches the brain, and light-headedness and sometimes fainting follow", "diagram.ventricular-fibrillation.title": "Diagram of the electrical impulse in the heart: normally the impulse from the sinus node goes through the atria and the AV node and spreads through the ventricles as one wave, so they contract and pump blood out; in ventricular fibrillation many small chaotic waves run in many places of the ventricles at once, the ventricles only quiver, and no blood is pumped out", "diagram.ventricular-septal-defect.title": "Diagram of the heart chambers: normal, with a ventricular septal defect and after the defect is closed", "diagram.ventricular-tachycardia.title": "Diagram of the electrical impulse path from the sinus node through the atria and the AV node to the ventricles: normally every beat starts in the sinus node; in ventricular tachycardia the impulse circles in the scar zone of the ventricular wall through a narrow isthmus, and every lap excites the ventricles again, so they beat fast and regularly on their own, apart from the atria", "diagram.vertebral-artery-stenosis.title": "Diagram of the subclavian, vertebral and basilar arteries seen from the front: normally both vertebral arteries carry blood upwards and join inside the skull into the basilar artery, which supplies the back of the brain; in stenosis a plaque narrows the start of the left vertebral artery, past the narrowing blood still flows up it, but more weakly, and a fragment may break off the plaque and be carried to the brain", "diagram.wpw-syndrome.title": "Diagram of the electrical impulse path from the sinus node through the atria to the ventricles, with the ECG of one beat: normally the impulse reaches the ventricles only through the AV node; in WPW syndrome an accessory pathway between an atrium and a ventricle conducts it earlier and excites part of the ventricle ahead of time, so on the ECG the PR interval is shorter, a delta wave appears at the start of the QRS complex and the QRS is wider", "doctors.error.text": "Found a wrong or outdated statement? Report it with a source. It takes a couple of minutes.", "doctors.error.title": "Report an error", "doctors.guide": "How a review works", "doctors.intro": "Heart Atlas is an open-source site about the heart and heart disease. Articles on diseases and tests cite clinical guidelines; the others cite reviews, textbooks and trusted references. No physician has reviewed the articles yet. We are looking for doctors who can help.", "doctors.offer": "Offer to help", "doctors.public": "Issues and pull requests on GitHub are public, and so is everything in the repository. You need a free GitHub account to write there. Do not send patient data, medical documents or copies of your diplomas. Your name goes into the article's public source file only if you agree.", "doctors.publicTitle": "What is public", "doctors.review.text": "Read an article on the site, check it against its sources and send your comments. Once the article is corrected and you are satisfied, its page no longer says that no physician has reviewed it.", "doctors.review.title": "Review an article", "doctors.template": "Author template", "doctors.title": "For physicians", "doctors.ways": "How you can help", "doctors.write.text": "Send plain text following the author template. No code or Git needed: we turn it into an article with diagrams and quiz questions and send it back to you before it is published.", "doctors.write.title": "Write or extend an article", "embed.code": "Code to paste", "embed.copied": "Code copied", "embed.copy": "Copy code", "embed.copyFailed": "Could not copy. The code is selected: copy it with your keyboard.", "embed.credits": "Third-party material: {credits}.", "embed.intro": "Pick a module and paste the code into your page. The module opens in a frame with a link to the full page, the medical disclaimer and the license. Articles keep the notice that no physician has reviewed them.", "embed.license": "Heart Atlas content is licensed under CC BY-SA 4.0: you may embed and share it if you keep the credit and the link.", "embed.module": "Module", "embed.noScript": "This module needs JavaScript. Open it on the site using the link below.", "embed.open": "open on the site", "embed.rateHint": "Optional. Leave empty for the default rate.", "embed.title": "Embed Heart Atlas on your site", "embed.tools": "Interactive models", "footer.disclaimer": "Heart Atlas is for learning and does not replace a doctor. If you have chest pain, severe shortness of breath or have fainted, call your local emergency number immediately (112 in the EU, 911 in the US and Canada, 999 in the UK).", "footer.disclaimerLink": "Medical disclaimer", "footer.embed": "Embed on your site", "footer.license": "Code: MIT. Content: CC BY-SA 4.0.", "footer.project": "Project", "footer.source": "Source code", "header.settings": "Settings", "header.tools": "Search and settings", "heartClock.condition": "Condition", "heartClock.ecgDescription": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.ecgLabel": "Synthetic ECG, lead {lead}. Grid: 25 mm per second, 10 mm per millivolt.", "heartClock.group.conduction": "Conduction blocks", "heartClock.group.rhythm": "Rhythm disorders", "heartClock.group.structure": "Heart and blood vessels", "heartClock.group.treated": "After treatment", "heartClock.heartRate": "Heart rate, beats per minute", "heartClock.inModel": "How it looks in the model", "heartClock.intro": "One timer drives the whole cardiac cycle. The ECG below is generated from it: change the heart rate and watch the waves and the phases of the cycle follow.", "heartClock.model3d": "Heart model", "heartClock.noPulse": "No pulse", "heartClock.noSounds": "No heart sounds", "heartClock.pause": "Pause", "heartClock.phase": "Phase of the cycle", "heartClock.phase.atrial-systole": "Atrial contraction", "heartClock.phase.ejection": "Ejection", "heartClock.phase.fibrillation": "Ventricular fibrillation: no coordinated contractions, no output", "heartClock.phase.filling": "Ventricular filling", "heartClock.phase.isovolumic-contraction": "Isovolumic contraction", "heartClock.phase.isovolumic-relaxation": "Isovolumic relaxation", "heartClock.phase.pause": "Sinus pause", "heartClock.play": "Play", "heartClock.preset.aortic-stenosis": "Aortic stenosis", "heartClock.preset.aortic-stenosis.