…A related entity is non A non B dissection , which involves the arch without involvement of the ascending aorta or represents retrograde extension from the…

…is often indicative of a noncardiac source [4]. 3. Pneumonia with Pleurisy Pain Characteristics: Pleuritic pain is a common presentation [2]. 4. Other Systemic/Local…

…In many cases, the initiating process is plaque disruption with thrombosis; other cases result from spasm, microvascular dysfunction, embolism, dissection, hypotension or shock, respiratory failure…

…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…

…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

…severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing…

…cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction…

…of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other…

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

…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…

…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…

…and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent distal to the obstruction…

…disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism, dissection…

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

…proportion of painless or silent STEMIs is greater in patients with diabetes mellitus and increases with age. STEMI may present as sudden onset breathlessness. Other…

…segments; assessment of stent expansion and apposition; recognition of edge dissection, tissue prolapse, thrombus, or other acute complications; investigation of restenosis and stent thrombosis. Intravascular…

…The emergency evaluation of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other cardiopulmonary causes…

…with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial proportion present…

…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 –…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…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…

…causes of pericardial effusion. Important clinical associations include: Idiopathic or viral pericarditis Malignant pericardial disease Tuberculosis Purulent or bacterial pericarditis Trauma Cardiac surgery and other…

…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…

…of the stent, stent diameter less than 3 mm, long stent length Large thrombotic burdens increase procedural risk because thrombus can fragment, embolize to other…

…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…

…to the QRS morphology during LBBB. Stimulation in other regions of the ventricle may result in a different QRS morphology. If the lead tip is…

…history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds…

…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…

…is a common and early electrocardiographic sign of acute pericarditis, reflecting pericardial involvement overlying the atria [4, 5]. Other Differential Diagnoses ST segment elevations simulating…

…the apex. Please note that for most clinicians it is not necessary to be able to determine the direction of the re entry loop. Figure…

…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…

…visible, it is retrograde in lead II (because of the reversed direction of atrial activation) and may be located before or after the QRS complex…

…impulse reaches the atrioventricular node when there are two pathways, one being refractory and the other capable of conducting the impulse, re entry may arise…

…incompletely performed drainage. Procedure 1. Locate the centre of the fluctuance, preferably with ultrasound if available. Mark the direction of the incision. 2. Clean and…

…in the form of a sound wave. If the sound waves encounter a new medium, some sound waves will be reflected while others will transfer…

…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…

…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…

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…

…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…

…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…

…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…

…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…

…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 …

…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…

…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…

…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…

…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…

…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…

…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…

…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)…

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…

…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…

…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…

…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…