Echocardiography The Doppler effect When sound waves hit objects some of the sound waves are reflected back to the sound source. If the reflector (i…

…afterwards whether a nerve injury was caused by the injury or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder, elbow…

…node, a phenomenon known as the bathmotropic effect . In contrast, parasympathetic stimulation increases resistance within the AV node, further slowing the transmission of impulses. Intense…

…tracer uptake plateaus. This saturation effect can lead to an underestimation of blood flow in regions affected by significant coronary artery disease, potentially resulting in…

…ventilation–perfusion matching, increased physiological dead space and the Haldane effect. It is therefore misleading to explain the whole phenomenon as abolition of the patie

…by beta blockers. Dobutamine β 1 agonist Infusion of 3−10 μg/kg/min. T½ 2 min Effective if inotropic effect is required. Theophylline …

…effect. AV system (AV node, His bundle, Purkinje system) Preexisting AV block, bundle branch block or fascicular block may become worse. Particularly, the degree of…

…The Doppler effect. The Doppler shift The Doppler shift depends on the velocity of blood flow (v), the frequency of the emitted ultrasound (f e…

…before revascularisation. Evaluation of treatment effect in stable angina. Exercise induced arrhythmia or exercise induced syncope. Assessment of chronotropic function and pacemaker settings. Preoperative functional…

Procedurer Three of the commonest minor procedures in general practice concern the nails, and all three rest on the same foundation: an effective digital block…

…and assess the effect before the next one is given. The serious incidents almost always arise when the principle of titration is abandoned — when a…

…variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular failure. Mechanism of action Enalaprilat is…

…a left main coronary stenosis of at least 50% is considered significant. These thresholds describe luminal narrowing, not necessarily the physiological effect of the lesion…

…gaze palsy — that can be assessed before and during the window of effect. The muscarinic effect may at the same time produce marked bradycardia and…

…much bicarbonate is given. Potassium replacement is not the management of a side effect; it is part of the treatment itself. Indications Salicylate poisoning with…

…Treatment of postoperative hypertension. Mechanism of action Ultra short acting calcium channel blocker (CCB). Half life: 5 minutes. Rapidly inactivated by esterases. Effects • Clevidipine is…

…min. Maximum infusion dose: 300 μg/kg/min. Bolus doses of 300 μg/kg can be repeated during infusion. Adverse effects Flushing. Nausea…

…is not an established drug interaction. The half life of adenosine is 8 seconds. Adverse effects are therefore very brief. Indications Paroxysmal supraventricular tachycardia (PSVT…

…patient with known lung disease. Follow up of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic disease, for example rheumatoid arthritis…

…dose , titrated against clinical effect. 2. Parenteral thiamine early , preferably before or at the same time as carbohydrate administration. 3. Rapid identification of seizures, delirium…

…the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ® Mechanism of action • Induces arteriolar vasodilation. No effect on venous…

…methods may also contribute. The cardioprotective effect is therefore likely to result from the cumulative influence of multiple modest dietary changes. Mediterranean type diets provide…

Cardiology Pharmacology & dosing Definition and pharmacological basis Ivabradine is a selective inhibitor of the If, or “funny,” current in sinoatrial node pacemaker cells. This current…

…volume by increasing its contractility. The Frank Starling mechanism is amplified by the positive inotropic effects of the sympathetic stimulation. Increased stroke volume and increased…

…of blood flow. However, the Doppler effect can also be used to study myocardial motion. Myocardial motion during systole and diastole alter the frequency of…

…the concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. 1 The pharmacokinetic profile of levosimendan is modulated…

…water soluble and short acting, not a depot preparation, and gives a shorter duration of effect. Lidocaine 10 mg/mL without adrenaline , 2–5 mL…

…hour. Indications CPAP: Acute cardiogenic pulmonary oedema with hypoxaemia and marked work of breathing — the strongest indication, with a rapid effect on dyspnoea and oxygenation…

…delivery of red cells, plasma and platelets. Observational data from trauma suggest a lower overall mortality after such protocols are introduced, although the effect on…

…Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment…

…acute heart failure. • Used cautiously in patients with asthma (due to risk of bronchospasm). • Used cautiously in bradycardia due to negative chronotropic effect. Metoprolol doses…

…Effects Antihypertensive. Antianginal. Time to onset of action 2 to 5 minutes Duration of action 5 to 10 minutes Delivery IV Dose Initial infusion dose…

…aggregation. Its antiplatelet effect begins within approximately 30–60 minutes and persists for up to 7 days after discontinuation because platelet inhibition is irreversible. Aspirin…

Arrhythmias and arrhythmology ECG Chronotropic incompetence: inability to adequately increase heart rate Chronotropic incompetence is an independent predictor of overall and cardiovascular mortality. The condition…

…lowering effect. Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal…

…the magnitude of additional LDL C lowering needed and the patient’s prior treatment. Inclisiran is particularly attractive when a durable treatment effect and infrequent…

…reconsidered if bradycardia is a side effect of the medication. Often, the medication must be continued despite the emergence of bradycardia (e.g beta blockers…

…hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect, the dosing, the adverse effects and the important precautions. A hypertensive…

…Functional limitation and effect on activities of daily living. Workload or exertion required to provoke symptoms. Response to current antianginal therapy. Adverse effects that restrict…

…negative chronotropic effect. • In patients with pheochromocytoma, cocaine or methamphetamine overdose, prior treatment with alpha blockade is necessary before administering labetalol (risk of elevating blood…

…angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II. By abrogating the effects of angiotensin II…

…aggregation. Because aspirin affects only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The…

…myocardial contractility and heart rate. Coronary compression and a Venturi or “suction” effect have been proposed as mechanisms of inducible ischaemia. The functional impact depends…

Cardiology Endocrinology & metabolism Definition and pathophysiology Hypertriglyceridaemia (HTG) is defined by an increased concentration of circulating triglycerides. Both fasting and non fasting measurements provide prognostic…

…greater ventricular wall stress, probably because of suppression of natriuretic peptide production or post translational modification rather than a simple clearance effect. Treatment also affects…

…a nonselective beta adrenoceptor blocker devoid of intrinsic sympathomimetic activity that also prolongs cardiac repolarization, thereby exerting combined class II and class III antiarrhythmic effects…

…ECG reaction in various settings with ischemia or increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery (no atherosclerosis) At rest…

…needs to be documented before referral to an arrhythmia unit. Assessment of the effect of adenosine, which can be given during the recording and unmask…

…of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the effect…

…The desired time to action, contraindications and risk of adverse effects should guide the choice of agent. Calcium channel blockers (CCB) Clevidipine Drug Clevidipine Brand…

…the larger effect of a PCSK9 inhibitor. Place in lipid lowering therapy General treatment sequence High intensity statin therapy remains the foundation of lipid lowering…

…measure of the physiological effect of an individual epicardial lesion rather than its anatomical appearance alone. Coronary angiography provides only an imperfect estimate of functional…

…be generated during exercise. Effect of preload and afterload on ejection fraction Ejection fraction is highly dependent on preload and afterload. A rapid increase in…

…acute myocardial infarction in order to assess the presence of myocardial ischemia, evaluate angina pectoris, evaluate exercise performance, evaluate the effect of interventions and medications…

…HFrEF. Toxic and infiltrative causes are increasingly recognized. The burgeoning field of cardio oncology has highlighted the cardiotoxic effects of anthracyclines, HER2 inhibitors (trastuzumab), and…

…The desired time to action, contraindications and risk of adverse effects should guide the choice of agent. Calcium channel blockers (CCB) Clevidipine Drug Clevidipine Brand…

…Evaluation of coronary artery disease. Assessment of therapeutic response. Exercise testing can be used to evaluate the effect of medications or interventions such as PCI…

…ventricular rhythm; idioventricular rhythm is primarily seen after reperfusion in an occluded coronary artery. It also occurs as side effect of drugs, hypoxia, myocarditis and…

…with or without food. Administering a 60 mg loading dose on an empty stomach may provide the fastest onset of effect. Do not crush or…

…without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and…