A 61-year-old man presented to our hospital with chest pain that had begun 50 minutes earlier. On arrival, an electrocardiogram (ECG) showed no obvious ST-T change, and troponin T was negative. The next morning, 11 hours after having chest pain, a re-examined ECG showed no obvious ST-T changes compared to the initial ECG, except for T wave inversion in lead aVL, and troponin T became positive. At that time, acute myocardial infarction (AMI) was highly suspected, and an emergent coronary angiogram was performed. Occlusion of the first diagonal branch was revealed, and successful percutaneous coronary angioplasty was performed. The later clinical course was uneventful. We realized that it is important to compare an initial ECG with serial or prior ECGs to be aware of subtle ECG changes and to repeat cardiac biomarker measurements a few hours later, in order not to miss or delay the diagnosis of AMI, when it has not been ruled out.

Ultrasound for microstructure characterisation is increasingly studied and is often assessed through inversion performance. However, the framework is fundamentally constrained by the information content available in the measured response. Hence, this work examines identifiability directly by analysing the geometry of the forward operator in both a canonical pulse-echo model and a stochastic surrogate microstructure. The analysis is conducted using feature-level ultrasonic observables, and the stochastic surrogate microstructure study focuses on attenuation and velocity. For the canonical model, a closed-form sensitivity analysis reveals information limits arising from parameter coupling, dimensional restriction, and interface-driven saturation. For the surrogate microstructures represented by Gaussian random fields, the forward map from correlation length D and texture-coherence parameter T to the attenuation and velocity observables remains structurally full rank. However, the sensitivity geometry is strongly anisotropic, with uneven parameter influence across the observable space. When intrinsic microstructural variability is incorporated, practical identifiability is further reduced. A variance-weighted Fisher framework shows that recoverability is governed by the balance between sensitivity magnitude and stochastic variability, rather than by structural rank alone. Inversion results confirm this behaviour: single observables produce elongated and weakly constrained objective landscapes, whereas combined observables improve conditioning through complementary sensitivities. These results show that, within the feature-level framework considered here, identifiability limits are governed primarily by forward-map structure and intrinsic variability. This provides a basis for future development of observable-selection strategies for ultrasonic microstructure characterisation.

Exercise imaging, particularly exercise stress echocardiography (ESE), has become a pivotal non-invasive tool for evaluating cardiovascular function in athletes and for distinguishing physiological adaptations from pathological conditions. This Clinical Consensus Statement by the European Association of Preventive Cardiology and the European Association of Cardiovascular Imaging synthesizes current evidence and provides practical guidance on indications, protocols, and interpretation of exercise imaging modalities in both competitive and recreational athletes. The document emphasizes the role of ESE in assessing cardiac reserve, unmasking concealed cardiomyopathies, and stratifying risk in clinical scenarios such as T-wave inversion, exercise-induced repolarization abnormalities, and extreme ventricular remodelling. Special attention is given to imaging protocols tailored to the athletic population, including dynamic assessment of the right and left ventricles, atria, and valvular function during various exercise modalities, highlighting the importance of the functional evaluation in athletes and active individuals. Additionally, the consensus explores the integration of advanced techniques such as cardiopulmonary exercise testing and exercise cardiac magnetic resonance imaging, highlighting their complementary roles in comprehensive cardiovascular evaluation. The statement advocates for individualized testing strategies that consider sport-specific demands, demographic factors such as body size, sex, ethnicity, and the underlying pathology. It also underscores the importance of exercise imaging in guiding sports eligibility and in tailoring exercise prescription for competitive athletes, as well as for patients willing to participate in recreational sports or exercise programs.