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.aortic-stenosis.summary": "The aortic valve is narrowed: during ejection the pressure in the left ventricle is on average 40 mmHg higher than in the aorta, the threshold of severe stenosis. The model does not show the murmur, the slow-rising, weak pulse (pulsus parvus et tardus) or the softer second heart sound.", "heartClock.preset.atrial-fibrillation": "Atrial fibrillation", "heartClock.preset.atrial-fibrillation.ecg": "Atrial fibrillation at an average of {rate} beats per minute. There are no P waves, the baseline shows small irregular f waves, the QRS complexes are narrow, and the intervals between them differ.", "heartClock.preset.atrial-fibrillation.summary": "The atria fibrillate instead of contracting: there are no P waves, the baseline shows small irregular f waves, and the intervals between beats vary without a pattern. The atria no longer add the last part of ventricular filling.", "heartClock.preset.atrial-flutter": "Atrial flutter (2:1 conduction)", "heartClock.preset.atrial-flutter.ecg": "Atrial flutter at {rate} beats per minute. There are no P waves: the baseline is a regular sawtooth of F waves, two for every narrow QRS complex, and the intervals between beats are equal.", "heartClock.preset.atrial-flutter.summary": "The atria are activated regularly at 250 to 350 per minute, and the ECG shows sawtooth F waves instead of P waves, with no flat line between them. The AV node lets every second impulse through to the ventricles (2:1 conduction), so the ventricles beat regularly at half the atrial rate. The model starts at 150 beats per minute, with F waves at 300 per minute, and keeps the ventricular rate from 126 to 175 so that the F waves stay in that range. The atria no longer add the last part of ventricular filling. In leads II and III the F waves point down; in lead I they are low. The model does not show other conduction ratios (4:1, 3:1, or a varying ratio that makes the rhythm irregular), atypical flutter, or the F waves in the chest leads, such as the positive ones in V1.", "heartClock.preset.atrial-premature-beats": "Atrial premature beats", "heartClock.preset.atrial-premature-beats.ecg": "Sinus rhythm at {rate} beats per minute, and every fourth beat comes early. The early beat has a P wave and a usual narrow QRS complex. The next beat comes one usual interval after the early one, so the beats on either side of it are less than two usual intervals apart.", "heartClock.preset.atrial-premature-beats.summary": "A premature beat comes earlier than the next normal beat, from an impulse that starts outside the sinus node. In an atrial premature beat the impulse starts in the atria. It can reach the ventricles the normal way, with a narrow QRS, or be conducted abnormally or not at all; the model shows the normal way. It resets the sinus node, so the pause after it is shorter than a full compensatory pause. Here every fourth beat is premature, so that the premature beats are easy to see; that is a lot of them, not a typical picture. It comes at 0.7 of the usual interval, and the next beat comes one usual interval after it. These timings are model choices, since the sources give no numbers; the model draws the P wave of the premature beat with the same shape as the sinus one. The beat before the premature one is cut short, so the model also shortens its contraction; in a real heart the timings of a beat depend on the interval before it, not after it. In the model every beat pumps the same amount. The slider sets the sinus rate from 40 to 86; with this timing the model works only in that range. The model does not show premature beats at random times or in pairs, or where in the atria the impulse starts.", "heartClock.preset.atrial-septal-defect": "Atrial septal defect", "heartClock.preset.atrial-septal-defect.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a wide QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.atrial-septal-defect.summary": "The second heart sound is split, and the split is the same on every beat. In atrial septal defect the ECG may show incomplete or complete right bundle branch block; the model only widens the QRS to the width of a complete block and does not draw its shape. With a large shunt through a secundum defect the electrical axis may turn to the right: the model shows that, so the QRS points down in lead I, and so does the T wave. A primum defect turns the axis up, which the model does not show. Blood flows from the left atrium to the right, and the model shows only the left side of the heart, so the Wiggers diagram does not change. The model does not play the murmur.", "heartClock.preset.av-block-first-degree": "First-degree AV block", "heartClock.preset.av-block-first-degree.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a long PR interval of more than 0.20 s, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.av-block-first-degree.summary": "The PR interval is longer than normal, more than 0.20 s. Every P wave is still followed by a QRS complex: every atrial impulse reaches the ventricles, only more slowly. This preset shows only first-degree block; second- and third-degree block, in which some or all atrial impulses do not reach the ventricles, have presets of their own.", "heartClock.preset.av-block-second-degree-mobitz-1": "Second-degree AV block, Mobitz I", "heartClock.preset.av-block-second-degree-mobitz-1.ecg": "Second-degree AV block, Mobitz I: P waves at a steady {rate} per minute. The PR interval grows with each beat until a P wave has no QRS complex after it; then the cycle starts again with the shortest PR. Three narrow QRS complexes for every four P waves.", "heartClock.preset.av-block-second-degree-mobitz-1.summary": "In second-degree AV block some impulses from the atria do not reach the ventricles: a P wave has no QRS complex after it. In Mobitz I (Wenckebach) the PR interval grows from beat to beat until a P wave is not conducted; the next beat has the shortest PR again, and the cycle repeats. Here the cycle has four P waves and three QRS complexes (4:3), and the QRS is narrow, as when the block is in the AV node. The slider sets the rate of the P waves; the ventricles beat at three quarters of it. A PR of 180 ms at 60 per minute, its equal growth of 80 ms per beat, the P wave rate of 60 to start with and the upper limit of 70 are model choices, since the sources give no numbers; because the growth is equal, the gaps between QRS complexes inside a cycle are equal too. Mobitz I often needs no treatment; a permanent pacemaker is recommended when the block causes clear symptoms and transient or reversible causes have been ruled out. The model does not show 2:1 or high-grade block, the atrial a wave after a P wave that is not conducted, or the atria contracting on the 3D model.", "heartClock.preset.av-block-second-degree-mobitz-2": "Second-degree AV block, Mobitz II", "heartClock.preset.av-block-second-degree-mobitz-2.ecg": "Second-degree AV block, Mobitz II: P waves at a steady {rate} per minute with the same PR interval before every narrow QRS complex. Every third P wave has no QRS after it, and the gap between QRS complexes across it is twice the others.", "heartClock.preset.av-block-second-degree-mobitz-2.summary": "In Mobitz II second-degree AV block a P wave has no QRS complex after it, and the PR interval is the same before and after it. Usually every third or fourth P wave is not conducted; here every third, so the ventricles beat at two thirds of the P wave rate the slider sets, and the RR interval that spans the block is exactly twice the others. The P wave rate of 75 to start with is a model choice. In Mobitz II the QRS is often wide because the block lies below the AV node, in the bundle of His or its branches; the model draws it narrow. Acquired Mobitz II without a reversible or physiological cause is treated with a permanent pacemaker even without symptoms. The model does not show 2:1 or high-grade block, the change to complete block, or the atria contracting on the 3D model.", "heartClock.preset.av-block-third-degree": "Complete AV block", "heartClock.preset.av-block-third-degree-paced": "Complete AV block after treatment: pacemaker", "heartClock.preset.av-block-third-degree-paced.ecg": "Rhythm of a dual-chamber pacemaker at {rate} beats per minute. Each beat starts with the heart's own P wave; after a delay comes a narrow vertical pacemaker spike, then a wide QRS complex and a T wave pointing down. The