…left ventricular hypertrophy or abnormal LV filling supports the diagnosis Unlike HFpEF, objective evidence of structural or functional cardiac abnormality or raised natriuretic peptides is…

…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…

…an assessment of the morphology (appearance) of the waves and intervals on the ECG curve. Therefore, ECG interpretation requires a structured assessment of the waves…

…Note that 10% of wide complex tachycardias actually originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g…

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

…assessment of myocardial regions in myocardial perfusion imaging (MPI) is based on principles similar to those used in echocardiography. The 17 segment model of the…

…ECG finding is the ST segment depressions. In STE ACS, on the other hand, the ST segment depressions are secondary findings and the primary findings…

…presents ECG findings during normal atrioventricular impulse transmission as well as ECG findings during pre excitation. Figure 1. Hallmarks of pre excitation on the ECG…

…wave amplitude is on average 3 mm in V2–V3 in females and it rarely exceeds 8 mm. Note that the amplitude of the T…

…effect on impulse conduction because digoxin slows impulse conduction. It is important to note that the association between ECG changes and the risk of arrhythmia…

…2nd AV block, prolonged QT interval, and profound sinus bradycardia are typically considered abnormal or profound findings that may require further investigation. 2. What heart…

…infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings, cardiac biomarkers, imaging…

…result, pupils often dilate widely within 30–120 seconds of cardiac arrest and light reactivity is lost when cerebral blood flow ceases. In other words…

…itself. It may cause symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other thromboembolic events. Subclinical…

…Note that 10% of wide complex tachycardias actually originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g…

…In clinical practice, obesity is conventionally defined by a body mass index (BMI) of ≥30 kg/m2. Severe obesity is generally defined as BMI ≥35…

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

…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…

…This is also a normal finding. Abnormal (pathological) causes of sinus bradycardia In all other situations, sinus bradycardia should be regarded as a pathological finding…

…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…

…Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow Jet width colour…

…volume/BSA, mL/m2 22 ± 6 29–33 34–39 40 22 ± 6 29–33 34–39 40 ​BSA, Body surface area; LA, left atrial…

…Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow Jet width colour…

ECG Introduction to ECG interpretation The QRS complex (ventricular complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R…

…characterised by an abnormal prolongation of the QT interval on the surface electrocardiogram (ECG), which predisposes the myocardium to a specific form of polymorphic ventricular…

…formerly termed Prinzmetal or variant angina, is myocardial ischaemia caused by transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible…

…ventricular rate (beta blockers being the mainstay of this therapy). Rate control does not affect the rhythm per se . Rhythm control, on the other hand…

…The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the albumin and the bilirubin — and they become abnormal late…

…imaging have higher diagnostic performance. Its most consistent contemporary role is therefore the assessment of functional capacity, symptoms, haemodynamic responses, arrhythmias and prognosis, with diagnostic…

…be excluded. Diagnostics Echocardiography TTE is the principal initial imaging method for detecting LV thrombus and assessing the substrate on which it develops. The thrombus…

…the diagnosis is straightforward, as sinus P waves are never negative in this lead. When P waves are positive in lead II, comparison of P…

…cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction…

…activation of the ventricles, conduction defects will typically cause abnormal ventricular activation (i.e. contraction). The significance of this will depend on the severity of…

…waves were present on previous recording, the amplitude must be increased in order to suggest ischemia. Inverted U waves are even more typical of ischemia …

…a premature ventricular contraction. Classification of premature ventricular contractions When every other beat on the ECG is a premature ventricular complex (PVC), the rhythm is…

…6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist…

…Body surface area; LV, left ventricular; 2D, 2 dimensional. Left ventricular dimensions Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly…

…Gonzalo; Baumgartner, Helmut et al. (2012): Guidelines on the management of valvular heart disease (version 2012). In European heart journal 33 (19), pp. 2451–2496…

…Moderate or severe chronic kidney disease (CKD) Hypertension mediated organ damage (HMOD) Probable or definite familial hypercholesterolaemia Other markedly abnormal single risk factors or genetic…

…and imaging technique. Coronary fistulae represent abnormal communications between a coronary artery and a cardiac chamber or vessel. Other congenital anomalies include anomalous origin of…

…this group, structural abnormalities such as left atrial enlargement or left ventricular hypertrophy, or echocardiographic evidence of impaired filling, make the diagnosis more likely. HFpEF…

…Clinical Implications and Prognosis Mechanical and Diagnostic Impact LBBB causes extensive reorganization of left ventricular activation [2]. This leads to abnormal LV mechanical function [7…

…cause abnormal vasoconstriction of coronary arterioles. Structural and functional mechanisms may coexist. The formal diagnostic construct for MVA incorporates four components: Symptoms suggestive of myocardial…

…during management of another condition, or identified only by implanted or wearable devices as subclinical AF. Some patients have frequent symptomatic episodes, whereas others have…

…potential risk of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic…

…Hypocalcemia Causes of hypocalcemia Acute pancreatitis, pancreas surgery, alkalosis (hyperventilation), rhabdomyolysis, septicemia (sepsis), osteolytic cancer metastases, abnormal calcium absorption (gastrointestinal) and resorption (from primary urine…

…to the abnormal depolarization sequence of the right ventricle in RBBB, repolarization is also abnormal, leading to secondary ST T changes, which appear on the…

…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…

…the investigation will be usable. Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended before treatment is started . Suspected white coat hypertension…

…ask which of the pCO₂ and the HCO₃ deviates most. What matters is which change can explain the pH, and whether the other variable lies…

…withdrawal, surgery or several concurrent factors. A diagnosis of delirium is therefore the beginning of the investigation, not the end. In a frail older patient…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow Jet width colour…

…which abnormal plasma cells produce misfolded immunoglobulin light chains [8, 19]. Light chains are directly toxic to cardiomyocytes, inducing the elaboration of high levels of…

…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…

…of an acute MI remains a comprehensive clinical diagnosis based on patient symptoms, ECG changes, highly sensitive biochemical markers, and information gleaned from various imaging…

…apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused by structural…

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

…in the myocardium. The electrical potential difference exists between ischemic and normal myocardium and it results in displacement of the ST segment. The ST segment…

…men and women, respectively, should be considered abnormal. A common cause of abnormally large T waves is hyperkalemia, which results in high, pointed and asymmetric…