Exercise imaging, particularly exercise stress echocardiography (ESE), has become a pivotal non-invasive tool for evaluating cardiovascular function in athletes and for distinguishing physiological adaptations from pathological conditions. This Clinical Consensus Statement by the European Association of Preventive Cardiology and the European Association of Cardiovascular Imaging synthesizes current evidence and provides practical guidance on indications, protocols, and interpretation of exercise imaging modalities in both competitive and recreational athletes. The document emphasizes the role of ESE in assessing cardiac reserve, unmasking concealed cardiomyopathies, and stratifying risk in clinical scenarios such as T-wave inversion, exercise-induced repolarization abnormalities, and extreme ventricular remodelling. Special attention is given to imaging protocols tailored to the athletic population, including dynamic assessment of the right and left ventricles, atria, and valvular function during various exercise modalities, highlighting the importance of the functional evaluation in athletes and active individuals. Additionally, the consensus explores the integration of advanced techniques such as cardiopulmonary exercise testing and exercise cardiac magnetic resonance imaging, highlighting their complementary roles in comprehensive cardiovascular evaluation. The statement advocates for individualized testing strategies that consider sport-specific demands, demographic factors such as body size, sex, ethnicity, and the underlying pathology. It also underscores the importance of exercise imaging in guiding sports eligibility and in tailoring exercise prescription for competitive athletes, as well as for patients willing to participate in recreational sports or exercise programs.

BACKGROUND Subarachnoid hemorrhage (SAH) is a neurological emergency accounting for 5% of all strokes, with mortality exceeding 50% in patients over 80 years of age. Aneurysmal SAH is particularly lethal in the elderly due to atypical presentations, including ECG abnormalities mimicking acute coronary syndromes, leading to delayed diagnosis and high complication rates. This case report highlights the diagnostic pitfalls of SAH-induced STEMI mimicry. CASE REPORT A in their 90s White woman with a remote history of diabetes presented to the Emergency Department (ED) with sudden-onset occipital headache, nausea, and hypertensive crisis (214/68 mmHg). Initial electrocardiography (ECG) showed ST-segment elevations (STEMI) in leads I/aVL with reciprocal depressions in III/aVF, prompting STEMI activation despite normal troponin levels. Emergency computed tomography angiography (CTA) revealed a ruptured 3×1 mm anterior communicating artery (ACOM) aneurysm with Fisher Grade 3 SAH. Echocardiography at admission showed normal ejection and no wall motion abnormalities. ECG performed 1 day after admission showed complete resolution of the ST-T segment changes and the patient did not require any coronary intervention. Despite successful endovascular coiling, her hospital course was complicated by Cronobacter sakazakii bacteremia, embolic infarcts, and refractory cachexia. Palliative care was initiated on hospital day 14 due to irreversible functional decline, culminating in hospice transition. CONCLUSIONS SAH-mediated autonomic dysregulation can produce STEMI-like ECG changes even in the absence of coronary ischemia. Geriatric SAH management requires balancing intervention risks against frailty and comorbidities. Early recognition of SAH-induced ECG changes from autonomic-mediated repolarization abnormalities is essential to avoid misdiagnosis and guide appropriate intervention, particularly in older patients in whom comorbidities and frailty complicate recovery trajectories.

ST-segment elevation on electrocardiography is classically associated with acute myocardial infarction and often prompts urgent invasive evaluation. However, non-ischemic causes may complicate diagnostic decision-making, particularly in elderly patients with acute non-cardiac illnesses. We report a 95-year-old woman admitted with COVID-19-associated pneumonia and aspiration pneumonia, whose admission electrocardiogram demonstrated ST-segment elevation with T-wave inversion in the lateral precordial leads, mimicking ST-elevation myocardial infarction. She had no chest pain, no elevation of cardiac biomarkers, and preserved left ventricular systolic function without regional wall motion abnormalities on echocardiography. Review of prior records revealed that similar electrocardiographic abnormalities had been consistently present for more than a decade. Serial imaging demonstrated no overt structural heart disease. However, the electrocardiographic pattern-localized and persistent ST-segment elevation with repolarization abnormalities-is most consistent with chronic localized myocardial remodeling, possibly related to unrecognized myocardial fibrosis. This case highlights the importance of integrating clinical presentation, biomarkers, and longitudinal electrocardiographic findings. Persistent ST-segment elevation does not always indicate acute coronary occlusion, but may reflect an underlying structural myocardial substrate not detectable by routine imaging.