rhythm is regular.", "heartClock.preset.av-block-third-degree-paced.summary": "Complete AV block without a reversible or physiological cause is treated with a permanent pacemaker, whether or not it causes symptoms. With sinus rhythm the ESC prefers a dual-chamber device to one that paces only the ventricle: it senses the heart's own P wave and, after a set delay, sends an impulse to the ventricles, so the atria and the ventricles work together again. Here every P wave is followed by a narrow vertical spike and a wide QRS complex: the impulse spreads from the lead through the heart muscle, not through the conduction system, and the complex looks like left bundle branch block, where the T wave points the opposite way. The width and shape of the QRS, the T wave, the delay after the P wave and the size of the spike are model choices, since the sources give no numbers for them; on a real ECG the spike can be hard to see. The rate follows the P waves, 75 to start with and 60 to 100 on the slider. The model does not show the pacemaker's lower and upper rate limits, a rate that rises with exercise, or the shift of the electrical axis to the left that paced beats can have: in leads I, II and III it draws the paced QRS with the usual axis.", "heartClock.preset.av-block-third-degree.ecg": "Complete AV block: P waves at a steady 75 per minute and, unrelated to them, narrow QRS complexes at {rate} beats per minute. The PR interval keeps changing, and from time to time a P wave falls on a QRS complex or a T wave. Near 37–38 beats per minute the PR changes slowly, and for a while it can look as if every second P wave were conducted.", "heartClock.preset.av-block-third-degree.summary": "In complete (third-degree) AV block no impulse from the atria reaches the ventricles. The atria keep their own rhythm and the ventricles are driven by a slower escape rhythm, so P waves and QRS complexes are unrelated and the P waves come more often. Here the escape rhythm starts above the branching of the bundle of His: the QRS is narrow and the rate is 35 to 50 beats per minute, 40 to start with. The P waves run at a steady 75 per minute; the sources do not say how regular they are, so this is a model choice. Because the atria and the ventricles no longer work together, the model gives the atria no share in filling the ventricles. The model does not show a slower escape rhythm from the ventricles with a wide QRS (20 to 40 per minute), the large (cannon) a waves in the neck veins, or the atria contracting on the 3D model.", "heartClock.preset.bidirectional-ventricular-tachycardia": "Bidirectional ventricular tachycardia", "heartClock.preset.bidirectional-ventricular-tachycardia.ecg": "Bidirectional ventricular tachycardia at {rate} beats per minute. Each beat has a wide QRS complex with no P wave before it, then a T wave pointing the other way. The complexes point up and down in turn, and the intervals between beats are equal.", "heartClock.preset.bidirectional-ventricular-tachycardia.summary": "A fast rhythm from the ventricles in which the QRS complexes alternate from beat to beat: one points up, the next points down. It is the most typical arrhythmia of catecholaminergic polymorphic ventricular tachycardia and also occurs in some other conditions. It is dangerous because it can turn into ventricular fibrillation. A ventricular tachycardia is faster than 100 beats per minute; the model starts at 150 and does not go below 101. The starting rate, the QRS width and the sizes of the waves are model choices. The model does not show how an episode starts with exercise or stress, or how it turns into fibrillation. Between episodes, at rest, the ECG in catecholaminergic polymorphic ventricular tachycardia is usually normal, so a normal ECG at rest does not rule the disease out.", "heartClock.preset.brugada-syndrome": "Brugada syndrome (type 1, lead V1)", "heartClock.preset.brugada-syndrome.ecg": "Lead V1, sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a QRS complex with a small R wave and a deep S wave. The ST segment starts raised, falls in a dome-shaped (coved) curve and goes into an inverted T wave. The intervals between beats are equal.", "heartClock.preset.brugada-syndrome.summary": "An inherited disorder of the heart's ion channels with a typical ECG and a high risk of ventricular fibrillation and sudden death. The model shows the type 1 pattern in lead V1 only: the J point and the ST segment are raised, and the ST segment is coved and descends into an inverted T wave. The Russian guideline makes the diagnosis when ST elevation of this shape is 2 mm (0.2 mV) or more in V1 or V2; the model raises it by 0.3 mV (3 mm). The rhythm is sinus, and the reader sets the rate. The model draws the raised J point as the start of the ST segment, without the r′-like wave that makes the QRS complex resemble right bundle branch block. It does not show leads V2 and V3, recordings with the electrodes one or two intercostal spaces higher, type 2 and type 3 patterns, how the pattern comes and goes or appears with fever or drugs, or the ventricular arrhythmias that cause fainting and sudden death.", "heartClock.preset.early-repolarization": "Early repolarisation pattern (lead II)", "heartClock.preset.early-repolarization.ecg": "Lead II, sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex. The J point, where the QRS ends, is raised, and the end of the QRS has a small notch (a J wave). The ST segment stays slightly raised and goes into an upright T wave. The intervals between beats are equal.", "heartClock.preset.early-repolarization.summary": "A common ECG pattern: the J point, where the QRS complex ends and the ST segment begins, is raised by 1 mm (0.1 mV) or more in two neighbouring inferior or lateral leads. A person with this pattern, no symptoms and no sudden deaths in the family needs no treatment. The rare early repolarisation syndrome is this pattern in someone resuscitated from unexplained ventricular fibrillation or polymorphic ventricular tachycardia. The model shows the pattern in leads II and III with a notch at the end of the QRS and a slightly raised ST segment; the notch and the ST change may be absent, and their heights are model choices. It shows no high-risk signs and cannot tell a harmless ECG from a dangerous one, which is a doctor's call.", "heartClock.preset.focal-atrial-tachycardia": "Focal atrial tachycardia", "heartClock.preset.focal-atrial-tachycardia.ecg": "Focal atrial tachycardia at {rate} beats per minute. Each beat has an inverted P wave, then a narrow QRS complex, then a T wave; the line between the waves is flat, and the intervals between beats are equal.", "heartClock.preset.focal-atrial-tachycardia.summary": "A fast, regular rhythm from one focus in the atria, 100 beats per minute or more, usually 150 to 200. Its sign is a P wave of a shape that differs from the sinus P, with a flat line between the P waves. The model draws a focus low in the atria: the P waves are negative in leads II and III. A focus elsewhere gives other P shapes, which help find where it is. The model starts at 150 and does not go below 100; the starting rate and the P wave are model choices. It does not show P waves hidden in the QRS complex or the T wave, AV block, when not every P wave reaches the ventricles and they beat more slowly, or multifocal atrial tachycardia with P waves of three or more shapes.", "heartClock.preset.heart-failure": "Heart failure with reduced ejection fraction", "heartClock.preset.heart-failure.