…An abnormal 24 hour rhythm should prompt investigation for sleep apnoea, renal disease and secondary hypertension, and lead to one dose being moved to the…

…tracer uptake plateaus. This saturation effect can lead to an underestimation of blood flow in regions affected by significant coronary artery disease, potentially resulting in…

…A 12 lead ECG is not required; limb lead II is sufficient and it provides adequate opportunities for rhythm diagnostics, as well as detection of…

…consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible…

…predictors of mortality in patients with cardiovascular disease after accounting for age. Chronotropic response, blood pressure behaviour and the development of arrhythmias provide additional information…

…Definition and Pathophysiological Basis High sensitivity cardiac troponin (hs cTn) assays detect circulating troponin released from injured cardiomyocytes at substantially lower concentrations than earlier generation…

…Rest Imaging : Conducted after a predefined interval to allow for radiotracer clearance or with a different radiotracer to capture myocardial blood flow under baseline conditions…

…has not been shown to reduce stroke risk, and detection may lead to inappropriate anxiety and invasive procedures. Symptomatic disease Symptoms of carotid disease include…

…rate response Blood pressure reaction ECG reaction: ST changes, T wave changes, arrhythmias, conduction defects Cause of termination This article will discuss each of these…

Echocardiography Aortic regurgitation Aortic regurgitation implies that the aortic valve leaks during diastole, such that blood regurgitates back from the aorta into the left ventricle…

…incorrect measurement may lead to misclassification. Blood pressure should be measured with a validated and calibrated device using a consistent method for the individual patient…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…an argument for imaging rather than a conventional exercise test. Preparation and equipment Cycle ergometer with a braked, workload controlled resistance; 12 lead ECG with…

…through the cable, not through the pads. A pulse oximeter, a blood pressure cuff, and an arterial line for prolonged pacing. Venous access, oxygen, suction…

…required to up to 900 μg/day. Transdermal (one patch lasts for a week): • Catapress TTS 1 (0.1 mg/24hrs). • Catapress TTS 2 …

…failure (HF) is a clinical syndrome in which the heart cannot deliver blood at a rate appropriate to tissue requirements unless filling pressures are elevated…

…Consider the fact that the left ventricle contracts and ejects blood into the aorta roughly 100,000 times daily, each time overcoming the aortic resistance…

…continuous ECG monitoring and pulse oximetry. Measure the blood pressure repeatedly as clinically indicated. Record a 12 lead ECG. Insert at least one functioning intravenous…

…of all major peripheral pulses. Blood pressure measurement in both arms. Cardiac auscultation. Pulmonary auscultation. Evaluation for heart failure. Assessment for circulatory compromise, haemodynamic instability…

…patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow to the infarct zone, thereby limiting infarct size and…

…of a 12 lead ECG. Assessment for haemodynamic instability, acute severe heart failure and cardiogenic shock. Identification of life threatening arrhythmias. Assessment for high risk…

…metabolism (and thus contractility). Stunning may persist for hours, days and weeks. It reduces cardiac output and lower blood pressure. Cardiogenic shock may develop as…

…as in panel A for cross modality comparison. Clinical features Occlusion of the left main coronary artery (LMCA) abruptly interrupts blood flow to both the…

…dominating method for assessing left ventricular systolic function. Ejection fraction is simple to calculate; if the left ventricle contains 100 ml of blood at the…

…volume. Reduced intrathoracic pressure will passively suck blood back to the heart. The increase in preload will lead to increased ventricular pressure and volume, which…

…the ischemia/infarction. The location of the thrombus in the artery: a proximally located thrombus will cut off blood flow to more branches, and thus…

…myocardial infarction may lead to papillary muscle rupture. The risk of rupture is greater for the posteromedial papillary muscle, which only receives blood supply from…

…For the purpose of assessing ST segment return, one should preferably use continuous ST segment monitoring. If monitoring equipment is not available, 12 lead ECGs…

…cannula: Intravenous drug treatment, fluid or blood products. Contrast medium for CT (this requires a large bore cannula in a suitable vein). Standby access in…

…CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II…

…changes in lead II and lead V1 ( Figure 3 ). Enlargement of the right atrium is commonly a consequence of increased resistance to empty blood into…

…The diagnostic prerequisite for clinical AF remains the documentation of the arrhythmia via a standard 12 lead ECG or a single lead ECG tracing lasting…

…patients with chest pain. A 12 lead ECG recording must be registered and interpreted within 10 minutes of arrival at the hospital. The ECG differentiates…

…reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS . STE ACS is the acronym for ST Elevation Acute…

…activation means that the atria activate first, filling the ventricles with adequate volumes of blood before the ventricles begin contracting. To coordinate these two tasks…

…successful primary preventive strategies, such as reduced smoking rates, aggressive lowering of blood lipids with statins and sophisticated treatments for hypertension. However, coronary artery disease…

…normal P wave does not exceed 2.5 mm in any limb lead. Reference values for the P wave The negative deflection of biphasic (diphasic)…

…artery (LCX), whereas the posteromedial papillary muscle receives blood supply from either LCX or the right coronary artery (RCA). For details, refer to chapter The…

…wide QRS complex (QRS duration ≥0.12 s). Refer to Figure 1 for an example. The premature ventricular impulse replaces a sinus beat and induces…

…be estimated with echocardiography. The PASP is an independent predictor of survival and for elevated left ventricular filling pressures (Lam et al). PASP is elevated…

…). Afterload Afterload is the resistance that the left ventricle must overcome to eject blood into the aorta. Afterload affects myocardial muscle fibers during systole and…

…with the vascular supply to these components. Figure 1 presents all relevant parts of the conduction system and their source of blood supply. Figure 1…

…for the pharynx and lidocaine gel for the electrode. A glass of water with a straw, a vomit bowl, tissues, suction. Monitoring with ECG, blood…

…aspiration, hypoventilation, circulatory failure or an anticipated need for anaesthesia. Consider a 12 lead ECG when the acute situation allows, particularly before fosphenytoin, or where…

…looking for Kussmaul’s sign Hepatomegaly as evidence of systemic venous congestion Blood pressure and evidence of hypotension Clinical evidence of low cardiac output or…

…wall stress and coronary artery perfusion. These changes gradually lead to insufficient coronary perfusion (i.e myocardial ischemia and angina pectoris), ventricular dysfunction (heart failure…

…Brugada syndrome. This disorder is easy to diagnose with a simple blood test and the ST segment elevations resolve after normalization of potassium levels. Brugada…

…Afterload : Afterload is the resistance that the the ventricle must overcome to pump blood out into the pulmonary artery. Resistance may increase in, for example…

…Pathophysiology Prolonged tachyarrhythmias lead to the following hemodynamic effects: Tachyarrhythmia results in reduced preload, diminished stroke volume, and subsequently lower blood pressure and reduced organ…

…failure. A peripheral venous blood gas is easier to obtain and can often be used for an initial assessment of pH and the metabolic component…

…by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of office blood pressure Category Systolic Diastolic : : :…

…in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the massive transfusion protocol…

Cardiology Clinical medicine Definition and Clinical Context Blood pressure management in older adults must account for chronological age, biological age, frailty, multimorbidity, cognitive status, functional…

…Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular…

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

Cardiology Emergency medicine Definition and Pathophysiology A hypertensive emergency is severe blood pressure elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European…

…Where resources permit, objective assessment may include directly observed treatment or detection of prescribed medications in blood or urine samples. In patients with an estimated…

…Haemodynamic measurements become interpretable only when related to one another. A low blood pressure may be due to low flow, low vascular tone or both…

CPR Hypoxia and asphyxiation Hypoxia refers to a reduced partial pressure of oxygen in the blood. Asphyxia is characterized by insufficient ventilation, leading to hypoxia…

…volumes, and pressure conditions in the heart. These techniques allow for the calculation of all clinically relevant hemodynamic parameters, with few exceptions. Prior to the…