…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…

…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…

…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…

…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…

…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…

…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…

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

…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…

…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…

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…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…failure may occur in the context of acute myocardial ischaemia, though abnormal cardiac troponin (cTn) values in the setting of acute or chronic heart failure…

…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…

…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…

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

…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…

…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…

…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…

…Rhythm control, on the other hand, attempts to restore sinus rhythm by use of antiarrhythmic drugs. Randomized controlled trials have not demonstrated any clear difference…

…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…

…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…

…Ejection fraction, % 55 45–54 30–44 <30 55 45–54 30–44 <30 2D, Two dimensional. Ejection fraction (EF) Normal Mildly abnormal Moderately abnormal…

…ml/beat) < 30 30 59 59 Regurgitation volume = EROA x TVI Regurgitation fraction (%) < 30 30 49 49 Miscellaneous parameters Mild regurgiation Moderate…

…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…

…been described in HFpEF, while nitrosative stress and abnormalities of cellular and molecular myocardial function may further impair contraction and relaxation. Structural and vascular consequences…

…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…

…other situations than does ventricular rhythm; idioventricular rhythm is primarily seen after reperfusion in an occluded coronary artery. It also occurs as side effect of…

…Evaluation of antiarrhythmic treatment or pacemaker function. Suspected bradyarrhythmia or pauses, particularly at night. Symptom–rhythm correlation in non specific complaints. The choice of recording…

…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…