…rapid aortic expansion, refractory pain and hypertension despite treatment. A related entity is non A non B dissection , which involves the arch without involvement of…

…aorta, aortic arch) All individuals 60 mm (descending aorta) All individuals Risk factors : previous dissection, family history of dissection, severe aortic regurgitation or mitral regurgitation…

…chest and/or back pain is the predominant symptom of both IMH and PAU. PAU pain may resemble the abrupt pain of classic aortic dissection…

…A large side to side difference may suggest aortic dissection CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The…

…unreliable: marked obesity, pronounced vasoconstriction, arrhythmia, intra aortic balloon pump. Assessment of stroke volume variation as part of fluid management. Contraindications Infection, burn or trauma…

…demand). The most common causes of acute aortic regurgitation are aortic dissection , endocarditis and trauma . Chronic aortic regurgitation If aortic regurgitation develops gradually, then the…

…failure) and arrhythmias. The annual risk of sudden cardiac arrest is <1% and median survival is 3 years. Long term prognosis in aortiv stenosis is…

…Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis, pericarditis or endocarditis. Acute aortic dissection…

…e. septal bulging ). Bedside echocardiography allows for immediate recognition of tamponade. Typically, acute tamponade arises from aortic dissection, and survival among such patients is, unfortunately…

…cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and rheumatic fever. Aortic dissection rupturing into the pericardium. Idiopathic pericardial effusion. Renal failure…

…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…

…an individualized assessment of the risks; if the benefit outweighs the risk, then relative contraindications may be disregarded. Absolute contraindications for exercise ECG Aortic dissection –…

…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…

…mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to…

…is to scrutinize potential cardiac sources of emboli and to evaluate the carotid and cerebral arteries. Ultrasound may reveal atherosclerotic plaques, thrombi, occlusions, and dissections…

…percentage (%). Normal FS 25% (M Mode) 18% (Direct 2 D measurement) Tissue Doppler Tissue Dopplerrecords the speed and direction of myocardial motion. This is possible…

…Findings: The sudden onset of symptoms coupled with diaphoresis should always raise concern for a cardiovascular cause [4]. 2. Aortic Dissection Pain Characteristics: The classic…

…other than the conditions in which the procedure is the wrong treatment : Aortic dissection with haemopericardium — drainage can increase the bleeding and worsen the prognosis…

…days. Hypertensive emergency: raised pressure with acute organ damage (encephalopathy, pulmonary oedema, aortic dissection, acute renal failure, pre eclampsia) — intravenous treatment with a controlled reduction…

…The leading causes of cardiac tamponade culminating in cardiac arrest include: Aortic dissection : The proximal 4 5 cm of the aortic root is covered within…

…of perfusion are essential. The abrupt arterial obstruction may result from progression of peripheral arterial disease, cardiac or aortic embolisation, acute aortic dissection, thrombosis of…

…ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the…

…Administration of thrombolysis requires careful consideration of absolute and relative contraindications (discussed below), and assessment of differential diagnoses; cardiac tamponade, aortic aneurysm and aortic dissection…

…Cardiac surgery and other iatrogenic cardiovascular procedures Acute aortic disease, particularly ascending or type A aortic dissection Myocardial free wall rupture after infarction Anticoagulant associated…

…reflects distinct mechanisms of acute cardiopulmonary disease: Pulmonary embolism and spontaneous pneumothorax may produce abrupt chest pain and respiratory distress. Aortic dissection may cause sudden…

…frequent trigger of decompensation and may produce abrupt pulmonary oedema, sometimes requiring non invasive ventilation or intubation. Aortic disease An acute aortic dissection is a…

…embolism, coronary dissection, hypotension, shock, respiratory failure, severe anaemia, sustained bradyarrhythmia Increased myocardial oxygen demand Sustained tachyarrhythmia, severe hypertension, hypertensive crisis, critical aortic stenosis, severe…

…The pulsed Doppler beam can be positioned using color Doppler (to visualize the direction of flow) and continuous Doppler (to locate the maximum flow velocities)…

