…heart disease. Endocarditis (common in intravenous drug addicts). Myxomatous degeneration. Rheumatic heart disease. Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension…

…risk factors • Patients with mutations in TGFBR1, TGFBR2 or Loes Dietz syndrome. 50 mm • Marfan syndrome • Bicuspid aortic valve with coarctation or additional risk factors…

…Table 1. Causes of aortic regurgitation Bicuspid aortic valve Rheumatic heart disease Calcified aortic valves Idiopathic aortic dilatation (aneurysm) Hypertension Aortic dissection, proximal Marfan syndrome…

…valve disease, which results in changes in the pressure volume relationships in the ventricle and the atrium. Pressure and/or volume overload causes dilation of…

…Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and evidence demonstrating long…

…ventricle, which is counteracted by dilatation of the ventricle. Dilatation of the right ventricle results in reduced intraventricular pressure and thereby reduced myoardial load. Pulmonary…

…ultimately leads to dilatation. Hypertrophy is caused by pressure (systolic) overload Pressure overload (systolic overload) implies that there is increased resistance across the aortic valve…

…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…during which there is no significant flow across the mitral valve. The duration of diastasis is inversely related to heart rate (diastasis is shorter at…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…a precaution. Dosage of vernakalant Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg. Normal dilution: 4 mg/ml. Recommended…

…a quick reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect…

…of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with…

…a patient on digoxin treatment 1 ECG signs of left atrial enlargement 3 Left axis deviation 2 QRS duration ≥90 milliseconds 1 Prolonged R wave…

…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…

…syringes, a three way tap. A Seldinger set with a guidewire, a dilator and a 5–8 F pigtail catheter , plus a drainage bag. Sample…

…the site, duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia initially produces pain and sensory disturbance. With progression, motor…

…Call the PCI service in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI…

…that the test failed to identify 27.8% of individuals with poor neurological recovery. The specificity of absent pupillary reflex for predicting a poor neurological…

…lead to ventricular dilation. However, the term dilated cardiomyopathy (DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop…

…prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or the connected myocardium may cause mitral prolapse, and thus regurgitation. Ischemia manifests with…

…with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy , can be caused by any tachyarrhythmia leading to prolonged periods of…

…patients with pulmonary hypertension. Echocardiography in pulmonary regurgitation Echocardiography is the modality of choice for diagnosing pulmonary regurgitation. Continuous Doppler through the pulmonary valve reveals…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…Elderly age ( 65), and Drugs/alcohol. A crucial clinical pitfall is the misapplication of this score. A high HAS BLED score (≥3) indicates a need…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…the reason for which remains elusive. Gene mutations can be confirmed in roughly 60% of individuals with ARVC. Mutations in the desmosomal gene PKP2 is…

…cardiac arrest. High quality compressions with minimal interruptions and early defibrillation are what determine the outcome; drugs are given without pausing the compressions. Anaphylaxis Intramuscular…

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

…Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The reference drug, with the greatest experience eGFR 30–60…

ECG Introduction to ECG interpretation The QRS complex (ventricular complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R…

…separate chapter discusses Long QT syndrome (LQTS). A complete list of drugs causing QT prolongation can be found here. Corrected QT intervals (QTc) can be…

…A duration of 6 months after ACS is generally considered too short for routine use, but it may be considered in selected patients with a…

…with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of the donation…

…Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment…

…interpretation requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation starts with assessment of the P wave…

…system (His Purkinje network), which results in rapid impulse transmission and thus shorter QRS duration (as compared with apical pacing). Because ventricular pacing results in…

…VT]). The VF waveform is initially coarse ( i.e fibrillatory waves have large amplitudes) but as the duration of VF is prolonged, the amplitude gradually…

…of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic considerations, with…

…III and aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation…

…III and aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation…

…requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation traditionally starts with an assessment of the P…

ECG Hypertrophy and dilatation Biventricular hypertrophy Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to…

…mitrale, because mitral valve disease is a common cause (Figure 1). The duration of the P wave will exceed 120 milliseconds in lead II. Biatrial…

…low risk of pneumothorax Uncomfortable for an awake patient, harder to keep the dressing clean with a tracheostomy or copious secretions Subclavian vein Most comfortable…

…echocardiography. Causes of right ventricular hypertrophy Lung disease (with increased pulmonary vascular resistance), congenital heart disease (transposition of the great arteries, pulmonary valve stenosis, atrial…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…PR interval <120 ms with a delta wave and wide QRS is indicative of 'Ventricular pre excitation', and QRS duration ≥140 ms is considered 'Profound…

…Time to onset of action 50 to 10 minutes Duration of action 30 to 60 minutes Delivery IV Dose Initial infusion dose: 0.1 μ…

…patient has a confirmed diagnosis of pheochromocytoma Treatment of hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of drugs with á adrenergic effects…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

…hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic prophylaxis. Deep…

…2 3 LQTS Risk model, a validated tool designed to estimate the 5 year risk of life threatening arrhythmic events in individuals with LQT1, LQT2…

…al ). Table 1. Singh–Vaughan Williams classification of antiarrhythmic drugs Class Definition Agents Class IA Na + channel blocker with intermediate offset kinetics Ajmaline, Cibenzoline, Disopyramide…

…al ). Table 1. Singh–Vaughan Williams classification of antiarrhythmic drugs Class Definition Agents Class IA Na + channel blocker with intermediate offset kinetics Ajmaline, Cibenzoline, Disopyramide…

…from dilating adequately during diastole. This leads to increased and equivalent diastolic pressure in all rooms. Because pressure is high in the atria, filling of…

…as patients with reduced left ventricular function. This is because these patients are at particularly high risk of developing life threatening arrhythmias. Antiarrhythmic drugs Disopyramide…

…Assess ventilation, airway protection, the expected course and the possibility of rapid reversal with an antidote. Intubation is recommended for neurological, respiratory or haemodynamic failure…

…Time to onset of action 1 minute Duration of action 20 30 minutes Delivery IV Dose Loading dose: 500 μg/kg bolus over 1…