…systolic function. This dynamic nature makes prior imaging particularly important when interpreting a current LVEF of 41–49%. Diagnostic phenotype Criterion HFmrEF Symptoms and/or…

…the sinoatrial node) is a common finding in athletes and during sleep; in these scenarios, it should not be considered abnormal. On the other hand…

…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…

…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…

…without haemodynamic instability require more detailed prognostic evaluation using two complementary domains: Indicators of acute PE severity , including clinical findings, RV dysfunction on imaging, and…

…defects and differentiate between normal and abnormal patterns. Reverse redistribution (RR) Reverse redistribution (RR) in SPECT myocardial perfusion imaging is an unusual phenomenon in which…

…on the other hand, the ST segment depressions are secondary findings and the primary findings are the ST segment elevations. As explained in the previous…

…ECG findings during pre excitation. Figure 1. Hallmarks of pre excitation on the ECG. Secondary ST T changes during pre excitation As mentioned in Chapter…

…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…

…Hence, arrhythmias may occur in the absence of ECG changes and vice versa (i.e. ECG changes may be pronounced without any arrhythmias occurring). Plasma…

…is borderline or abnormal and the heart rate is less than 50 beats/min? A: Proceed directly to an exercise ECG test without repeating the…

…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…

…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…

…segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular activation…

…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…

…adiposity. Ethnic specific thresholds are lower or otherwise modified in some populations. Cardiometabolic mechanisms Visceral and ectopic fat are particularly relevant to cardiovascular risk. Excess…

…studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and…

…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…

Diastolic function Criteria Normal, young Normal, adult Abnormal relaxation (grade 1 dysfunction) Pseudonormal (grade 2 dysfunction) Reversible restrictive filling (grade 3 dysfunction) Irreversible restrictive filling…

…cm 1.5–2.1 2.2–2.5 2.6–2.9 3.0 RV SIZE AND FUNCTION (MEASURED IN A4C) RV diastolic area…

…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…

…Part 1: aortic and pulmonary regurgitation (native valve disease). In European journal of echocardiography : the journal of the Working Group on Echocardiography of the European…

…of the action potential occur from one contractile cell to another, starting in the endocardium and heading towards the epicardium. As evident from Figure 7 …

…Drugs and electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT interval on the…

…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…

…stroke and two times increased mortality, as compared with individuals without atrial fibrillation. The increased risk of stroke is explained by formation of thrombi in…

…E), iron studies and ferritin, ANA, SMA, AMA, IgG subclasses, caeruloplasmin in people under 40, alpha 1 antitrypsin, TSH and coeliac serology , together with ultrasound…

…prominent as a primary diagnostic test for obstructive coronary artery disease (CAD), because coronary computed tomography angiography (CCTA) and functional imaging have higher diagnostic performance…

…on multiple imaging planes. Location adjacent to hyperkinetic myocardium. Large thrombus burden. Cardiac magnetic resonance (CMR) can further characterize thrombus morphology and may assist in…

…may also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine…

…a lubricant that prevents friction during ventricular contraction and relaxation. Pericardial effusion is the presence of an abnormal amount of fluid in the pericardial space…

…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…

…notches are required in the S wave or R wave. Fragmented QRS complexes are indications of previous myocardial infarction. There are imaging studies demonstrating that…

…interchangeably in this discussion. A premature ventricular complex is recognized on the ECG as an abnormal and wide QRS complex occurring earlier than expected in…

…abnormal renal/liver function, stroke history, bleeding history, labile INR, age 65, and concomitant drug/alcohol use. Some studies suggest HAS BLED has comparable or…

…echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal cardiovascular Imaging 16…

…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…

…according to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification…

…The wide range reflects differences in ascertainment and imaging technique. Coronary fistulae represent abnormal communications between a coronary artery and a cardiac chamber or vessel…

…patients with reduced EF. Pathophysiology Abnormal ventricular relaxation and increased filling pressures The central hemodynamic abnormality in HFpEF is impaired diastolic function. The left ventricle…

…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…

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

…abnormal renal or liver function, prior stroke, bleeding tendency or previous bleeding, labile international normalized ratio (INR), older age, drugs predisposing to bleeding and alcohol…

…morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic considerations, with recommendations aligned…

…cardiac action potential may be altered by electrolyte imbalance, owing to changes in intra and extracellular electrolyte concentrations. Some electrolyte imbalances are clinically negligible (from…

…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…

…rhythm. Recognizing these arrhythmias on the electrocardiogram (ECG) is of clinical importance. Diagnosis and management of ventricular tachycardia will be addressed in a separate chapter…

…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…

…of pH and the metabolic component, but it should not be regarded as fully interchangeable with an arterial sample [3]. Venous pH is on average…

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

…for example after relatives have given carbohydrate or glucagon. In a person without diabetes, a hypoglycaemic disorder is defined primarily by Whipple's triad : 1…

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

…history of increasing frequency of hospitalizations and visits for heart failure without disease recognition in the 3 years preceding diagnosis is also a notable red…

…m² Abnormal urinalysis or renal imaging Risk of progression rises with proteinuria and depends on cause 2 60 mL/min/1.73 m² Abnormal urinalysis…

…clinical diagnosis based on patient symptoms, ECG changes, highly sensitive biochemical markers, and information gleaned from various imaging techniques. For types 1, 2, and 3…

…50% or more in any potential infarct related artery. MINOCA is not a definitive disease diagnosis. It is a descriptive and provisional classification that should…

…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…

…changes into primary and secondary. Primary and secondary ST T changes Primary ST T changes are caused by abnormal repolarization . This is seen in ischemia…

…abnormally large T waves is hyperkalemia, which results in high, pointed and asymmetric T waves. These must be differentiated from hyperacute T waves seen in…