…It is also possible to zoom in on regions of interest; e.g the aortic valve can be zoomed in to study its anatomy and…

…calculate pressure gradients across valvular stenoses and regurgitations. The equation is agnostic to the direction of the blood flow; it merely measures the pressure gradient…

…Figure 2. Color Doppler reveals the direction and extent of aortic valve regurgitation. Because color Doppler is a type of pulsed wave Doppler, it is…

…velocities greater than the Nyquist limit. Aliasing implies that neither the direction nor velocity of flow can be determined. This results in the Doppler signal…

…Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of an intramural haematoma…

…exposure of thrombogenic material. Superficial plaque erosion. Thrombosis associated with a calcified nodule. Epicardial or microvascular coronary spasm. Spontaneous coronary artery dissection. Coronary embolism of…

…In severe cases, there can be a rupture of the atria or ventricles. Myocardial infarction : The contusion can cause coronary artery dissection, atherothrombosis or rupture…

…of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection with or without intramural haematoma. Spontaneous coronary artery dissection is defined as spontaneous dissection of…

…dissection that extends into the media or adventitia can compromise the true lumen and cause ischemia. Guiding catheter trauma is an additional mechanism of dissection…

…the patient is clinically unstable. Particular attention is required for evidence of: Ongoing or recurrent chest discomfort. Haemodynamic instability. Electrical instability or arrhythmia. Heart failure…

…apposition, edge dissections, and endothelial coverage. Complementary Characteristics IVUS and OCT are complementary rather than interchangeable. IVUS generally provides better visualization of overall vessel dimensions…

…Coronary dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft Side branch occlusion or thrombus Disruption of collateral…

…temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This corresponds to the principles of TiTrATE, in which…

…stenosis Long lesions Diabetes mellitus Untreated edge dissection Components and mechanisms of DES A conventional durable polymer DES consists of: A balloon expandable metallic scaffold…

…or collapse Residual edge dissection Incomplete lesion preparation Persistent stenosis within the treated segment Mechanical factors are particularly important because correction of the underlying problem…

…despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography…

…disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge dissection, overlapping stents…

…speed , and direction . The underlying mathematical principles are simple and important to understand. Figure 2 illustrates the wavelength and amplitude of sine curves. Figure 2…

…ECG machine. The axis can also be approximated manually by judging the net direction of the QRS complex in leads I and II. The following…

…ECG machine. The axis can also be approximated manually by judging the net direction of the QRS complex in leads I and II. The following…

…than the base rate should inhibit the pacemaker. P waves The appearance of the P wave depends on where the atrial lead is fixed. Typically…

…Figure 5 shows examples of naming of the QRS complex. Net direction of the QRS complex The QRS complex can be classified as net positive…

…the sequence of activation of the piezoelectric crystals (Figure 3). By activating all crystals simultaneously, the resulting sound wave travels in a straight direction (Figure…

…making this formula easier to handle. Velocity and direction of blood flow can be calculated by using the Doppler equation. Blood flow in the heart…

…lower frequency. Doppler shift The Doppler effect is utilized to calculate velocity and direction of moving objects. To calculate the velocity of blood flow, the…

…severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement…

…thickened (about 80% have thickening). The parietal and visceral leaves of the pericardium are most often fused. The process most often affects the entire pericardium…

…If it is located near the atrioventricular node, activation of the atria will proceed in the opposite direction, which produces an inverted (retrograde) P wave…

…and infarction Definition and pathophysiology Post infarction mechanical complications are structural disruptions of acutely infarcted myocardium occurring most often during the first days after ST…

…Characteristics of ST Elevation in Acute Transmural Ischemia When acute ischemia is transmural, the ST vector typically shifts in the direction of the outer epicardial…

…lead correlates directly with the projection of the heart vector onto that specific lead vector [3]. When the direction of cardiac activation is parallel to…

…use of greater pulse repetition frequency, which results in greater resolution. PRF must be high in order to assess the velocity and direction of blood…