…coronary disorders. The investigation should be undertaken when its diagnostic or therapeutic consequences are likely to outweigh procedural risks. This balance forms part of shared…

…mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to…

…dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of an intramural haematoma that compresses the…

…and Pathophysiology Pulmonary hypertension (PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise from pulmonary vascular disease…

…biologically active. Endothelial and smooth muscle cells normally regulate vascular tone, preserve an antithrombotic surface, and control the adhesion and migration of inflammatory cells. Dyslipidaemia…

…Cessation also improves vascular health and may reduce cardiovascular risk within several years, although risk may remain higher than that of never smokers for a…

…s disease), degeneration associated with connective tissue disorders (Marfan syndrome, Ehlers Danlos syndrome), osteogenesis imperfecta typically causes prolapse of P2 (Figure 1). Myocardial ischemia affecting…

…The most common causes are coronary heart disease (acute coronary syndromes or ischemic heart disease), heart failure , cardiomyopathy (dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy), valvular disease …

…populations [14] . Non ischemic etiologies encompass a highly heterogeneous group of disorders. Idiopathic dilated cardiomyopathy (DCM) is frequently diagnosed when ischemic, valvular, and hypertensive causes…

…obesity, valvular disease, cardiomyopathies, myocarditis, arrhythmias, thyroid disease, iron deficiency and anaemia, kidney dysfunction, sleep disordered breathing, cancer related disease and cardiac amyloidosis among the…

…acute aortic dissection, thrombosis of a graft or aneurysm, popliteal artery entrapment, trauma, phlegmasia cerulea dolens, ergotism, hypercoagulable states or iatrogenic vascular injury. Acute occlusion…

…are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically…

…The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset…

…is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner is trained. Brief attacks triggered by the position of the…

…Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for approximately 80%–90% of acute…

…Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the basal portion of the left…

…associated with fewer vascular and bleeding complications than femoral access. In patients with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site…

…in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows: The size of the…

…rate of treatment are determined by the affected organ function, not by the blood pressure figure alone [2]. A markedly raised blood pressure without acute…

…neutrophil chemotaxis toward inflammatory sites. Its cardiovascular effects therefore appear to reflect modulation of vascular inflammation rather than lipid lowering. Other anti inflammatory strategies have…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…threshold is diagnostically sufficient: the presence of ongoing acute organ injury is decisive. The pathophysiology reflects failure of vascular autoregulation during a rapid or severe…

…injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more…

…Historically viewed as a simple plumbing problem characterized by the gradual accumulation of inert cholesterol debris, modern vascular biology has redefined atherosclerosis as a dynamic…

…failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension…

…or diastolic pressure ≥120 mmHg) with concurrent signs of acute organ damage or failure. Any of the drugs listed below may be used to treat…

…vascular resistance. The resulting mild reduction in blood pressure is often accompanied by a compensatory rise in cardiac output. Although these changes are usually of…

…or diastolic pressure ≥120 mmHg) with concurrent signs of acute organ damage or failure. Any of the drugs listed below may be used to treat…

…diabetes of 10 years' duration, or in diabetes with age 50 years. Risk assessment in known coronary or cerebrovascular disease. Follow up after vascular surgery…

…in patients with intracoronary stents. In acute ACS, aspirin should be administered as soon as possible in the absence of contraindications, using a loading dose…

…for excluding non ST segment elevation acute coronary syndrome (NSTE ACS) in patients with a low to intermediate likelihood of CAD when cardiac troponin and…

…and symptoms Symptoms of congestion Dyspnea is the dominant presenting symptom in acute decompensated heart failure and occurs in more than 90% of patients presenting…

…PCI and stent implantation produce local vascular injury and initiate a sustained inflammatory and reparative response. Proliferation and accumulation of tissue within the stent progressively…

…left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures…

…flow limitation. The mechanisms are incompletely defined. Proposed contributors include hypercontractility or hypersensitivity of coronary vascular smooth muscle to vasoconstrictor stimuli, including adrenergic agonists, leukotrienes…

…acute myocardial infarction (AMI) Pharmacologic agents in perfusion imaging Vasodilators (adenosine, dipyridamole, regadenoson) These agents exert vasodilatory effects, increasing coronary blood flow by relaxing vascular…

…suggests vascular disease, and the arm with the higher reading is used thereafter Two to three measurements one minute apart, taking the mean of the…

…in vascular smooth muscle. Activation results in vasodilatation. D1 and D2 (dopamine receptors): activation of D1 and D2 in the kidneys and the splanchnic vascular…

…interaction between these acquired risks and age related cardiovascular remodeling contributes to the high incidence and prevalence of coronary and vascular disease in older adults…

…vascular injury and inflammation, faster endothelialization, less neointimal proliferation and lower thrombogenicity. Stent thrombosis Early metallic stents reduced acute closure but introduced the risk of…

…depends on the vascular territory involved and may include systemic arterial embolic manifestations. The source material does not provide a detailed catalogue of specific embolic…

…small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge…

…stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular disease. Age and sex…

…is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities…

…Unhealthy diet. Cerebral / peripheral vascular disease. Cancer. Acute coronary syndromes cause symptoms already at rest. Stable ischemic heart disease does not cause symptoms at rest…

…the vascular supply. RCA = right coronary artery. LAD = Left anterior descending coronary artery. LCX = left circumflex coronary artery. Arterial blood supply of…

…Surgeon or mammography Sole of the foot Deep compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury…

…30 mmHg) under vascular surgical supervision Diabetes with neuropathy Reduced compression, closer monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As…

…but approximately one quarter of aneurysms are not calcified and therefore cannot be identified reliably by radiography. Assessment should include consideration of associated vascular disease…

…be acute, when serial troponin values show a dynamic change, or chronic, when troponin elevation persists without such a change. Myocarditis, sepsis, takotsubo cardiomyopathy, valvular…

…Hypotension can be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g…

…with acute severe mitral regurgitation—predominant right ventricular (RV) infarction, cardiac rupture with tamponade, and less common causes such as severe pre existing valvular disease…

…an acute stressor superimposed on the patient's baseline cardiovascular state. For instance, a patient with stable CAD may present with clinical manifestations of myocardial…

…Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1. Etiologies in acute endocarditis…

…and after acute coronary syndromes in patients with reduced left ventricular ejection fraction (LVEF). They are also recommended in patients within one year of MI…

…excluding the diagnosis of HF Estimating disease severity and prognosis Contributing to longitudinal assessment and risk stratification They are useful in both acute and ambulatory…

…with increased risk of hypotension in patients with autonomic dysfunction, hypovolemia, or severe coronary or valvular disease Recent (<48 hours) use of dipyridamole or dipyridamole…

…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…