…coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection with or without…

…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…

…11.029. Pulmonary valve Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow…

…m2 22 ± 6 29–33 34–39 40 22 ± 6 29–33 34–39 40 ​BSA, Body surface area; LA, left atrial; RA, right atrial.

Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep…

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…

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

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

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

…bilirubin Unconjugated, the others normal Gilbert's syndrome, haemolysis The R value = (ALT / upper limit of normal) / (ALP / upper limit of normal). An R…

…when limiting symptoms, significant electrocardiographic changes, arrhythmias or an abnormal haemodynamic response occurs, or when a predefined target heart rate is reached. Its principal outputs…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal automaticity or re entry mechanisms; triggered activity is a less…

…during ventricular contraction and relaxation. Pericardial effusion is the presence of an abnormal amount of fluid in the pericardial space. It can be caused by…

…Because the conduction system is crucial for rapid and synchronized activation of the ventricles, conduction defects will typically cause abnormal ventricular activation (i.e. contraction)…

…V6. Refer to Figure 1 . Abnormal R wave progression implies that the gradual increase from V1 to V5 is absent. It may be broken, as…

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

…artery into the right ventricle during diastole. The most common cause of abnormal pulmonary regurgitation is pulmonary hypertension. Table 1 presents the causes of pulmonary…

…scores. Each incorporates various clinical parameters to stratify bleeding risk. HAS BLED: Incorporates factors such as hypertension, abnormal renal/liver function, stroke history, bleeding history…

…Left ventricular mass and geometry Women Men Reference Mildy abnormal Moderately abnormal Severely abnormal Reference Mildly abnormal Moderately abnormal Severely abnormal LINEAR METHOD LV mass…

…abnormal often abnormal abnormal, possibly flail CW profile mitral regurgitation weak variable dense Shape CW profile mitral regurgitation parabolic variable early peak, triangular Size left…

…originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g sinus tachycardia with simultaneous left bundle branch block)…

…blood flow increases RV pressure load and may impair RV filling and forward output. The resulting syndrome may progress to systemic congestion, reduced cardiac output…

…fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in decompensated…

…hypercholesterolaemia Other markedly abnormal single risk factors or genetic, rare lipid, or BP disorders Pregnancy Established ASCVD includes previous acute coronary syndrome, chronic coronary syndromes…

…The intramyocardial segment is termed the tunnelled artery. The left anterior descending artery (LAD) is most commonly involved. The reported prevalence depends substantially on the…

…fraction (HFmrEF) is a clinical syndrome defined by the combination of symptoms and/or signs of heart failure and a left ventricular ejection fraction (LVEF…

…Pathophysiology Abnormal ventricular relaxation and increased filling pressures The central hemodynamic abnormality in HFpEF is impaired diastolic function. The left ventricle may have apparently preserved…

…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…

…coronary flow reserve (CFR), reduce microcirculatory conductance, or cause abnormal vasoconstriction of coronary arterioles. Structural and functional mechanisms may coexist. The formal diagnostic construct for…

…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…

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

…8%. This implies that approximately one third of the patients who ultimately had a favorable neurological recovery exhibited an abnormal pupillary reflex upon initial examination…

…clarity, however, tachyarrhythmia is defined as an abnormal and rapid heart rate, whereas tachycardia is defined as the subjective perception of a rapid heart rate…

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

…this chapter, you will learn the physiological basis of all ECG waves and how to determine whether the ECG is normal or abnormal. Although heart…

…the rhythm is referred to as sinus rhythm . An arrhythmia is defined as an abnormal heart rhythm or heart rate, which is not physiologically justified …

…RBBB). In the presence of right bundle branch block, depolarization of the right ventricle relies on electrical impulses originating from the left ventricle. However, these…

…SB at rest due to high vagal tone. These individuals have developed a highly efficient left ventricle, capable of generating sufficient cardiac output at low…

…the QRS complex head in opposite directions, the T wave is said to be discordant which is abnormal. Because most ECG leads have net positive…

…rhythms. Increased automaticity (in His Purkinje fibers), abnormal automaticity (in contractile myocardium), re entry (anywhere) or triggered activity (anywhere) may all cause ventricular arrhythmias. Indeed…

…Extreme dipper 20 % Also unfavourable, particularly in the elderly An abnormal 24 hour rhythm should prompt investigation for sleep apnoea, renal disease and secondary hypertension…

…with respiratory compensation, or a mixed metabolic and respiratory alkalosis if the pCO₂ is too low Normal Abnormal Abnormal A compensated simple disorder, or two…

…use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and a clinical diagnosis, often described as acute brain failure…

…supply of glucose to the brain can cause: difficulty concentrating irritability or abnormal behaviour slurred speech visual disturbance confusion focal neurological signs drowsiness or unconsciousness…

…11.029. Pulmonary valve Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow…

…Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left ventricular (LV) wall thickness [3…

…vascular calcification Albuminuria and proteinuria Neurohormonal activation Plasma volume expansion Myocardial remodelling and fibrosis These processes form part of the broader cardiovascular kidney metabolic syndrome…

…myocardial injury, defined by an elevated cardiac troponin (cTn) value with at least one value above the 99th percentile upper reference limit (URL). The injury…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS)…

…Myocardial injury Myocardial injury is a biochemical diagnosis defined by at least one cardiac troponin value above the assay specific 99th percentile upper reference limit…

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

…pulmonary venous hypertension caused by left heart disease from pulmonary vascular disease. Although a PAWP of 12 mmHg represents the upper limit of normal in…

…injury. Myocardial injury Myocardial injury is defined by at least one cardiac troponin (cTn) concentration above the assay specific 99th percentile upper reference limit (URL)…

…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…

…after infarction and after successful reperfusion (PCI). Post ischemic T wave inversion is caused by abnormal repolarization. These T wave inversions are symmetric with varying…

…dysfunction, and hypercoagulability [1] [2] . Mechanical stasis in AF is most pronounced in the left atrial appendage (LAA). The LAA is a highly trabeculated, windsock…

…ventricular hypertrophy, and to the left in left ventricular hypertrophy). ST T segment Significant hypertrophy may result in abnormal depolarization of the ventricular myocardium. This…

…For laypeople, confirming absent or abnormal breathing is sufficient to alert the emergency service and commence CPR. Agonal breathing before apnea A cardiac arrest occurs…

…define an upper reference limit . Any value above the upper reference limit is considered elevated (abnormal) and thus indicates myocardial necrosis. The upper reference limit…