Visual assessment of regional wall motion (left ventricle) TYPE OF MOTION DEFINITION WALL MOTION SCORE Normal Normal thickening (typically 30% thickening from end diastole to…

…the S wave does not reach the baseline. The second R wave (denoted R') is virtually always larger than the first R wave. Leads V5…

…rhythms. Increased automaticity (in His Purkinje fibers), abnormal automaticity (in contractile myocardium), re entry (anywhere) or triggered activity (anywhere) may all cause ventricular arrhythmias. Indeed…

…attention. The ventricular rate is typically very high (100–250 beats per minute) and cardiac output is affected (i.e reduced) in virtually all cases…

…not exclude delirium, however, and an abnormal result is not specific to delirium. Symptoms are often worse in the evening and at night, but diurnal…

…glucose to the brain can cause: difficulty concentrating irritability or abnormal behaviour slurred speech visual disturbance confusion focal neurological signs drowsiness or unconsciousness seizures coma…

…ventricles. This increases the automaticity in cells with natural automaticity but it may also provoke abnormal automaticity in cells that normally do not exhibit automaticity…

…rate is usually set to 60 beats/min. The base rate is virtually always 50 beats/min, meaning that any heart rate below 50 beats…

…uncommon that sinus arrest leads to persistent asystole; latent pacemakers virtually always awake and salvage the rhythm. Adam Stokes attack Syncope due to sinus arrest…

…ST segment depressions. These are all common conditions in which an abnormal depolarization (QRS complex) causes abnormalities in the repolarization (ST T segment). For example…

…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…

…11.029. Pulmonary valve Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow…

…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 regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep…

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…

…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)…

…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…

…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…

…when limiting symptoms, significant electrocardiographic changes, arrhythmias or an abnormal haemodynamic response occurs, or when a predefined target heart rate is reached. Its principal outputs…

…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…

…of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal automaticity or re entry mechanisms; triggered activity is a less…

…during ventricular contraction and relaxation. Pericardial effusion is the presence of an abnormal amount of fluid in the pericardial space. It can be caused by…

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

…V6. Refer to Figure 1 . Abnormal R wave progression implies that the gradual increase from V1 to V5 is absent. It may be broken, as…

…discussion. A premature ventricular complex is recognized on the ECG as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle…

…artery into the right ventricle during diastole. The most common cause of abnormal pulmonary regurgitation is pulmonary hypertension. Table 1 presents the causes of pulmonary…

…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…

…wave systolic flow reversal, Qualitative parameters Mild regurgiation Moderate regurgitation Severe regurgitation Mitral valve apparatus normal or mildly abnormal often abnormal abnormal, possibly flail CW…

…actually originate from the atria but the QRS complexes become wide due to abnormal ventricular depolarization (e.g sinus tachycardia with simultaneous left bundle branch…

…either RV dysfunction or elevated biomarkers, or neither of these abnormalities in the presence of abnormal clinical risk assessment. Low risk PE is characterized by…

…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…

…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…

…in ascertainment and imaging technique. Coronary fistulae represent abnormal communications between a coronary artery and a cardiac chamber or vessel. Other congenital anomalies include anomalous…

…Evidence such as increased left atrial size, left ventricular hypertrophy or abnormal LV filling supports the diagnosis Unlike HFpEF, objective evidence of structural or functional…

…patients with reduced EF. Pathophysiology Abnormal ventricular relaxation and increased filling pressures The central hemodynamic abnormality in HFpEF is impaired diastolic function. The left ventricle…

…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…

…vasoconstricting mediators, producing abnormal vascular responses and potentially increasing the future risk of obstructive coronary disease. ANOCA/INOCA is heterogeneous. Potential mechanisms include: CMD; epicardial…

…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…

…8%. This implies that approximately one third of the patients who ultimately had a favorable neurological recovery exhibited an abnormal pupillary reflex upon initial examination…

…and evidence based interventions. Many tachyarrhythmias carry a potential risk of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach…

Drugs and electrolyte imbalance ECG ECG changes due to electrolyte imbalance (electrolyte disorder) The normal cardiac action potential may be altered by electrolyte imbalance, owing…

…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…

…the rhythm is referred to as sinus rhythm . An arrhythmia is defined as an abnormal heart rhythm or heart rate, which is not physiologically justified …

…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…

…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…

…Extreme dipper 20 % Also unfavourable, particularly in the elderly An abnormal 24 hour rhythm should prompt investigation for sleep apnoea, renal disease and secondary hypertension…

…with respiratory compensation, or a mixed metabolic and respiratory alkalosis if the pCO₂ is too low Normal Abnormal Abnormal A compensated simple disorder, or two…

…11.029. Pulmonary valve Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow…

…amyloidosis [8, 15]. AL Amyloidosis: This is a plasma cell dyscrasia in which abnormal plasma cells produce misfolded immunoglobulin light chains [8, 19]. Light chains…

…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 myocardial ischaemia and presumed new ischaemic ECG changes, occurring before cTn values become available or abnormal. Type 4a MI: Represents a periprocedural myocardial infarction…

…coronary artery. Non obstructive disease is generally defined as the absence of a stenosis of 50% or more in any potential infarct related artery. MINOCA…

…acute coronary atherothrombosis. Type 3 myocardial infarction: presumed fatal myocardial infarction in which death occurs before biomarkers can be obtained or become abnormal, in the…

…low grade systemic inflammation Insulin resistance Abnormal adipokine signalling Endothelial dysfunction Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate Development of type…

…blood flow rather than pulmonary vascular disease. This state is termed unclassified PH. Potential explanations include congenital heart disease, liver disease, airway or lung disease…

…3 MI. A diagnosis of MI should not be made solely from an abnormal cTn concentration in the absence of evidence of ischaemia. Classification of…

…normal appearance, ST depression & ST elevation The ST segment corresponds to the plateau phase of the action potential ( Figure 13 ). The ST segment extends from…

…after infarction and after successful reperfusion (PCI). Post ischemic T wave inversion is caused by abnormal repolarization. These T wave inversions are symmetric with varying…