…in order to minimize the probability of missing significant abnormalities. The following parameters must be assessed, in chronological order: Heart rate Rhythm P wave PR…

…Structural Heart Disease (SHD): Accounting for approximately 90% of all VT presentations, SHD provides the macroscopic architectural abnormalities necessary for arrhythmogenesis. Ischemic heart disease (IHD…

…drug induced arrhythmias in patients receiving agents known to alter the electrical properties of the heart (inducing QRS or QT prolongation) or causing electrolyte abnormalities…

…structural heart disease High risk features on examination include: Unexplained systolic blood pressure < 90 mmHg Suggestion of gastrointestinal hemorrhage Persistent bradycardia (< 40 beats…

…facilitated by using an algorithm, as it minimizes the risk of missing important abnormalities and also speeds up the interpretation. Note that this chapter is…

…the square root of the RR interval (the time between two successive R wave peaks). However, it tends to overcorrect at high heart rates and…

…ECG, clinical characteristics and management Pre excitation The atrioventricular node and bundle of His are normally the only communication between the atria and the ventricles…

…used interchangeably throughout this text. Wall motion abnormalities in ischemic heart disease In the setting of stable ischemic heart disease, an atherosclerotic plaque causes ischemia…

…The clinical consequences of extracellular volume expansion include elevated cardiac filling pressures, pulmonary congestion, systemic venous hypertension, and peripheral interstitial edema. These abnormalities produce breathlessness…

…a characteristic clinical phenotype of breathlessness, fatigue and oedema. This definition does not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection…

…including abnormalities of LV relaxation and filling. Hypertension and diabetes can contribute to the development of heart failure in the preserved and mildly reduced EF…

…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…

…does not imply low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities, myocardial necrosis, haemodynamic deterioration, heart failure, malignant arrhythmias…

…In heart failure, the interaction between the cardiac and renal axes may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is…

…transitions between stable angina, angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), post ACS or post revascularization states, and heart failure of ischaemic…

…5% of otherwise normal angiograms demonstrate bridging. The wide range reflects differences in ascertainment and imaging technique. Coronary fistulae represent abnormal communications between a coronary…

…between cells via gap junctions, facilitating the propagation of depolarization across the cells. Electrical potential differences arise as the electrical impulse travels through the heart…

…from structural or functional abnormalities of the coronary arteries or coronary microcirculation. These abnormalities can produce a transient and reversible mismatch between myocardial oxygen demand…

…Palpitations and awareness of an irregular or rapid heartbeat Dyspnoea and worsening pulmonary congestion Reduced exercise capacity Symptoms or signs of heart failure Haemodynamic instability…

…valvular abnormalities, arrhythmias, and heart failure. Aging also accumulates conventional cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, smoking exposure, and physical inactivity. The interaction between…

…formal diagnosis of Type 2 MI. However, clinical presentations can be heterogeneous. In the context of acutely decompensated heart failure, shortness of breath is the…

…heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a J shaped association between…

…indirectly as reciprocal abnormalities in the anterior precordial leads. Acute myocardial ischaemia alters the resting membrane potential and action potential duration of affected myocardial cells…

…imbalance between myocardial oxygen demand and coronary blood supply. Stress increases myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of…

…to renal or hepatic impairment or the inhibition of cytochrome P450 metabolism [1]. Nonmodifiable risk factors encompass female sex, underlying genetic predisposition, structural heart disease…

…severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering ST T interpretation difficult, including left bundle branch block (LBBB) or pacemaker…

…structural cardiac abnormalities, HF and sudden cardiac death. The relationship between glycaemia and cardiovascular disease is complex. Glycaemic control is important for prevention of microvascular…

…the product of stroke volume (SV) and heart rate (HR). CO = HR · SV Cardiac Index (CI) Cardiac Index (CI) is the ratio between cardiac…

