…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…

…determine whether the ECG waves and intervals are normal. This chapter will focus on the ECG waves in terms of morphology (appearance), durations and intervals…

…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…

…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…

…a standardized framework for identifying and localizing areas of ischemia or infarction. This segmentation facilitates precise reporting and ensures consistent communication of findings across clinicians…

…Figure 1. Characteristics of ischemic ST segment depressions on ECG. Current guideline criteria for ischemic ST segment depression: New horizontal or downsloping ST segment depressions…

…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…

…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…

…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 (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings, cardiac biomarkers, imaging, angiography, and, occasionally, pathological examination…

…120 seconds of cardiac arrest and light reactivity is lost when cerebral blood flow ceases. In other words, during prolonged cardiac arrest without effective perfusion…

…and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These findings determine…

…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…

…systemic inflammation Insulin resistance Abnormal adipokine signalling Endothelial dysfunction Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate Development of type 2 diabetes…

…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…

…size and volume Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly abnormal Moderately abnormal Severely abnormal ATRIAL DIMENSIONS LA diameter…

…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…

…ECG diagnosis and management Atrial fibrillation is the most common abnormal tachyarrhythmia (only sinus tachycardia is more common). The prevalence of atrial fibrillation correlates strongly…

…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…

…exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic blood pressure, particularly when accompanied by evidence of ischaemia, may indicate…

…and reduced LV systolic function. The principal mechanisms are the combination of an abnormal thrombogenic endocardial surface and blood stasis. During the acute infarction phase…

…at a rate exceeding that of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal automaticity or re entry mechanisms…

…amount of serous fluid which acts as a lubricant that prevents friction during ventricular contraction and relaxation. Pericardial effusion is the presence of an abnormal…

…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 …

…through the bundle of His). Abnormal depolarization will consequently lead to abnormal repolarization. This explains the secondary ST T changes seen on premature ventricular complexes…

…Lane DA, Lip GYH. Evaluation of the HAS BLED, ATRIA, and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin. Am J Med . 2016…

…54 30–44 <30 2D, Two dimensional. Ejection fraction (EF) Normal Mildly abnormal Moderately abnormal Severely abnormal Ejection fraction (%), biplan, males 52 72 41 51…

…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…

…competing risk of death from non cardiovascular causes, an important consideration in older populations. Risk prediction is particularly relevant in adults with elevated blood pressure…

…substantially on the diagnostic method. Myocardial bridging has been identified in approximately 0.5–12% of angiographic series and up to 5–75% of CT…

…deliver blood at a rate appropriate to tissue requirements unless filling pressures are elevated. The syndrome is therefore defined by symptoms and signs of congestion…

…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…

…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…

…risk must be considered alongside thromboembolic risk. The HAS BLED score includes hypertension, abnormal renal or liver function, prior stroke, bleeding tendency or previous bleeding…

…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…

…Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended before treatment is started . Suspected white coat hypertension: raised office blood pressure without…

…and supplemental oxygen [1]. Distinguish between: Acidaemia and alkalaemia , which describe the current pH of the blood. Acidosis and alkalosis , which describe processes that lower…

…Delirium is common but often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high…

…delay treatment of a neurologically compromised patient. Continuous glucose monitoring reflects interstitial glucose and lags behind the blood glucose during rapid changes. Pressure on the…

…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…

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

…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…

…artery bypass grafting (CABG). Clinical Presentation and Symptoms The diagnosis of an acute MI remains a comprehensive clinical diagnosis based on patient symptoms, ECG changes…

…tomography (OCT) can reveal lesions that are not apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…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…