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

…small intimal disruptions in approximately 20%–60% of cases. These disruptions may initiate or complicate the haematoma. IMH most frequently involves the descending thoracic aorta…

…arise from a range of injuries. Any trauma impairing ventilation or gas exchange can cause hypoxia. Such traumas include cerebral, facial, airway and thoracic injuries…

…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…

…Conventional thoracic X ray sometimes reveals calcification of the pericardium. With MRI or CT, the thickness of the pericardium can be measured and in most…

…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…

…additional risk factors 55 mm (ascending aorta, aortic arch) All individuals 60 mm (descending aorta) All individuals Risk factors : previous dissection, family history of dissection…

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

…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…

…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…

…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…

…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…

…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…

…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…

…life threatening clinical syndrome in which increased intrapericardial pressure compresses the heart and impairs ventricular filling. It generally results from accumulation of pericardial fluid, blood…

…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…

…pathophysiology reflects failure of vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in the brain, retina, heart, aorta…

…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…

…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…

…the transvalvular resistance increases, making it more difficult to eject blood into the aorta. In the early stages of aortic stenosis, stroke volume becomes smaller…

…is a leading cause of death worldwide (1). Emboli originating in the atria, left atrial appendage (LAA), ventricles, valves, and proximal aorta can cause stroke…

…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…

…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…