…of obstructing coronary arteries include embolism, dissection, coronary arteritis associated with systemic vasculitis, extrinsic compression, myocardial bridging and radiation induced coronary disease. The distinction between…

…The pathophysiology reflects failure of vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in the brain, retina, heart…

…disease, Carvajal syndrome). The prevalence of ARVC is between 0.02 and 0.05% in Europe (Corrado et al). ARVC is more malignant in men…

…complex interaction between the muscle fibers in these layers, which collectively produces a highly efficient pumping mechanism. Figure 1A 2C. The orientation of myocardial muscle…

…80% of cases), obesity, type 2 diabetes mellitus, chronic kidney disease (CKD), sedentary lifestyle, and atrial fibrillation (AF) [5] . Unlike HFrEF, where epicardial ischemic heart…

…include depletion of glycogen, relaxation of myofibrils, and disruption of the sarcolemma. These changes may appear within 10–15 minutes of ischaemia. Mitochondrial abnormalities can…

…syndrome is therefore both a clinical risk factor cluster and a marker of broader metabolic dysfunction. Associated abnormalities may include increased apoB and apoC III…

…The ischemic cascade The ischemic cascade describes the sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina…

…for structural and hemodynamic cardiac abnormalities. Right Axis Deviation (RAD) RAD holds significant diagnostic weight in the evaluation of pulmonary vascular and right heart pathology…

…scope Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular…

…The increasing prevalence of refractory angina reflects population ageing and improved survival among patients with CAD following advances in anti ischaemic treatment and coronary revascularization…

…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…

…as heart failure, although this is described as uncommon. In pregnancy associated ACS, STEMI is more frequent than NSTEMI, and up to two thirds of…

…Atrial fibrillation and ventricular arrhythmias were observed in the fifth decade of life in several family members. Imaging studies did not reveal structural cardiac abnormalities…

…rest images to distinguish between: Reversible defects : Indicative of ischemia, where reduced perfusion during stress normalizes at rest. Irreversible defects : Suggestive of infarction or scar…

…25% Normal FS, 2D measurement 18% Advantages of fractional shortening If ventricular geometry is normal and there are no regional wall motion abnormalities, then fractional…

…in the same order every time, reduces the risk of missing abnormalities. The eight steps below go through the rhythm and then the waveforms one…

…diagnosed without proteinuria when clinical symptoms or laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a…

…significant reorganization of the activation and recovery patterns within the left ventricle, resulting in a widened QRS complex and secondary ST T wave abnormalities [7…

…abnormalities, diabetes and glycaemic status, body weight, smoking, diet, physical inactivity, and alcohol consumption. Additional considerations include psychosocial stress, obstructive sleep apnoea, social determinants of…

…methodological ECG interpretation. We recommend this approach as it minimizes the risk of missing important abnormalities and also speeds up the ECG interpretation. Press the…

…great paper written by a dozen of merited scholars. In this paper the authors discuss normal variants and abnormalities which athletes may exhibit on the…

…abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in left…

…bridging; myocardial metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis…

…cardiometabolic abnormalities make LDL C an incomplete representation of atherogenic burden. Clinical Presentation and Symptoms ApoB elevation and increased non HDL C are laboratory abnormalities…

…Coarctation of the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension. Dietary sodium and potassium abnormalities and commonly…

…in V1. V7–V9 should display a positive T wave. T wave abnormalities are common and occur in a wide range of conditions. Unfortunately, many…

…Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused by structural or functional microvascular abnormalities…

…angiography provides only an imperfect estimate of functional severity. Angiographic interpretation is affected by interobserver variability, and the relationship between diameter stenosis and haemodynamic significance…

…The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms Mechanical abnormalities may…

…with advancing age. Presentations without pain may include: Sudden breathlessness Syncope or sudden loss of consciousness Confusion Profound weakness An arrhythmia Peripheral embolism An ot

…However, the significance of the ST segment depression differs markedly in NSTE ACS and STE ACS. In NSTE ACS the ST segment depressions are the…