…implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…or pericarditis Acute aortic dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe…

…and subject preparations. We will also discuss the relevance of withholding specific cardioactive medications during exercise testing (exercise ECG). Indications for exercise stress test Indications…

…history suggesting an autoimmune disorder or known malignancy may suggest specific, nonidiopathic etiologies [2]. Summary of Pain Characteristics The following table synthesizes the key differential…

…Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated…

…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…

…Criteria for ST Elevation Myocardial Infarction (STEMI) The diagnosis of STEMI relies on specific electrocardiographic thresholds for ST segment elevation measured at the J point…

…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…

…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…

…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…

…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

…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…

…coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection…

…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…

…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…

…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…

…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…

…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…

…absence of pulmonary congestion. Patients may obtain relief by sitting forward. Other symptoms depend on the extent of reduction in cardiac output and arterial pressure…

…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…

…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…

…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…

…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…

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

…Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and symptoms in known heart disease…

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…

…use Deceleration injury Systemic hypertension coexists in approximately 70% of patients with aortic dissection. PAU is particularly associated with advanced age, smoking, coronary artery disease…

…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…

…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…

…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 …

…Cardiopulmonary effects of pulmonary embolism Figure 1. Pathophysiology of pulmonary embolism (PE). Hemodynamic effects Pulmonary embolism leads to increased resistance in the main pulmonary artery…

…from acute compromise of coronary flow. Mechanisms include: Coronary dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft…

…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…

…procedural complexity, and the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty…

…are components of the myocardial contractile apparatus and are expressed predominantly in cardiac muscle. Troponin I is highly specific for myocardial injury. Interpretation of troponin…

…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)…

…multiple controls that each represent a specific depth in the image (Figure 1). The bottom control adjusts gain at the bottom of the image etc …

…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…

…a consequence of increased resistance to empty blood into the right ventricle. This may be due to pulmonary valve stenosis, increased pulmonary artery pressure etc…