Cardiology Pharmacology & dosing Definition and pathophysiology Congestion is a central expression of the heart failure syndrome and reflects excessive retention of sodium and water, with…

…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…

…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…

…medicine Procedurer Definition and Pathophysiology Cardiac tamponade is a life threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs ventricular filling…

…Valve function and stress related haemodynamic changes Diastolic function Pulmonary hypertension Coronary flow velocity reserve (CFVR) Pulmonary congestion detected by B lines on lung ultrasound…

…Rheumatic heart disease typically results in thickening of the leaflets and may coexist with mitral stenosis. Idiopathic degeneration (Barlow's disease), degeneration associated with connective…

…underlying basement membrane and a small layer of loose connective tissue. The endocardium joins the endothelium that lines the greater vessels connected to the heart…

…Figure 2). It is important to note that the apex of the heart is fixed to the diaphragm via pericardium and connective tissue. Therefore the…

…right ventricle is rare. The clinical spectrum extends from limited right ventricular dysfunction to severe right sided failure and cardiogenic shock. The haemodynamic disturbance results…

Diastolic function Criteria Normal, young Normal, adult Abnormal relaxation (grade 1 dysfunction) Pseudonormal (grade 2 dysfunction) Reversible restrictive filling (grade 3 dysfunction) Irreversible restrictive filling…

…Diastolic heart failure is presumably at least as common as systolic heart failure ( heart failure with reduced ejection fraction, HFREF ). Diastolic heart failure is particularly…

…EACVI) stress that the following parameters are of particular importance for the evaluation of diastolic function: The ratio between E wave and A wave ( E…

…must overcome to eject blood into the aorta. Afterload affects myocardial muscle fibers during systole and diastole. Afterload is a function of the following three…

…Classification of office blood pressure Category Systolic Diastolic : : : : : Optimal < 120 and < 80 Normal 120–129 and/or 80–84 High normal 130–139…

…heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure (MAP) = diastolic + (systolic − diastolic)/3 Cardiac output = stroke volume × heart…

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency)…

…3 Dyskinesia Paradoxical thinning and/or outward directed motion during systole 4 Aneurysmatic Diastolic deformation 5 Recommended by the American Society for Echocardiography (J Am…

…represents the average pressure within the arteries throughout a single cardiac cycle, encompassing both systole and diastole. It is a critical parameter in cardiovascular physiology…

…weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow Jet width colour Doppler small,, < 10 mm length, narrow origin variable large…

…thresholds. The 2024 European guideline defines hypertension as an office systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥90 mmHg…

…inhibitors and inducers. Clinical indications Heart failure with reduced ejection fraction Ivabradine is an adjunctive option for selected patients with symptomatic HFrEF. The guideline defined…

…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…

…axis view (PLAX) using M mode. The end systolic and end diastolic left ventricular diameters are measured. The following formula is used to calculate fractional…

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency)…

…sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In contrast, modalities…

…is a clinical diagnosis supported by echocardiography: Finding Comment : : Hypotension, distended neck veins, muffled heart sounds Beck's triad; complete in a minority Tachycardia, tachypnoea…

…cm 1.5–2.1 2.2–2.5 2.6–2.9 3.0 RV SIZE AND FUNCTION (MEASURED IN A4C) RV diastolic area…

…including heart failure and ischaemic heart disease. Ageing is associated with progressive increases in systolic blood pressure (SBP), while diastolic blood pressure (DBP) rises less…

…vascular remodeling, altered diastolic filling, chronotropic incompetence, and impaired hemodynamic stability commonly coexist. These changes promote hypertension, ischemia, valvular abnormalities, arrhythmias, and heart failure. Aging…

…is associated with cardiac hypertrophy, myocardial fibrosis, diastolic dysfunction and heart failure. Compared with patients with primary hypertension matched for age, sex and blood pressure…

…extracellular processes that ultimately lead to heart failure. This initially results in greater diastolic volume and increased compliance. Increasing diastolic volumes requires that the myocardium…

…Doppler and measurement of the diameter. Cardiac output (CO) Cardiac output is the product of stroke volume (SV) and heart rate (HR). CO = HR ·…

…For example, aortic regurgitation causes the flow of blood from the aorta back into the left ventricle during diastole. The flow of blood into the…

…fraction (EF) may be reduced because the end diastolic volume of the ventricle (EDV) is reduced. Constrictive pericarditis also leads to right sided heart failure…

…fraction <55%. This implies that left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection…

…tailored to each patient. Optimal blood pressure Optimal blood pressure is 115 mm Hg systolic and 75 mm Hg diastolic (115/75 mm Hg). Thus…

…Figure 1. Left ventricular pressure volume relationship during a single cardiac cycle. In Figure 1 we begin in diastole, when the mitral valve opens. When…

…doppler 500 200 500 < 200 Diastolic flow reversal – PW doppler aorta descendens if present, early diastolic early diastolic holodiastolic Quantification of jet Mild regurgitation…

…doppler 500 200 500 < 200 Diastolic flow reversal PW doppler aorta descendens if present, early diastolic early diastolic holodiastolic Quantification of regurgitant jet Mild…

…cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium…

…weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow Jet width colour Doppler small,, < 10 mm length, narrow origin variable large…

…Thus, a family history with early onset of heart failure is common among these individuals. The majority of the mutations are inherited in an autosomal…

…Increased stroke volume and increased heart rate lead to increased cardiac output . Systolic blood pressure increases when cardiac output increases. Diastolic blood pressure is not…

…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…

…in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole…

…Decompensated heart failure – due to the risk of circulatory collapse and arrhythmias Pulmonary embolism in acute phase – due to risk of aggravation of the condition…

…cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium…

…of ventricular end diastolic and residual volumes. Experimental and clinical observations with a precordial dilution technic. Circulation. Redfield et al: Heart Failure with Preserved Ejection…

…ratios (iFR / RFR / Pd Pa / dPR) Resting Pd/Pa during the diastolic “wave free period” (iFR) or the lowest ratio across the full cardiac cycle…

…considered a normal finding. The regurgitation results in blood flowing back from the pulmonary artery into the right ventricle during diastole. The most common cause…

…may extend into diastole, so the physiological effect is not limited to systole. Exercise may amplify the abnormality through increased myocardial contractility and heart rate…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…during diastole. This causes adverse hemodynamic effects, and the condition is classified as cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart…

…which is not the case in the heart. Blood flow is pulsatile during the cardiac cycle; flow is high during systole and ceases during diastole…

…Thus, the blood volume flowing through the mitral valve in diastole is equal to the volume flowing through the aortic valve during systole (Figure 2)…

…ischemia. As a clear example, consider a patient with ischemic heart disease, who has normal ejection fraction but impaired contractile function in the inferior wall…

…to the pressure difference between the aortic root and right atrium during diastole (coronary blood flow occurs in diastole or the decompression phase during CPR)…

…parameters (Figure 4). The ECG signal is presented at the bottom and it is used to identify diastole and systole, which is necessary to perform…