…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…

…origin of right ventricular dysfunction, must also be evaluated. The pulmonary, aortic and mitral valve must also be evaluated, particularly in the setting of rheumatic…

…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…

…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…

…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…

…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…

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

…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…

…diagnosis. With a longer expected delay and a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed…

…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…

…profound driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke and systemic embolism. The contemporary understanding of AF has…

…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…

…repeated to a maximum of 3 mg 0.02 mg/kg, minimum 0.1 mg, maximum 0.5 mg For bradycardia with compromise Isoprenaline 0…

…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…

…10 mL with sodium chloride) before intravenous titration. Half of all opioid dosing errors arise at the dilution step, and an undiluted syringe of 10…

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…

…QT dispersion. Increased QT dispersion is associated with increased morbidity and mortality. This is presumably explained by a higher incidence of malignant ventricular arrhythmias. It…

…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…

Enalaprilat Enalaprilat is rarely used in hypertensive crisis due to its slow onset, prolonged duration of effect, and significant individual variations in its effect. Drug…

…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…

…Time to onset of action 1 to 2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg…

…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…

…apart. A wound through the full thickness of the dermis, particularly over joints and in cosmetically sensitive areas. Superficial wounds with well apposed edges, abrasions…

…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…

…decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude)…

…decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude)…

…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…

…Effects of disopyramide on ECG, heart rhythm and conduction Effect on sinoatrial (SA) node SA node function may become worse in patients with established SA…

…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…