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.heart-failure.summary": "The ECG in the model is the same as normal: the model changes only how the left ventricle pumps blood out. You can see it on the Wiggers diagram below: on each beat the ventricle ejects 30% of its volume instead of about two thirds, so the volume line dips less. A reduced ejection fraction means 40% or less. The model does not play the third heart sound.", "heartClock.preset.hypertension": "Arterial hypertension", "heartClock.preset.hypertension.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.hypertension.summary": "Blood pressure is 160/100 mmHg, above the hypertension threshold of 140/90 mmHg; NICE calls this level stage 2. The ECG does not change.", "heartClock.preset.left-anterior-fascicular-block": "Left anterior fascicular block", "heartClock.preset.left-anterior-fascicular-block.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a QRS complex slightly wider than normal that points up in lead I and down in leads II and III, then a T wave, and the intervals between beats are equal.", "heartClock.preset.left-anterior-fascicular-block.summary": "The left bundle branch divides into an anterior and a posterior fascicle. When the anterior fascicle does not conduct (left anterior hemiblock), the QRS lengthens a little but stays under 0.12 s, and the electrical axis turns left and up, more negative than −45°. In the model the axis is −60°: the QRS points up in lead I and down in leads II and III, deepest in III. The QRS width of 110 ms and the shapes and sizes of the waves are model choices, since the sources give no numbers.", "heartClock.preset.left-bundle-branch-block": "Left bundle branch block", "heartClock.preset.left-bundle-branch-block.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a wide QRS complex with a broad notched R wave and no Q wave in lead I, then an ST segment and a T wave pointing the opposite way, and the intervals between beats are equal.", "heartClock.preset.left-bundle-branch-block.summary": "The left bundle branch does not conduct, so the left ventricle is activated late and the QRS widens to 0.12 s or more. In leads I, aVL, V5 and V6 the R wave is broad and notched or slurred, with no Q wave, and the ST segment and T wave point opposite to the QRS. The model draws leads I, II and III and shows these signs in lead I. The QRS width of 150 ms, the electrical axis, the depth of the notch and the sizes of the waves are model choices, since the sources give no numbers. The model does not go above 144 beats per minute: at faster rates the wide QRS does not fit the beat. Late activation of the left ventricle can make the ventricles contract out of step, so the left ventricle pumps less efficiently; the model does not show that, and the Wiggers diagram stays normal.", "heartClock.preset.long-qt-syndrome": "Long QT syndrome", "heartClock.preset.long-qt-syndrome.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave that ends late: the QT interval is long, with a QTc of 500 ms. The intervals between beats are equal.", "heartClock.preset.long-qt-syndrome.summary": "The QT interval is long: the T wave ends later. One of the diagnostic criteria is a QTc of 480 ms or more, and the longer the QTc, especially above 500 ms, the higher the risk of torsades de pointes. The model shows a QTc of 500 ms at every heart rate and does not go above 137 beats per minute: at faster rates a QT this long does not fit between two beats in the model. The model does not show torsades de pointes.", "heartClock.preset.normal": "Normal", "heartClock.preset.normal.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.normal.summary": "Sinus rhythm, pressure in the aorta 120/80 mmHg, and the left ventricle ejects about two thirds of its volume (65%) on each beat.", "heartClock.preset.right-bundle-branch-block": "Right bundle branch block", "heartClock.preset.right-bundle-branch-block.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a wide QRS complex that ends in a broad S wave in lead I, then a T wave, and the intervals between beats are equal.", "heartClock.preset.right-bundle-branch-block.summary": "The right bundle branch does not conduct, so the right ventricle is activated late and the QRS widens to 0.12 s or more. The late activation gives a broad S wave in leads I and V6 and an rsR' complex in V1 or V2. The model draws leads I, II and III, so it shows the broad S wave in lead I and does not draw V1. The QRS width of 140 ms and the direction and size of the late wave are model choices, since the sources give no numbers. The model does not go above 157 beats per minute: at faster rates the wide QRS does not fit the beat. On its own the block causes no symptoms, and the model does not change how the heart pumps.", "heartClock.preset.short-qt-syndrome": "Short QT syndrome", "heartClock.preset.short-qt-syndrome.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave that ends early: the QT interval is short, with a QTc of 320 ms. The intervals between beats are equal.", "heartClock.preset.short-qt-syndrome.summary": "The QT interval is short: the T wave ends earlier. There is no single number for the diagnosis: guidelines use thresholds from about 316 to 370 ms (316 ms in people under 20) together with symptoms, family history and genetic tests. The model shows a QTc of 320 ms at every heart rate, the level at which the European guideline advises doctors to consider the diagnosis even without other signs; the shape of the T wave is a model choice. The model does not show the dangerous arrhythmias this syndrome can cause.", "heartClock.preset.sick-sinus-syndrome": "Sick sinus syndrome (sinus pauses)", "heartClock.preset.sick-sinus-syndrome-paced": "Sick sinus syndrome after treatment: pacemaker", "heartClock.preset.sick-sinus-syndrome-paced.ecg": "Rhythm of an atrial pacemaker at {rate} beats per minute. Each beat starts with a narrow vertical pacemaker spike, then a P wave, then a narrow QRS complex and a T wave. The rhythm is regular, with no pauses.", "heartClock.preset.sick-sinus-syndrome-paced.summary": "The main treatment for sick sinus syndrome with symptoms is a permanent pacemaker. The ESC and the Russian guideline recommend a dual-chamber device programmed to avoid pacing the ventricles when it is not needed. The pacemaker sends an impulse when the heart's own rhythm slows down or stops, so the pauses are gone. Here every beat starts with a stimulus to the atria: a narrow vertical spike, then the P wave the stimulus causes, then, when conduction to the ventricles is normal, the usual narrow QRS complex. The model draws the spike larger than it often is: on a real ECG a pacemaker spike can be so small that it is hard to see. The rate is the pacemaker's lower rate, 60 beats per minute to start with and 50 to 70 on the slider; the sources give no single usual setting, so these numbers are a model choice. The model does not show pacing of the ventricles, a rate that rises with exercise, the heart's own beats above the lower rate, or the bouts of fast rhythm of tachy-brady syndrome.", "heartClock.preset.sick-sinus-syndrome.ecg": "Sinus bradycardia at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave. After every third beat there is a pause of 3 seconds with no P wave and no QRS complex: the line stays flat.", "heartClock.preset.sick-sinus-syndrome.summary": "The sinus node fires too rarely (sinus bradycardia) and now and then stops (sinus pause). The model keeps the rate below 40 beats per minute: the Russian guideline takes 40 as the lowest normal resting rate by day, and the ESC says 40 to 50 at rest can be normal. The model starts at 35 and keeps the rate from 30 to 39. After every third beat the sinus node is silent for 3 seconds: there is no P wave and no QRS complex, and 4.5 to 5 seconds pass between the beats around the pause. The Russian guideline accepts pauses of up to 2 seconds, and the ESC says pauses longer than 2.5 seconds are rare in healthy people. Real pauses come irregularly, and during a pause lower pacemakers usually take over with escape beats; the model does not draw them. The model does not show tachy-brady syndrome or a heart rate that fails to rise with exercise.", "heartClock.preset.sinus-tachycardia": "Sinus tachycardia", "heartClock.preset.sinus-tachycardia.ecg": "Sinus tachycardia at {rate} beats per minute. Each beat has a P wave, then a narrow QRS complex, then a T wave, and the intervals between beats are equal.", "heartClock.preset.sinus-tachycardia.summary": "Sinus rhythm faster than 100 beats per minute. The P waves are the same as in the normal rhythm, and the rest of the beat is drawn as in the normal preset. The model starts at 120 and does not go below 101; the starting rate is a model choice. The model does not show how the rate rises and falls gradually, or its link to standing up in POTS. On one strip, inappropriate sinus tachycardia and the tachycardia of POTS look like any other sinus tachycardia: the cause is found from when and why the rate rises and by ruling out other causes, not from the shape of the waves.", "heartClock.preset.stemi": "ST-elevation myocardial infarction", "heartClock.preset.stemi.ecg": "Sinus rhythm at {rate} beats per minute. Each beat has a P wave and a narrow QRS complex; in lead II the ST segment after it is raised by 2 mm and runs into the T wave.", "heartClock.preset.stemi.summary": "The ST segment in lead II is raised by 2 mm from the J point. A diagnosis needs ST elevation in at least two contiguous leads. The model shows an inferior infarction: ST is raised in leads II and III, more in III, a sign that the right coronary artery is the likely culprit, and lowered in lead I (reciprocal depression). The model does not show leads aVR, aVL, aVF or the chest leads.", "heartClock.preset.supraventricular-tachycardia": "Supraventricular tachycardia (AVNRT)", "heartClock.preset.supraventricular-tachycardia.ecg": "Supraventricular tachycardia at {rate} beats per minute. Each beat has a narrow QRS complex with no separate P wave before it, then a T wave, and the intervals between beats are equal.", "heartClock.preset.supraventricular-tachycardia.summary": "A fast, regular rhythm: in paroxysmal SVT the heart rate is 120 to 250 beats per minute. The model starts at 170 and does not go below 120. The model stops at 180, its upper limit, while the range in the article goes up to 250. The QRS complexes are narrow, and there is no separate P wave: in typical AVNRT the retrograde P′ waves usually merge with the QRS complex. The model does not show the sudden start and end of an episode, or a P′ wave seen at the end of the QRS complex.", "heartClock.preset.ventricular-fibrillation": "Ventricular fibrillation", "heartClock.preset.ventricular-fibrillation.ecg": "Ventricular fibrillation: irregular oscillations from 300 per minute that keep changing in shape and size, with no P waves, QRS complexes or T waves.", "heartClock.preset.ventricular-fibrillation.summary": "Ventricular fibrillation is a form of cardiac arrest: the ventricles merely quiver and do not contract in a coordinated way, so the heart pumps no blood and there is no pulse. The ECG shows irregular oscillations from 300 per minute that change in shape and size, with no P waves, QRS complexes or T waves. It needs an ambulance called at once, cardiopulmonary resuscitation started straight away and defibrillation as early as possible. The rate and size of the oscillations are chosen for the model; it does not show how fibrillation starts or how it is treated.", "heartClock.preset.ventricular-premature-beats": "Ventricular premature beats", "heartClock.preset.ventricular-premature-beats.ecg": "Sinus rhythm at {rate} beats per minute, and every fourth beat comes early. The early beat has no P wave, a wide QRS complex and a T wave pointing the opposite way. After it comes a pause, and the next sinus beat comes when it would have come without the early beat.", "heartClock.preset.ventricular-premature-beats.summary": "A premature beat comes earlier than the next normal beat, from an impulse that starts outside the sinus node. In a ventricular premature beat the impulse starts in a ventricle: there is no P wave before it, the QRS is wide, 0.12 s or more, and the T wave points the opposite way. The pause after it is usually fully compensatory. Here every fourth beat is premature, so that the premature beats are easy to see; that is a lot of them, not a typical picture. It comes at 0.7 of the usual interval, and the next sinus beat comes when it would have come without the premature beat, two usual intervals after the beat before it. The QRS width of 140 ms, the depth of the T wave, the timings and that length of the pause are model choices, since the sources give no numbers. The beat before the premature one is cut short, so the model also shortens its contraction; in a real heart the timings of a beat depend on the interval before it, not after it. People usually do not feel the premature beat itself but the stronger beat after it; in the model every beat pumps the same amount. The slider sets the sinus rate from 40 to 86; with this timing the model works only in that range. The model draws the beat as one from a ventricular outflow tract: its axis points vertically down, so its QRS is high in leads II and III and small in lead I. Such beats look like left bundle branch block; the model does not draw the shape of the QRS. The model does not show premature beats at random times or in pairs, or ones from other places in the ventricles.", "heartClock.preset.ventricular-tachycardia": "Ventricular tachycardia (monomorphic)", "heartClock.preset.ventricular-tachycardia.ecg": "Ventricular tachycardia at {rate} beats per minute. Each beat has a wide QRS complex with no P wave before it, then a T wave pointing the opposite way to the QRS complex. The complexes are identical, and the intervals between beats are equal.", "heartClock.preset.ventricular-tachycardia.summary": "A fast, regular rhythm that starts in the ventricles: ventricular tachycardia is three or more ventricular beats in a row at more than 100 beats per minute. The model starts at 150 and does not go below 101. The QRS complexes are wide, 120 ms or more, and identical; there is no P wave before them, and the T wave points the opposite way to the main deflection of the QRS complex. The model does not go above 169 beats per minute: at faster rates its wide QRS does not fit the beat. The model draws VT from a ventricular outflow tract: its axis points vertically down, so the QRS is high in leads II and III and small in lead I, and it does not draw the QRS shape, which looks like left bundle branch block; VT