…beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the kidneys, retina, and…

…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…

…compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock and cerebral or…

…traumatic cardiac arrest and can arise from a range of injuries. Any trauma impairing ventilation or gas exchange can cause hypoxia. Such traumas include cerebral…

…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…

…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…

…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…

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

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

Referensvärden A diagnosis of hypertension is not made on a single reading. It requires repeated measurements on at least two occasions, and preferably confirmation by…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…aortic trauma Pregnancy, particularly the third trimester Weightlifting Cocaine use Deceleration injury Systemic hypertension coexists in approximately 70% of patients with aortic dissection. PAU is…

…is classified as cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus…

…or deep vein thrombosis Acute myocarditis or pericarditis Acute aortic dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main…

…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…

…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…

…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…

…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…

…unexplained drop in arterial pressure. Silent or unrecognized infarction occurs more often in patients without antecedent angina and in those with diabetes and hypertension. Of

…at risk of bending or damage during chest compressions. References DeBehnke DJ, Hilander SJ, Doubles DW, Wickman LL, Swart GL. The hemodynamic and arterial blood…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism, dissection, coronary arteritis associated with systemic vasculitis…

…diminishes in parallel with increasing myocardial load (and hence oxygen demand). The most common causes of acute aortic regurgitation are aortic dissection , endocarditis and trauma …

…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 –…

…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…

…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…

…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…

…of the artery with two fingertips and note the direction. Disinfect and allow to air dry. 2. Anaesthetise the skin with a small amount of…

…right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling, reduced stroke volume, diminished cardiac output, falling arterial pressure, and…

…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…

…Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes…

…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…

…acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased concentrations may result from acute…

…valves may develop symptomatic aortic stenosis already at the age of 60 years. Bicuspid aortic valves also increase the risk of aortic aneurysm, aortic dissection…

…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)…

…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…

Echocardiography Principles of image optimization in echocardiography In order to obtain optimal ultrasound images, it is necessary to adjust several parameters continuously during the examination…

…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…

…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…

…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…

…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…

…Suggests : : Nystagmus that is purely vertical, downbeating or direction changing Central cause Nystagmus without latency that does not fatigue Central cause New headache, neck pain…

…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…

…concordant with the QRS complex, meaning that it has the same direction as the net direction of the QRS complex. A net positive QRS complex…

…in the same order every time, reduces the risk of missing abnormalities. The eight steps below go through the rhythm and then the waveforms one…