…Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also be used to study…

…SPECT imaging is recommended as the initial study in patients with low to moderate risk of CAD. In patients with a high to very high…

…If the examination is performed urgently, the examination can be performed before personal identification data is assigned to the study. Electrocardiogram (ECG) The ECG is…

…and infarction Definition and conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and…

…disease Type 3 Focal or tubular stenosis resembling atherosclerosis Often requires intravascular imaging to demonstrate an intramural haematoma or double lumen Type 1 is reported…

…autosomal dominant syndrome (4). Figure 1 . 12 lead ECG (presented according to Cabrera), recorded at 63 years of age, demonstrates concave upward ST segment depression…

…which during systole travels towards the apex, and then recoils to its starting position. Mitral annulus velocity is used to study longitudinal contraction; during systole…

…intravascular imaging provides cross sectional and longitudinal information about the artery. The clinical value of these techniques rests on their ability to characterize the anatomy…

…Imaging is generally performed at rest and during exercise or pharmacological stress, allowing comparison between myocardial blood flow states. MPI is used principally to: Diagnose…

Echocardiography Ultrasound artifacts The following artifacts are common in ultrasound imaging: The ultrasound image displays non existing structures. The ultrasound image does not display existing…

…What is myocardial redistribution? In myocardial perfusion imaging, redistribution refers to the movement of a radiotracer within the myocardium over time. Radiotracers without redistribution maintain…

…blood flow disparities between healthy and diseased coronary arteries, allowing ischemia to be detected during imaging. Exercise is the preferred method for inducing myocardial stress…

…Echocardiographic windows to obtain images. The standard examination include the following four imaging windows: Parasternal window Apical window Subcostal window (SC) Suprasternal window (suprasternal notch…

…and nomenclature is to develop consistency across examinations. This is of utmost importance when assessing myocardial structure, perfusion and wall motion. Cardiac planes All imaging…

…medications such as nitrates, beta blockers, or calcium channel blockers Recent acute myocardial infarction (AMI) Pharmacologic agents in perfusion imaging Vasodilators (adenosine, dipyridamole, regadenoson) These…

…Pathophysiology Stress echocardiography is a functional cardiac imaging technique used primarily to identify inducible myocardial ischaemia and to estimate prognosis in patients with suspected or…

…decision whether to perform it now or after imaging, how the patient is positioned, which needle is chosen, and that the tubes go to the…

…American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI). Use the table of contents to go straight to the relevant section…

…a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus, but avoid…

…they may be categorized according to whether they are: Not associated with ischaemia Associated with episodic ischaemia Associated with obligatory ischaemia Anomalies may involve the…

…infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings, cardiac biomarkers, imaging, angiography, and, occasionally, pathological examination…

…perfusion imaging (MPI) is based on principles similar to those used in echocardiography. The 17 segment model of the left ventricle serves as a standardized…

…of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET…

…positive results are false positives; at a high probability a negative test adds little. Imaging (coronary CT angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater…

…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…

…mm. Limitations Formulas assume normal body habitus Ethnic variations may require adjusted thresholds Always correlate with imaging measurements Not valid for pediatric patients <15 years

…inhibitor to prevent symptomatic hypotension. Diagnostics The source material does not cover specific diagnostic modalities such as ECG, imaging, or electrophysiology in relation to ACE…

…lumen. It is commonly attributed to rupture of the vasa vasorum, although improved imaging demonstrates small intimal disruptions in approximately 20%–60% of cases. These…

…biomarkers, and no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical…

…the diagnostic method. Myocardial bridging has been identified in approximately 0.5–12% of angiographic series and up to 5–75% of CT series; other…

…as an imaging biomarker of coronary atherosclerotic burden rather than as a direct measure of luminal obstruction. Calcified plaque is generally less likely to rupture…

…CAC imaging is a rapid, non contrast, low radiation CT examination that quantifies coronary calcification, whereas CCTA uses iodinated contrast to assess the coronary lumen…

…when imaging is unavailable, or in individuals with a low pre test likelihood in whom a negative test may reduce the estimated likelihood sufficiently to…

…Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent several clinically distinct trajectories…

…haemorrhage occurs within the media without imaging evidence of an intimal tear or flap. AAS is classified anatomically according to involvement of the ascending aorta…

…the clinical significance of imaging findings. Historically, revascularization was considered capable of improving LV systolic function and prognosis by restoring perfusion to viable dysfunctional myocardium…

…include: Greater thrombus mobility. Protrusion into the LV cavity. Visualization on multiple imaging planes. Location adjacent to hyperkinetic myocardium. Large thrombus burden. Cardiac magnetic resonance…

…applicable to the relevant infarction category Myocardial infarction results from an imbalance between myocardial oxygen supply and demand. The universal classification distinguishes infarction according to…

…leading to substantial delays in reperfusion therapy. Advanced ECG interpretation, combined with clinical assessment and imaging modalities, has been shown to improve the identification of…

…Tissue Doppler is used to measuring mitral annular plane velocity. The American Society for Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) stress…

…predisposes to ventricular tachycardia. The ECG is a useful tool for detecting hypertrophy/dilatation but echocardiography and magnetic resonance imaging (cardiac MRI) are superior to…

…Moreover, magnetic resonance imaging has suggested that pathological Q waves may also arise due to extensive subendocardial infarction (NSTEMI). If pathological Q waves occur as…

…provides a fundamental parameter that cannot be obtained by other imaging methods, namely exercise capacity (and VO2 max , see below). In addition to exercise capacity…

…the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood tests and…

…The Bernoulli principle. According to the Bernoulli principle, the sum of kinetic energy (K) and pressure energy (P) is constant as blood flows through the…

…the principle of ultrasound imaging is simple: sound waves are sent into the tissue and the reflected waves are used to create an image of…

…cardiac magnetic resonance (CMR) imaging, and landmark clinical trials, the field has transitioned from a predominantly pharmacological strategy to one that heavily integrates early catheter…

…10. In unknown time of onset, wake up stroke or a late time window: perform advanced imaging according to the local protocol. 11. Document weight…

…but only if the examiner is trained. Brief attacks triggered by the position of the head relative to gravity: perform Dix Hallpike and, if needed…

…gain valuable insights into shunt severity and directionality. While the technique requires meticulous attention to imaging standards, its non invasive nature and reproducibility make it…

…The HCM Risk SCD score aims to identify individuals with a high risk of SCD and determine whether an implantable cardioverter defibrillator (ICD) is warranted…

…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)…

…abdominal aortic diameter exceeds 3 cm. Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of AAAs…

…imaging and revascularisation. Severe sensory loss, profound anaesthesia and paralysis suggest that the limb may already be unsalvageable. Clinical categories ALI is classified according to…

…manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack (TIA) or stroke. The risk associated…

…symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen…

…1.73 m², excess urinary albumin excretion—typically a spot urinary albumin to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is…

…Historically referred to as coronary thrombosis, the term myocardial infarction ultimately prevailed. The need for a standardized global definition led to early efforts by the…

…CFR) is the ratio of maximum hyperaemic coronary flow to resting coronary flow. It can be assessed invasively or with myocardial perfusion imaging using PET…

…problem is necessary for durable treatment. Intracoronary imaging is encouraged to define the mechanism rather than relying on angiography alone. Factors associated with restenosis The…