from other places turns the axis elsewhere. The model does not show AV dissociation (the atria working independently of the ventricles): in the model the atria stay still. It does not show fusion complexes, polymorphic VT or torsades de pointes, or a change into ventricular fibrillation.", "heartClock.preset.wpw-syndrome": "WPW syndrome (pre-excitation)", "heartClock.preset.wpw-syndrome.ecg": "Sinus rhythm with pre-excitation at {rate} beats per minute. Each beat has a P wave and, after a short PR interval, a wide QRS complex that starts with a slow rise (the delta wave), then a T wave. The intervals between beats are equal.", "heartClock.preset.wpw-syndrome.summary": "An extra pathway between an atrium and a ventricle bypasses the AV node, so part of the ventricles is activated early (ventricular pre-excitation). Between attacks, in sinus rhythm, the ECG shows a short PR interval, under 120 ms, a slow rise at the start of the QRS complex (the delta wave) and a wide QRS, over 120 ms. In the model PR stays under 120 ms at every rate (about 80 ms at 75 beats per minute), and the QRS is 130 ms, of which the delta wave takes the first 40 ms. The model does not go above 153 beats per minute: at faster rates its late R peak does not fit the beat. In the model the P wave shortens along with PR; on a real ECG the P wave keeps its usual length. WPW syndrome means pre-excitation together with recurring attacks of tachycardia; the model shows only the ECG between attacks. It does not show the tachycardias themselves (orthodromic or antidromic AV reentrant tachycardia), atrial fibrillation conducted over the extra pathway, the secondary changes of the ST segment and T wave, the leads beyond I, II and III, or the extra pathway in the 3D model. In the model the delta wave points the same way as the QRS in every lead; on a real ECG its direction depends on where the extra pathway is.", "heartClock.schematic": "A schematic teaching model, not a recording and not for diagnosis. Not reviewed by a physician. Durations follow published averages and are simplified; some values are model assumptions.", "heartClock.soundOff": "Turn sound off", "heartClock.soundOn": "Turn sound on", "heartClock.sources": "Sources", "heartClock.speed": "Speed", "heartClock.title": "Heart clock", "heartClock.wiggers.aorta": "Aorta", "heartClock.wiggers.description": "During ventricular systole the pressure in the left ventricle rises above the aortic pressure and blood is ejected, so the ventricular volume falls. After the aortic valve closes the pressure in the ventricle drops below the atrial pressure, the mitral valve opens and the ventricle fills again; atrial contraction adds the last part of the filling.", "heartClock.wiggers.ecg": "ECG", "heartClock.wiggers.ejectionFraction": "Ejection fraction: {value}%", "heartClock.wiggers.la": "Left atrium", "heartClock.wiggers.label": "Wiggers diagram: pressure in the left ventricle, aorta and left atrium, left ventricular volume and the ECG over one cardiac cycle, with a cursor at the current moment.", "heartClock.wiggers.lv": "Left ventricle", "heartClock.wiggers.lvVolume": "Left ventricular volume", "heartClock.wiggers.noCycles": "The heart does not pump blood: there are no cycles.", "heartClock.wiggers.pressure": "Pressure, mmHg", "heartClock.wiggers.systole": "Ventricular systole", "heartClock.wiggers.title": "Wiggers diagram", "heartClock.wiggers.volume": "LV volume, % of end-diastolic", "heartSounds.articleTitle": "Listen to the heart", "heartSounds.choose": "Sound", "heartSounds.click": "click", "heartSounds.diagramLabel": "Phonocardiogram of one heart cycle: {sound}", "heartSounds.diastole": "Diastole", "heartSounds.intro": "A doctor listens to the heart with a stethoscope: two heart sounds in every beat and, with a valve disease, a murmur between or after them. Pick a sound and press Listen. It plays in step with the heart clock at 60 beats per minute, and the diagram shows where in the cycle each sound falls.", "heartSounds.link": "Listen to heart sounds and valve murmurs", "heartSounds.listen": "Listen", "heartSounds.openingSnap": "OS", "heartSounds.schematic": "The sounds are synthesised from descriptions in medical references. This is a teaching model, not a patient recording and not a diagnostic tool. Pitches are higher than real heart sounds so phone speakers can play them. Not reviewed by a physician.", "heartSounds.sound.aortic-regurgitation": "Aortic regurgitation", "heartSounds.sound.aortic-regurgitation.description": "A diastolic murmur that starts soon after the second sound and fades away (decrescendo). It is high-pitched and blowing. It is loudest at the third or fourth intercostal space left of the sternum or at the apex, and is heard best with the person leaning forward and holding their breath after breathing out. When the regurgitation is slight, the murmur may be heard only in early diastole.", "heartSounds.sound.aortic-stenosis": "Aortic stenosis", "heartSounds.sound.aortic-stenosis.description": "An ejection murmur in mid-systole: it starts after the first sound, rises and falls (crescendo-decrescendo) and ends before the second sound. It sounds harsh or grating. It is heard best at the right and left upper sternal border, with the person sitting up and leaning forward, and spreads to the right collarbone and both carotid arteries. The second sound is soft or single. As the stenosis gets more severe, the murmur gets longer and peaks later in systole; the player shows a moderate one.", "heartSounds.sound.mitral-regurgitation": "Mitral regurgitation", "heartSounds.sound.mitral-regurgitation.description": "A holosystolic (pansystolic) murmur: it fills all of systole, from the first to the second sound, at the same loudness. It is heard best at the apex, with the person lying on their left side, and spreads to the left armpit. The first sound is soft.", "heartSounds.sound.mitral-stenosis": "Mitral stenosis", "heartSounds.sound.mitral-stenosis.description": "A loud first sound. Soon after the second sound (0.06–0.11 s) comes the opening snap (OS) of the mitral valve, then a low-pitched rumbling diastolic murmur: it fades, then grows again just before the next first sound, when the atria contract. It is heard at the apex of the heart, best with the person lying on their left side, and does not spread anywhere. With atrial fibrillation the presystolic rise disappears.", "heartSounds.sound.mitral-valve-prolapse": "Mitral valve prolapse", "heartSounds.sound.mitral-valve-prolapse.description": "A high-pitched click in mid-systole: the structures under the valve (the chordae tendineae) suddenly tighten as the leaflet prolapses. If blood leaks back through the valve (regurgitation), a late systolic murmur follows the click, as in the player. Prolapse without regurgitation often gives only the click. It is heard best at the apex, with the person lying on their left side.", "heartSounds.sound.normal": "Normal", "heartSounds.sound.normal.description": "Two short sounds in every beat. The first (S1) comes at the start of ventricular systole, mostly from the mitral valve closing. The second (S2) comes at the start of diastole, when the aortic and pulmonary valves close. Together they make the familiar “lub-dub”.", "heartSounds.sources": "Sources", "heartSounds.stop": "Stop", "heartSounds.systole": "Systole", "heartSounds.title": "Heart sounds and