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

…favorable neurological recovery exhibited an abnormal pupillary reflex upon initial examination. Notably, 31.2% of patients discharged with intact neurological function were observed to lack…

…depolarizes the ventricles) passes through the bundle of His, and hence it originates in the atria. In other words: tachycardias with narrow QRS complexes originate…

…to the QRS morphology during LBBB. Stimulation in other regions of the ventricle may result in a different QRS morphology. If the lead tip is…

…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…

…is myocardial ischaemia caused by transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural…

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

…part of the initial stroke assessment [1]. Treat immediately when there are symptoms and a low glucose. Do not wait for the venous laboratory result…

…by itself identify the cause. The result must always be weighed together with the clinical picture, medication, fluid balance, renal function, electrolytes and supplemental oxygen…

…of the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused by structural or functional microvascular abnormalities, impaired coronary flow reserve, reduced microcirculatory conductance, or abnormal…

…patient to recite the months of the year backwards. A normal result does not exclude delirium, however, and an abnormal result is not specific to…

…potentially indicating microvascular dysfunction or other pathologies. The software allows for detailed regional analysis of myocardial perfusion, highlighting specific segments of the left ventricle that…

…events in the setting of a stent thrombosis or restenosis. Type 1 myocardial infarction Definition and pathophysiology Type 1 MI results from acute coronary atherothrombosis…

…platelets and coagulation factors, which results in thrombus formation (Figure 1). Disruption of an atherosclerotic plaque may also release atherosclerotic debris downstream, causing microvascular embolization…

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

…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…

…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…

…simultaneously as the cause of the arrhythmia already affects cellular function. This results in electrical instability which explains why ventricular tachycardia may progress to ventricular…

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…

…Significant hypertrophy may result in abnormal depolarization of the ventricular myocardium. This is presumably due to a mismatch between the expansion of contractile cells as…

…leads [7]. These stricter parameters correlate more closely with abnormal LV mechanical function and the potential benefit of resynchronization pacemaker therapy [7]. R Wave Peak…

…stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available…

…pulmonary arterial remodelling, with fibroproliferative, plexogenic, and sometimes thrombotic changes that may result in near total obliteration of affected vessels. Genetic, molecular, and acquired factors…

…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…

…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…

…within the AV node, further slowing the transmission of impulses. Intense parasympathetic activity can result in a complete blockage of impulse conduction. If such blockage…

…T wave should be included in the measurement. This may result in an overestimation of the QT interval. If the patient uses QT prolonging drugs…

Diastolic function Criteria Normal, young Normal, adult Abnormal relaxation (grade 1 dysfunction) Pseudonormal (grade 2 dysfunction) Reversible restrictive filling (grade 3 dysfunction) Irreversible restrictive filling…

…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…

…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…

…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…

…with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and prognosis…

…LV aneurysm formation, and reduced LV systolic function. The principal mechanisms are the combination of an abnormal thrombogenic endocardial surface and blood stasis. During the…

…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…

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

…defect): constellations of bundle branch blocks and fascicular blocks (hemiblocks) This chapter discusses intraventricular conduction delays (defects), which are caused by functional or anatomical defects…

…ischemia. Inverted U waves are even more typical of ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes…

…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…

…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…

…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)…

…with the Society for Cardiovascular Magnetic Resonance. In Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 30 (4…

…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…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…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…

…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…

…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…

…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…

…structural or functional abnormalities of the coronary microcirculation. These abnormalities may impair coronary flow reserve (CFR), reduce microcirculatory conductance, or cause abnormal vasoconstriction of coronary…

…to ECG interpretation 1. Which of the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family history? A:…

…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…

…the ECG is normal or abnormal. Although heart rhythm will be discussed in detail in the next chapters, fundamental aspects of rhythm will also be…

…considered abnormal. On the other hand, sinus bradycardia developing during physical exercise is considered abnormal, because heart rate must increase during exercise. Mechanisms of cardiac…

…an anatomical or functional dysfunction in the right bundle branch, such that the electrical impulse is blocked. Figure 1 illustrates the components of the ventricular…

ECG Myocardial ischemia and infarction T wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided…

…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…

…arrhythmic origin. Assessment of rate control in atrial fibrillation. Suspected paroxysmal atrial fibrillation, including after cryptogenic stroke. Evaluation of antiarrhythmic treatment or pacemaker function. Suspected…

…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…

…ATTR CA typically present as heart failure with preserved ejection fraction (HFpEF), and a multitude of clinical symptoms cannot reliably distinguish AL from ATTR CA…