Cardiac pacemaker controls the rate of contraction for the entire heart muscle because its cells have the quickest rate of spontaneous depolarization, thus they initiate action potentials the quickest. The action potential generated by the SA node passes down the electrical conduction system of the heart, and depolarizes the other potential pacemaker cells (AV node) to initiate action potentials before these other cells have had a chance to generate their own spontaneous action potential, thus they contract and propagate electrical impulses to the pace set by the cells of the SA node. This is the normal conduction of electrical activity in the
Strain rate imaging Cardiac stress test), the regional dysfunction due to ischemia will become evident when the myocardial oxygen demand surpasses the Coronary flow reserve of a stenosed coronary artery. Strain rate imaging during stress has been shown to give incremental value over ordinary echocardiography, both diagnostic and prognostic. In stress echo, the increased heart rate has speckle tracking at a disadvantage, due to the limited frame rate that affects tracking at higher heart rates. In Left bundle branch block (LBBB), the asynchronous activation of the left ventricle gives asynchronous contraction as well. This asynchrony can be visualised by ordinary echocardiography. It can