murmurs", "home.card.anatomy": "Anatomy", "home.card.anatomyNote": "Structure and position", "home.card.chambers": "Heart chambers", "home.card.chambersNote": "Atria and ventricles", "home.card.disease": "Diseases", "home.card.diseaseNote": "{count, plural, one {# article on causes, symptoms and treatment} other {# articles on causes, symptoms and treatment}}", "home.card.ecg": "ECG", "home.card.ecgNote": "Conduction system and rhythm", "home.card.flow": "Blood flow", "home.card.flowNote": "Coronary circulation", "home.card.valves": "Valves", "home.card.valvesNote": "How they open and close", "home.cta.clock": "Heart clock", "home.cta.clockNote": "The cardiac cycle and ECG", "home.cta.explore": "Explore the atlas", "home.eyebrow": "Where knowledge of the heart comes together", "home.fact.articles": "{count, plural, one {# article} other {# articles}}", "home.fact.articlesNote": "with sources", "home.fact.code": "Open source", "home.fact.codeNote": "MIT and CC BY-SA", "home.fact.languagesNote": "and room for any language", "home.hand": "More than anatomy. This is life.", "home.heart3d": "3D model of the heart. Drag it or use the left and right arrow keys to turn it.", "home.lead": "How the heart is built, how it beats, which diseases affect it and how doctors find them. Every article cites its sources.", "home.posterAlt": "The heart seen from the front: atria, ventricles, aorta, pulmonary trunk and coronary vessels.", "home.section.anatomyNote": "{count, plural, one {# topic and a 3D heart model} other {# topics and a 3D heart model}}", "home.section.clockNote": "The cardiac cycle and a live ECG", "home.section.code": "Open source", "home.section.codeNote": "Sources, licenses and how to help", "home.section.diagnosticNote": "{count, plural, one {# article on how heart disease is found} other {# articles on how heart disease is found}}", "home.section.diseaseNote": "{count, plural, one {# article on causes, diagnosis and treatment} other {# articles on causes, diagnosis and treatment}}", "home.section.model": "3D model", "home.section.modelNote": "Turn the heart and light up its parts", "home.section.soundsNote": "What heart sounds and valve murmurs sound like", "home.sections.note": "Everything in the atlas today, in one place", "home.sections.title": "Explore the key sections", "home.side.text": "Every heartbeat is the joint work of the chambers, valves and conduction system. This atlas shows how they work.", "home.side.world": "An open project\nfor the whole world", "home.stage.hint": "Point at a card to see which part of the heart it is about.", "home.stage.label": "Topics around the heart", "home.stage.tags": "3D · Interactive · Sourced · Open to everyone", "home.tagline": "An interactive atlas.\nSources for every article.\nClear explanations.", "home.title": "Heart Atlas", "home.titleAccent": "Heart", "level.label": "Explanation level", "level.patient": "For patients", "level.patient.hint": "A plain explanation without unnecessary medical terms.", "level.student": "For students", "level.student.hint": "In depth: medical terms, mechanisms and figures.", "motion.auto": "Auto", "motion.autoPicked": "Picked by Auto: {level}", "motion.calm": "Calm", "motion.full": "Full", "motion.label": "Animation", "motion.load3d": "Rotate in 3D", "motion.off": "Off", "nav.anatomy": "Heart anatomy in 3D", "nav.clock": "Heart clock", "nav.heartClock": "Heart clock: ECG and the cardiac cycle", "nav.home": "Home", "nav.lab": "Heart laboratory", "nav.language": "Language", "nav.sections": "Sections", "nav.sounds": "Sounds and murmurs", "nav.tracks": "Tracks", "notFound.home": "Go to the home page", "notFound.search": "Search the site", "notFound.text": "There is no page at this address. It may have moved, or the link has a typo.", "notFound.title": "Page not found", "offline.home": "Go to the home page", "offline.text": "This page has not been saved for offline reading yet. Pages you have opened before are still available.", "offline.title": "You are offline", "quiz.answer": "Answer:", "quiz.check": "Check", "quiz.choose": "Choose an answer first.", "quiz.correct": "Correct.", "quiz.incorrect": "Not quite.", "quiz.mark.chosen": "your answer", "quiz.mark.correct": "correct answer", "quiz.retry": "Try again", "quiz.score": "Correct answers: {correct} of {total}.", "quiz.showAnswer": "Show the answer", "quiz.title": "Check yourself", "redirect.link": "Open the site", "redirect.text": "Redirecting…", "redirect.title": "Heart Atlas", "report.fictional": "A made-up teaching example. It is not a reading of your test: the report is assessed by a doctor together with your symptoms, examination and other tests.", "report.more": "More: {title}", "report.placeholder": "no value is given in the sample", "report.title": "How to read an echo report: a teaching sample", "review.notice": "Based on clinical guidelines. Not reviewed by a physician.", "review.report": "Report an error", "search.label": "Search the atlas", "search.noIndex": "Search works only in the built site. Run pnpm build and pnpm preview.", "search.noScript": "Search needs JavaScript.", "search.placeholder": "Search the atlas", "search.submit": "Search", "search.title": "Search", "search.ui.alt_search": "No results for [SEARCH_TERM]. Showing results for [DIFFERENT_TERM] instead", "search.ui.clear_search": "Clear", "search.ui.filters_label": "Filters", "search.ui.load_more": "Load more results", "search.ui.many_results": "[COUNT] results for [SEARCH_TERM]", "search.ui.one_result": "[COUNT] result for [SEARCH_TERM]", "search.ui.placeholder": "Search the atlas", "search.ui.search_label": "Search the atlas", "search.ui.search_suggestion": "No results for [SEARCH_TERM]. Try one of the following searches:", "search.ui.searching": "Searching for [SEARCH_TERM]…", "search.ui.zero_results": "No results for [SEARCH_TERM]", "site.description": "An open-source interactive atlas of the heart and heart disease.", "site.name": "Heart Atlas", "site.tagline": "Open knowledge about the heart", "sources.checked": "Sources checked on {date}", "sources.cite": "Source {n}", "sources.title": "Sources", "structure.aorta": "Aorta", "structure.aortic-valve": "Aortic valve", "structure.av-node": "Atrioventricular node", "structure.blood-pool": "Blood in the chambers and vessels", "structure.bundle-of-his": "Bundle of His", "structure.cardiac-veins": "Cardiac veins", "structure.circumflex-artery": "Circumflex artery", "structure.coronary-sinus": "Coronary sinus", "structure.inferior-vena-cava": "Inferior vena cava", "structure.interatrial-septum": "Interatrial septum", "structure.interventricular-septum": "Interventricular septum", "structure.left-anterior-descending-artery": "Left anterior descending artery", "structure.left-atrium": "Left atrium", "structure.left-bundle-branch": "Left bundle branch", "structure.left-main-coronary-artery": "Left main coronary artery", "structure.left-papillary-muscles": "Papillary muscles of the left ventricle", "structure.left-ventricle": "Left ventricle", "structure.mitral-valve": "Mitral valve", "structure.myocardium": "Heart muscle (myocardium)", "structure.pulmonary-circulation": "Blood of the pulmonary circulation (the lungs' circuit)", "structure.pulmonary-trunk": "Pulmonary trunk", "structure.pulmonary-valve": "Pulmonary valve", "structure.pulmonary-veins": "Pulmonary veins", "structure.purkinje-fibers": "Purkinje fibres", "structure.right-atrium": "Right