…6. Which of the following ECG findings is generally considered a normal variant in asymptomatic athletes and typically does not require further evaluation, assuming no…

…Proposed explanations in the source material include cardiac memory after abnormal ventricular activation, transient rate related conduction abnormalities, pacing related repolarization changes, and inadequate coronary…

…the pupils in response to light – is a fundamental neurological examination finding that reflects brainstem (midbrain) function. In the context of cardiac arrest and the…

…block (RBBB) and pre excitation (WPW syndrome) may all cause ST segment depressions. These are all common conditions in which an abnormal depolarization (QRS complex…

…P waves should precede every QRS complex and the P wave should be positive in lead II. Common findings Sinus rhythm (which is the normal…

…reader firm knowledge of normal findings , normal variants (i.e less common variants of what is considered normal) and pathological variants . Thus, in this chapter…

…these abnormalities in the presence of abnormal clinical risk assessment. Low risk PE is characterized by clinical low risk features, negative cardiac biomarkers, and no…

…except in type 2 and type 3 MI. A diagnosis of MI should not be made solely from an abnormal cTn concentration in the absence…

…sex and age, to identify deviations from normal values. This enhances the ability to detect subtle perfusion defects and differentiate between normal and abnormal patterns…

…than in HFpEF. The clinical population is heterogeneous because the HFmrEF range includes both patients with recovering systolic function and those with deterioration from a…

…of obesity or excess abdominal adiposity. Ethnic specific thresholds are lower or otherwise modified in some populations. Cardiometabolic mechanisms Visceral and ectopic fat are particularly…

…P waves should precede every QRS complex and the P wave should be positive in lead II. Common findings Sinus rhythm (which is the normal…

…L/min from rest to exercise. This response is age dependent and may rarely occur in healthy people older than 60 years. The abnormal slope…

…The physiological advantages of this configuration have been discussed in Chapter 1. Some individuals, however, possess an additional pathway between the atria and the ventricles…

…1 ). If the T wave and the QRS complex head in opposite directions, the T wave is said to be discordant which is abnormal. Because…

…normal finding. The regurgitation results in blood flowing back from the pulmonary artery into the right ventricle during diastole. The most common cause of abnormal…

…discover SB in healthy young individuals who are not well trained. This is also a normal finding. Abnormal (pathological) causes of sinus bradycardia In all…

…considered abnormal. For example, sinus bradycardia (a slow rhythm directed by the sinoatrial node) is a common finding in athletes and during sleep; in these…

…it may also provoke abnormal automaticity in cells that normally do not exhibit automaticity. The effect on automaticity should be distinguished from the effect on…

…adult Abnormal relaxation (grade 1 dysfunction) Pseudonormal (grade 2 dysfunction) Reversible restrictive filling (grade 3 dysfunction) Irreversible restrictive filling (grade 4 dysfunction) E/A ratio…

…regurgitation Jet size < 5cm² 5 10 cm² 10 cm² size vena cava inferior < 2,1 cm and compressible in between 2,1 cm…

…for atrial size and volume Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly abnormal Moderately abnormal Severely abnormal ATRIAL DIMENSIONS…

…for evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication…

…in V5. The third vector: the ventricular free wall The vectors resulting from activation of the ventricular free walls is directed to the left and…

…In patients with severe mental illness (SMI) receiving antipsychotic therapy, sinus tachycardia is common, and symptoms may reflect underlying arrhythmia or sudden cardiac death (SCD…

…transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in…

…appendage and enter the systemic circulation which causes thromboembolic occlusions of arteries in the brain, limbs or other organs. However, the increased risk in mortality…

…the liver are the prothrombin time (INR) , the albumin and the bilirubin — and they become abnormal late. A cirrhotic liver can have entirely normal transaminases…

…for appropriately selected patients. Pathophysiological basis Exercise progressively increases myocardial oxygen demand through increases in heart rate, myocardial contractility and blood pressure. When coronary blood…

…Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise after MI, mechanical complications should be considered. Transthoracic echocardiography (TTE…

…response. The ECG in ectopic atrial rhythm and atrial tachycardia A regular rhythm with P waves that differ in contour from sinus P waves. If…

…of an abnormal amount of fluid in the pericardial space. It can be caused by numerous local and systemic disorders. Accumulation of fluid in the…

…cause abnormal ventricular activation (i.e. contraction). The significance of this will depend on the severity of the conduction defect and the affected ventricle. In…

…gradually from V1 to V5 and then diminishes again in V6. Refer to Figure 1 . Abnormal R wave progression implies that the gradual increase from…

…as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle. It is caused by an impulse discharged from an ectopic…

…GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur…

…chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal…

…for evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication…

…Moderate ≥2% to <10% High ≥10% to <20% Very high ≥20% The risk categories are distinct from the treatment threshold used in the BP guidelines…

…coronary artery from the pulmonary artery can result in reduced coronary oxygen content, coronary steal, and myocardial ischaemia. Coronary fistulae create an abnormal connection between…

…of cardiovascular and non cardiovascular comorbidity than patients with reduced EF. Pathophysiology Abnormal ventricular relaxation and increased filling pressures The central hemodynamic abnormality in HFpEF…

…the mid QRS in at least two left facing leads [7]. These stricter parameters correlate more closely with abnormal LV mechanical function and the potential…

…bridging; myocardial metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis…

…one in five strokes. Thrombus formation is most commonly related to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small…

…seconds) indicate the ventricles are depolarized via the His Purkinje system and thus the impulse originates in the atria (i.e the arrhythmia is supraventricular)…

…hyperventilation), rhabdomyolysis, septicemia (sepsis), osteolytic cancer metastases, abnormal calcium absorption (gastrointestinal) and resorption (from primary urine), renal failure, small bowel syndrome, parathyroid gland surgery, use…

…prolonged and abnormal QRS complex on the ECG. The hallmark of right bundle branch block is QRS duration ≥0,12 seconds, large R' wave in…

…ventricular rhythm and idioventricular rhythm The usual mechanisms are responsible for all ventricular rhythms. Increased automaticity (in His Purkinje fibers), abnormal automaticity (in contractile myocardium…

…particularly in the elderly An abnormal 24 hour rhythm should prompt investigation for sleep apnoea, renal disease and secondary hypertension, and lead to one dose…

…Normal Abnormal Abnormal A compensated simple disorder, or two opposing primary disorders It is therefore not enough to ask which of the pCO₂ and the…

…however, and an abnormal result is not specific to delirium. Symptoms are often worse in the evening and at night, but diurnal variation is not…

…hypoglycaemia No defined threshold The patient has cognitive or physical impairment and needs help from another person Level 3 can occur even when the glucose…

…regurgitation Jet size < 5cm² 5 10 cm² 10 cm² size vena cava inferior < 2,1 cm and compressible in between 2,1 cm…

…chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis [8, 15]. AL Amyloidosis: This is a plasma cell dyscrasia in which abnormal plasma cells produce misfolded immunoglobulin…

…renal function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to the renal veins and can…

…a documented rise and/or fall of cTn values. However, myocardial injury alone is an entity in itself and may arise from non ischaemic cardiac…

…or abnormal arteriolar vasoconstriction. More than one mechanism may coexist. Supply–demand mismatch MINOCA may result from a mismatch between myocardial oxygen supply and demand…

…myocardial infarction in which death occurs before biomarkers can be obtained or become abnormal, in the presence of symptoms suggestive of ischaemia and presumed new…

…transition from ST segment to T wave is smooth, and not abrupt. ST segment deviation (elevation, depression) is measured as the height difference (in millimeters…

…abnormal. A common cause of abnormally large T waves is hyperkalemia, which results in high, pointed and asymmetric T waves. These must be differentiated from…