…can cause hemiparesis, aphasia and radiological changes resembling ischaemic stroke. Glucose measurement is therefore always part of the initial stroke assessment [1]. Treat immediately when…

…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…

…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…

…increased embolic potential include: Greater thrombus mobility. Protrusion into the LV cavity. Visualization on multiple imaging planes. Location adjacent to hyperkinetic myocardium. Large thrombus burden…

…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…

…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…

…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…

…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…

…in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal cardiovascular Imaging 16 (3)…

…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…

…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…

…increase the risk of stroke and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the…

…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…

…the diagnosis of heart failure is clinically secure and the LVEF measurement is reliable. Nevertheless, these findings increase diagnostic confidence. The presence of symptoms alone…

…despite often having a greater burden of cardiovascular and non cardiovascular comorbidity than patients with reduced EF. Pathophysiology Abnormal ventricular relaxation and increased filling pressures…

…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…

…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…

…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…

…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…

…focuses on practical diagnostic and therapeutic considerations, with recommendations aligned with current guidelines from both the American Heart Association (AHA) and American College of Cardiology…

…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…

…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…

…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…

…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…

…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…

…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…

…entirely outside of the ventricular conduction system, and thus the ventricular depolarization is slow (yielding a wide QRS complex). Because the ventricular depolarization is abnormal…

…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…

…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…

…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…

…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…

…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…

…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…

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

…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…

…acute stressor superimposed on the patient's baseline cardiovascular state. For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia…

…OAC) hinges on a rigorous assessment of both thromboembolic and hemorrhagic risks. The diagnostic prerequisite for clinical AF remains the documentation of the arrhythmia via…

…increased afterload. ECG changes in hypertrophy and dilatation Increased QRS amplitudes Hypertrophy manifests on the ECG as increased amplitudes of the QRS complexes. The explanation…

…of skin color is not necessary to confirm cardiac arrest. Skin color is pale or cyanotic, but this may be difficult to discern depending on…

…by elevated levels of cardiac proteins in the blood. Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following…