…accompanied by already impaired ventricular function, does not allow for adequate filling of the ventricles, which results in reduced stroke volume and reduced cardiac output…

…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…

…studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and…

…function and perform troubleshooting should be considered a basic clinical skill. Pacing activity may be visible or invisible, depending on e.g the type of…

…hypoxia. As a result, pupils often dilate widely within 30–120 seconds of cardiac arrest and light reactivity is lost when cerebral blood flow ceases…

…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…

…due to diminished automaticity (pacemaker function) in the sinoatrial node or conduction defects (e.g. second degree AV block) as a result of ischemia/infarction…

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

…Normal Abnormal Abnormal A compensated simple disorder, or two opposing primary disorders It is therefore not enough to ask which of the pCO₂ and the…

…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…

…of a coronary artery from the pulmonary artery can result in reduced coronary oxygen content, coronary steal, and myocardial ischaemia. Coronary fistulae create an abnormal…

…response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be…

…or abnormal arteriolar vasoconstriction. More than one mechanism may coexist. Supply–demand mismatch MINOCA may result from a mismatch between myocardial oxygen supply and demand…

…ECG interpretation The QRS complex (ventricular complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R and S wave…

…in the ventricles will result in wide QRS complexes because the impulse will spread entirely or partly outside of the conduction system (which is slow…

…specific segments of the left ventricle that demonstrate abnormalities. These tools compare perfusion data to population based reference databases, often adjusted for sex and age…

…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…

…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…

…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…

…of a vulnerable (unstable) atherosclerotic coronary plaque. Upon such damage, the plaque exposes highly thrombogenic materials which activate circulating platelets and coagulation factors, which results…

…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…

…or become abnormal, in the presence of symptoms suggestive of ischaemia and presumed new ischaemic ECG changes. The distinction between myocardial injury and type 2…

…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…

…and certain disease entities can span both categories; for example, acute heart failure may occur in the context of acute myocardial ischaemia, though abnormal cardiac…

…Causes of hyperkalaemia Severe hyperkalemia is usually the result of several interacting factors, such as renal failure, insufficient corticosteroid substitution, acidosis, hemolysis and massive muscle…

…these branches and fascicles, Purkinje fibers extend into the myocardium. Conduction through the Purkinje system is very rapid, due to the high density of gap…

…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…

…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…

…for atrial size and volume Women Men Normal range Mildly abnormal Moderately abnormal Severely abnormal Normal range Mildly abnormal Moderately abnormal Severely abnormal ATRIAL DIMENSIONS…

…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…

Arrhythmias and arrhythmology Drugs and electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT…

…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…

…function. The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the albumin and the bilirubin — and they become abnormal…

…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…

…factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine states. EAT typically has an abrupt onset, although a brief…

…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…

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

…type of infarction may cause pathological R wave progression. However, the specificity for pathological R wave progression is considerably lower than pathological Q waves and…

…discharged in the ventricles it will spread partly or entirely outside of the conduction system and thus produce a wide QRS complex (QRS duration ≥0…

…abnormal renal/liver function, stroke history, bleeding history, labile INR, age 65, and concomitant drug/alcohol use. Some studies suggest HAS BLED has comparable or…

…2015): Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging…

…evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of…

…retrograde (inverted) P waves, which can be located anywhere between the J point and the terminal part of the T wave. PR interval 0,22…

…presence of abnormal clinical risk assessment. Low risk PE is characterized by clinical low risk features, negative cardiac biomarkers, and no imaging evidence of RV…

…present and whether left ventricular systolic function is depressed or preserved Whether hypotension is present Whether an accessory pathway is suspected, particularly before administration of…

…stroke, transient ischaemic attack, and peripheral arterial disease. Heart failure is also considered established clinical CVD in the risk based approach to elevated BP. Risk…

…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…

…raised natriuretic peptides. HF with mildly reduced ejection fraction (HFmrEF) is defined by symptoms and/or signs of HF with LVEF 41–49%. In this…

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

…a normal variant. Explanation: If the QTc value is borderline or abnormal and the heart rate is less than 50 beats/min, it is recommended…

…abnormal renal or liver function, prior stroke, bleeding tendency or previous bleeding, labile international normalized ratio (INR), older age, drugs predisposing to bleeding and alcohol…

…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…

…of intense research activity. This is partly due to the rise of cardiac imaging and invasive electrophysiological methods which allow for detailed in vivo studies…

…specialized conduction system. This slow propagation leads to a delayed and abnormal activation sequence of the right ventricle, resulting in a prolonged and abnormal QRS…

…limb. A rather detailed reference regarding the direction of T waves follows: I, II, aVR, V5 and V6 should display positive T waves in adults…

…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 set up and the instructions decide whether the investigation will be usable. Ambulatory blood pressure monitoring (ABPM) Indications Confirmation of newly detected hypertension — recommended…

…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…

…preserved ejection fraction (HFpEF), and a multitude of clinical symptoms cannot reliably distinguish AL from ATTR CA [8]. However, their clinical trajectories and extracardiac manifestations…