…as misalignment can lead to incorrect interpretation of perfusion differences. Perfusion assessment The assessment of myocardial regions in myocardial perfusion imaging (MPI) is based on…

…Increased QRS amplitude. Diminished T wave amplitude Osborn like waves. ST segment elevation in leads V1–V2. All degrees of AV block. Sinus node dysfunction…

…and population level risk estimation, but it does not characterize body composition, fat distribution, skeletal muscle mass, physical fitness or individual health status. In particular…

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

…The most classical ECG finding is generalized ST segment depressions with curved ST segment (generalized implies that the depressions may occur in most ECG leads)…

…spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left ventricular function may lead to myocardial infarction, ventricular tachycardia…

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

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…

…atrial rate (beats/min)? P waves should precede every QRS complex and the P wave should be positive in lead II. Common findings Sinus rhythm …

…females) C: Incomplete Right Bundle Branch Block (rSR' pattern in lead V1 and qRS pattern in V6 with QRS duration <120 ms) D: Profound sinus…

…from one beat to another (in the same lead). This is due to the swinging back and forth of the heart in the pericardial space…

…wave is positive in limb lead II. Normal (physiological) causes of sinus bradycardia Sinus bradycardia (SB) is considered a normal finding in the following circumstances…

…focus in the ventricles will spread abnormally (because the impulse did not enter the ventricles through the bundle of His). Abnormal depolarization will consequently lead…

…tachycardia A regular rhythm with P waves that differ in contour from sinus P waves. If the P waves in lead II are retrograde (negative)…

…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…

…classification Heart failure (HF) is a clinical syndrome in which the heart cannot deliver blood at a rate appropriate to tissue requirements unless filling pressures…

…misunderstood, particularly in the setting of ischemia. Normal T wave inversion An isolated (single) T wave inversion in lead V1 is common and normal. It…

…atrial rate (beats/min)? P waves should precede every QRS complex and the P wave should be positive in lead II. Common findings Sinus rhythm …

…must then enlarge (hypertrophy) in order to manage to pump blood into the right ventricle. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and…

…This slow propagation leads to a delayed and abnormal activation sequence of the right ventricle, resulting in a prolonged and abnormal QRS complex on the…

…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…

…ultimately prevailed. The need for a standardized global definition led to early efforts by the World Health Organization in the mid 20th century, relying primarily…

…framed by Virchow’s triad: blood stasis, endothelial dysfunction, and hypercoagulability [1] [2] . Mechanical stasis in AF is most pronounced in the left atrial appendage …

…atrial lead and triggers ventricular stimulations. The QRS complex is wide due to ventricular depolarization proceeding outside the conduction system. Figure 4. Pacing in the…

…visible, it is retrograde in lead II (because of the reversed direction of atrial activation) and may be located before or after the QRS complex…

…depressions ≥0,5 mm in at least two anatomically contiguous leads. The transition from ST segment to T wave is more abrupt in ischemia (the…

…acute RV failure. In acute PE, obstruction of pulmonary blood flow increases RV pressure load and may impair RV filling and forward output. The resulting…

…descending artery (LAD) is most commonly involved. The reported prevalence depends substantially on the diagnostic method. Myocardial bridging has been identified in approximately 0.5…

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

…chamber and this leads to dilatation. The most common cause is valvular regurgitation (insufficiency). For example, aortic regurgitation causes the flow of blood from the…

…may emerge due to increased/abnormal automaticity, re entry or triggered activity. All types of myocardial cells may be engaged in initiation and maintenance of…

…As mentioned in Chapter 1, pre excitation causes secondary ST T changes. This is due to the fact that pre excitation leads to abnormal depolarization…

…for each lead and use the longest QT interval obtained. Large U waves that are fused with the T wave should be included in the…

…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…

…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…

…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…

…with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 16 (7), pp…

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

…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…

…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…

…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…

…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…

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

…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…

…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…

…with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 16 (7), pp…

…inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular activation, transient rate related conduction abnormalities…

…an important consideration in older populations. Risk prediction is particularly relevant in adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably…

…in which the heart cannot provide blood flow commensurate with the body’s requirements or can do so only at the cost of elevated filling…

…CMD: resting vascular tone is generally normal, but the increase in coronary blood flow during stress is inadequate. Structural CMD: resting vascular tone is increased…

…atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also contribute to stroke in patients with AF. Stroke risk…

…when cerebral blood flow ceases. In other words, during prolonged cardiac arrest without effective perfusion, one expects fixed, dilated pupils. Conversely, if some blood flow…

…tachycardia (WCT) will be emphasized, as this distinction significantly informs both diagnostic reasoning and treatment decisions in clinical practice. Note that the terms tachycardia and…

…an in depth discussion on mechanisms are referred to Zipes et al . Main causes of cardiac arrhythmias Arrhythmias arise if the impulse formation is abnormal…

…usual mechanisms are responsible for all ventricular rhythms. Increased automaticity (in His Purkinje fibers), abnormal automaticity (in contractile myocardium), re entry (anywhere) or triggered activity…

…pO₂, A–a gradient or PaO₂/FiO₂ Arterial blood gas COHb or MetHb Arterial or venous sample with co oximetry Follow up of pH in…

…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…

…but abnormal or unexpected values should be confirmed with a laboratory analysed plasma glucose when the situation allows. Glucose meters are less reliable in the…

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