…therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure with preserved ejection fraction (HFpEF…

…Obesity and heart failure Obesity increases the risk of HF and is common among patients with established HF, particularly HFpEF. Assessment of congestion may be…

…congestive heart failure, congenital heart disease, diabetes mellitus (both type 1 and type 2), obesity, smoking, obstructive sleep apnea and chronic obstructive pulmonary disease (COPD…

…predominantly by atrial tissue; its midregional pro ANP assay may provide information comparable to BNP and NT proBNP in heart failure (HF). The biologically active…

…to fluid retention and worsening congestion The clinical course may be chronic and relatively stable or punctuated by episodes of worsening heart failure requiring hospitalization…

…Unstable myocardial ischaemia. Ventricular arrhythmia or sudden cardiac arrest. Chronic coronary dissection presenting as heart failure, although this is described as uncommon. In pregnancy associated…

…Ischemic heart disease is the most common cause of wall motion abnormalities. Assessment of wall motion abnormalities is particularly important in the setting of chronic…

…incomplete because the ventricles cannot expand normally. This leads to diastolic heart failure. The systolic function is usually unaffected, but the shock volume and ejection…

…ischemic dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left ventricular (LV) remodeling Ischemic cardiomyopathy is the leading cause of heart failure with…

…tolerated 70–79 Diabetes 120–130 70–79 Chronic kidney disease 130–139 70–79 Avoid a systolic pressure < 120 mmHg and a diastolic…

…cancer, chronic cardiac or pulmonary disease, a pulse ≥ 110/min, a systolic blood pressure < 100 mmHg and a saturation < 90 per cent. An…

…and excess cardiovascular risk. The European definition requires failure to reduce office systolic and diastolic blood pressure to below 140 mmHg and 90 mmHg, respectively…

…Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium dose : 3.0 10…

…chronic coronary syndromes, coronary revascularization, stroke, transient ischaemic attack, and peripheral arterial disease. Heart failure is also considered established clinical CVD in the risk based…

…is variable. Patients may have: Stable angina or an anginal equivalent Exertional dyspnoea or reduced exercise tolerance Acute coronary syndrome Silent ischaemia Heart failure, particularly…

…Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium dose : 3.0 10…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…antecedent of heart failure—particularly heart failure with preserved ejection fraction—and chronic kidney disease. After approximately 70 years of age, isolated systolic hypertension accounts…

…symptoms, a 12 lead ECG, heart rate and blood pressure are monitored. The test is generally symptom limited and is stopped when limiting symptoms, significant…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

Cardiology Coronary Atherosclerosis Coronary atherosclerosis is a chronic, progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental…

…constitute a cornerstone in the management of cardiovascular disease, heart failure, and chronic kidney disease (CKD). These agents interfere with the renin angiotensin aldosterone system…

…oxygen supply–demand imbalance, direct myocardial injury, systemic illness, structural heart disease, or several mechanisms acting simultaneously. Acute myocardial infarction Acute myocardial infarction requires: Acute…

…adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients frequently have…

…Increases complexity and risk. Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with higher perioperative risk. Clinical Applications Personalized Decision…

…coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze or…

…The shunt fraction (Qp/Qs) is a critical hemodynamic parameter used to quantify the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs)…

…When administered intravenously (150 mg over 10 minutes followed by 1 mg/min), it decreases heart rate, systemic vascular resistance, and left ventricular dP/dt…

…arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size…

…environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial injury is determined not only…

…myocardial injury may accompany numerous cardiac and systemic disorders, including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic kidney disease Cardiomyopathy Stroke or subarachnoid…

…sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered …

…Few Dopamine — intermediate dose Cardiogenic shock. Vasodilatory shock. Heart failure, acute or chronic. Bradycardia (second line option). 3.0–10.0 μg/kg/min…

…heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic…

…glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart failure armamentarium. Its use has declined over time due…

…Crucially, contemporary definitions distinguish HFpEF from "Heart Failure with improved EF" (HFimpEF). HFimpEF refers to patients with a historical baseline LVEF ≤40% that has subsequently…

…smoking, coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute chest and/or…

…coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…concentric remodelling, reduced longitudinal strain and heart failure with preserved ejection fraction are more frequent in women. Diabetes confers greater cardiovascular risk in women than…

…Rheumatoid arthritis (RA) Systemic Lupus Erythematosus (SLE) Acute myocardial infarction (AMI) Post infarction (including Dressler syndrome) Uremia Radiation to the heart Trauma Tuberculousis Neoplasms (cancer…

…post ACS or post revascularization states, and heart failure of ischaemic or cardiometabolic origin. Major clinical presentations The principal outpatient presentations include: Reproducible stress induced…

…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…

Myocardial ischemia and infarction Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for…

…recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and coronary artery disease …

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

…recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and coronary artery disease …

…precipitating factors such as anaemia, uncontrolled hypertension, thyrotoxicosis, tachyarrhythmia, uncontrolled heart failure, and concomitant valvular disease. Risk factor modification, physical activity, dietary and lifestyle measures…

…be selected according to clinical judgement. Low to moderate probability: greater than 5% to 50% in the chronic coronary syndrome pathway. Coronary CT angiography (CCTA…

Cardiology Clinical medicine Definition and clinical classification Hypertensive disorders of pregnancy comprise chronic or pre existing hypertension, gestational hypertension, and preeclampsia. Collectively, they affect approximately…

…hypertension, thyrotoxicosis, tachyarrhythmias, uncontrolled heart failure, and concomitant valvular heart disease. In patients with ANOCA/INOCA, symptoms may persist despite non obstructive coronary anatomy. Such…

…take months or years to develop (e.g. myocardial remodeling in heart failure or after myocardial infarction). Ventricular arrhythmias are easier to induce in the…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced…

…medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care…

…component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS), peripheral artery disease (PAD), and acute coronary syndromes…

…It is uncommon for chronic pericardial effusions to cause sudden cardiac arrest since these cases tend to be recognized and managed before circulatory collapse occurs…

…workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A…

…oxygen. Acute on chronic hypercapnic failure in obesity hypoventilation and neuromuscular disease. Hypercapnic failure in cardiogenic pulmonary oedema that does not improve with CPAP alone…

…3 IV Pneumonia, in chronic lung disease amoxicillin 750 mg × 3 PO 5–7 days or benzylpenicillin 3 g × 4 IV Pneumonia, suspected atypical pathogen…