atrium", "structure.right-bundle-branch": "Right bundle branch", "structure.right-coronary-artery": "Right coronary artery", "structure.right-papillary-muscles": "Papillary muscles of the right ventricle", "structure.right-ventricle": "Right ventricle", "structure.sa-node": "Sinoatrial node", "structure.superior-vena-cava": "Superior vena cava", "structure.systemic-circulation": "Blood of the systemic circulation (the body's circuit)", "structure.tricuspid-valve": "Tricuspid valve", "tracks.continue": "Continue with {title}", "tracks.finished": "You have marked every article in this track as read.", "tracks.intro": "Read a topic in order, one article after another.", "tracks.level.all": "For everyone", "tracks.level.patient": "For patients", "tracks.level.student": "For students", "tracks.next": "Next: {title}", "tracks.position": "Track {title}: step {n} of {total}", "tracks.previous": "Previous: {title}", "tracks.quizDone": "Quiz done", "tracks.read": "Read", "tracks.start": "Start with {title}", "tracks.stepLabel": "Learning track", "tracks.steps": "{count, plural, one {# article} other {# articles}}", "tracks.title": "Learning tracks", "tracks.translationMissing": "This track has not been translated yet, so it is shown in another language.", "translation.help": "Help translate it", "translation.missing": "This article has not been translated yet, so it is shown in the original language.", "update.button": "Update", "update.text": "A new version of Heart Atlas is available.", "viewer.attribution": "3D model: Heart Atlas contributors, CC BY-SA 4.0, based on {source}.", "viewer.canvasLabel": "Interactive 3D model of the heart", "viewer.clear": "Clear", "viewer.disease.aortic-regurgitation": "The aortic valve does not close fully, so a gap stays in it. In long-standing regurgitation the left ventricle widens.", "viewer.disease.aortic-stenosis.beat": "The aortic valve does not open fully: the opening is narrowed.", "viewer.disease.article": "Article: {title}", "viewer.disease.atrial-fibrillation.beat": "The atria do not contract effectively, so on the model they do not squeeze.", "viewer.disease.atrial-septal-defect": "The marker shows where the hole in the wall between the atria is. The model does not show the hole itself.", "viewer.disease.coronary-heart-disease": "An example: a heart attack in the lower (inferior) wall of the left ventricle. The area usually supplied by the right coronary artery is coloured darker.", "viewer.disease.coronary-heart-disease.beat": "While the heart beats, the coloured area moves less than the rest of the wall.", "viewer.disease.dilated-cardiomyopathy": "The left ventricle is enlarged.", "viewer.disease.dilated-cardiomyopathy.beat": "It contracts less than normal.", "viewer.disease.heart-failure.beat": "Heart failure with reduced ejection fraction: the ventricles contract less than normal.", "viewer.disease.hypertension": "The left ventricle is highlighted: in high blood pressure its wall can thicken (hypertrophy). The model does not show wall thickness.", "viewer.disease.hypertrophic-cardiomyopathy": "The left ventricle is highlighted, and its part next to the septum is darker. In HCM the left ventricular wall in adults is 15 mm or thicker in at least one part, often unevenly because of the septum. The model does not show wall thickness.", "viewer.disease.marker.atrial-septal-defect": "Septal defect", "viewer.disease.marker.ventricular-septal-defect": "Septal defect", "viewer.disease.mitral-regurgitation": "The mitral valve does not close fully, so a gap stays in it. In severe regurgitation the left atrium widens.", "viewer.disease.mitral-stenosis": "The left atrium is enlarged.", "viewer.disease.mitral-stenosis.beat": "The mitral valve does not open fully: the opening is narrowed.", "viewer.disease.note": "The signs of disease are a schematic: sizes and colours are chosen to be easy to see.", "viewer.disease.pick": "Show on the model", "viewer.disease.pick.normal": "Normal heart", "viewer.disease.pulmonary-hypertension": "The right ventricle is highlighted: in pulmonary hypertension its wall thickens, and later it widens. The model does not show wall thickness.", "viewer.disease.pulmonary-valve-stenosis.beat": "The pulmonary valve does not open fully: the opening is narrowed.", "viewer.disease.restrictive-cardiomyopathy": "Both atria are enlarged; the left ventricle is usually not enlarged.", "viewer.disease.sources": "Sources for the model:", "viewer.disease.startBeat": "Start the heartbeat to see how the motion changes.", "viewer.disease.thoracic-aortic-aneurysm": "The ascending aorta is widened. There is no single size at which a widening is called an aneurysm.", "viewer.disease.tricuspid-regurgitation": "The tricuspid valve does not close fully, so a gap stays in it. The right atrium is enlarged; most often the cause is a widened right ventricle.", "viewer.disease.ventricular-septal-defect": "The marker shows where the hole in the wall between the ventricles is; the model does not show the hole itself. With a large flow through the hole, the left atrium and left ventricle widen.", "viewer.disease.view": "Model", "viewer.disease.view.disease": "With the disease", "viewer.disease.view.normal": "Normal", "viewer.error": "The 3D model could not be loaded. The list of structures still works.", "viewer.ghost": "See-through chambers", "viewer.group.artery": "Great arteries", "viewer.group.cardiac-vein": "Cardiac veins", "viewer.group.chamber": "Chambers", "viewer.group.conduction": "Conduction system", "viewer.group.coronary-artery": "Coronary arteries", "viewer.group.layer": "Model layers", "viewer.group.muscle": "Papillary muscles", "viewer.group.septum": "Septa", "viewer.group.valve": "Valves", "viewer.group.vein": "Great veins", "viewer.heartbeat.fibrillation": "Ventricular fibrillation: the ventricles quiver but pump no blood. The model does not draw the quivering, so it stays still.", "viewer.heartbeat.note": "The heartbeat is a schematic: the atria and then the ventricles contract and the valves open in time with a model of the cardiac cycle, but the size of the movement is exaggerated so it is easy to see.", "viewer.heartbeat.rate": "Heart rate", "viewer.heartbeat.rateValue": "{rate} beats per minute", "viewer.heartbeat.start": "Start the heartbeat", "viewer.heartbeat.stop": "Stop the heartbeat", "viewer.isolate": "Show only the selected structure", "viewer.keyboardHelp": "Drag to rotate. Click the model, then scroll or pinch to zoom. With the keyboard, focus the model, then use the arrow keys to rotate, + and − to zoom, and 0 or Home to reset the view.", "viewer.load": "Show the 3D model", "viewer.loading": "Loading the 3D model…", "viewer.none": "nothing", "viewer.posterAlt": "The heart seen from the front: chambers, great vessels and coronary arteries", "viewer.schematic": "The conduction system is a schematic drawing: its position is approximate, placed after a published anatomical description rather than taken from the source model.", "viewer.section": "Cut", "viewer.section.frontal": "Front and back", "viewer.section.off": "No cut", "viewer.section.position": "Cut position", "viewer.section.sagittal": "Left and right", "viewer.section.transverse": "Top and bottom", "viewer.selected": "Selected", "viewer.structures": "Structures", "viewer.unavailable": "This browser cannot show 3D graphics (WebGL). The picture and the list of structures still work." }