…the majority of all anterior bleeds. Step 2 — cautery 1. Suction clear and identify the bleeding point with a nasal speculum and a head lamp…

…Assessment of exercise capacity and symptoms in known heart disease. Risk assessment after myocardial infarction or before revascularisation. Evaluation of treatment effect in stable angina…

…heart failure and cardiac arrest. In cases with intermittent symptoms, it is important to establish a temporal correlation between symptoms and episodes of bradyarrhythmia on…

…This is a paradoxical and worrisome trend, particularly in light of the improvements in the management of hypertension (coronary heart disease and hypertension are traditionally…

…This is a paradoxical and worrisome trend, particularly in light of the improvements in the management of hypertension (coronary heart disease and hypertension are traditionally…

…driver of atherosclerosis and cardiovascular disease. Its relationship with cardiovascular risk is nonlinear: even light smoking carries a substantial proportion of the excess ischaemic heart…

…and resting heart rate 75 beats/min, based on a retrospective subgroup analysis in which a survival benefit was observed. Inappropriate sinus tachycardia Treatment of…

…choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of…

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…

…heart and vessels A liquid flowing in a straight cylinder exhibits laminar flow , which implies that the flow velocity is highest at the center of…

…Universal Definition of Heart Failure, endorsed by major global cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or…

…points Levosimendan alleviates heart failure symptoms, increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is…

…In the setting of acute heart failure, N terminal pro B type natriuretic peptide (NT proBNP) values, potassium concentrations, and estimated glomerular filtration rate (eGFR…

…increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery (no atherosclerosis) At rest Oxygen supply is adequate and ischemia cannot occur…

…5–7.5 cmH₂O Increase in steps of 2.5 to 10–12.5 cmH₂O according to tolerance and effect SpO₂ 94–98% COPD exacerbation…

…both reduced clearance and the high prevalence of structural heart disease in this population. Obesity is associated with lower than expected BNP and NT proBNP…

…to a prosthesis) — a high risk of avascular necrosis of the femoral head and of vascular injury; always an orthopaedic surgeon, and usually general anaesthesia…

…cardiac arrest and influence on outcome. Resuscitation 2012;83:120611. Wang CH, Huang CH, Chang WT, et al. The effects of calcium and sodium bicarbonate…

…These sympatho inhibitory effects decrease serum norepinephrine levels, plasma renin levels, and potentially aldosterone levels. Clinical Presentation and Symptoms In the management of heart failure…

…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…

…all of the beta blocking activity. Sotalol does not block alpha adrenoceptors and lacks sodium channel blocking activity, meaning it exerts no membrane stabilizing effects…

…no consistent effect on cardiovascular complications in T2DM. Cardiovascular benefit depends substantially on comprehensive risk factor management and, in appropriate patients, selection of glucose lowering…

…disease (ischemic heart disease). Evaluation of coronary artery disease. Assessment of therapeutic response. Exercise testing can be used to evaluate the effect of medications or…

…and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of…

…the abnormality through increased myocardial contractility and heart rate. Coronary compression and a Venturi or “suction” effect have been proposed as mechanisms of inducible ischaemia…

…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

…Gain of function PCSK9 mutations are associated with familial hypercholesterolaemia (FH) and premature coronary heart disease, whereas loss of function variants are associated with protection…

…after reperfusion in an occluded coronary artery. It also occurs as side effect of drugs, hypoxia, myocarditis and electrolyte disorders. Because the rate (60–100…

…Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual for inotropes and vasopressors Drug Indications Dose α1 effect β1 effect β2 effect…

…Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual for inotropes and vasopressors Drug Indications Dose α1 effect β1 effect β2 effect…

…Figure 1. Components of the ventricular conduction system and the temporal association between the ECG waveforms and impulse transmission through the heart. Atrioventricular (AV) blocks…

…chronotropy (heart rate). Beta 2 adrenergic receptors: expressed in vascular smooth muscle. Activation results in vasodilatation. D1 and D2 (dopamine receptors): activation of D1 and…

…square root of the RR interval (the time between two successive R wave peaks). However, it tends to overcorrect at high heart rates and undercorrect…

…in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and the respiratory rate, not to a…

…correlates best with total cumulative dose—may be a better predictor of long term tolerability. Hemodynamic Effects Amiodarone acts as a peripheral and coronary vasodilator…

…pronounced symptoms and other therapies have failed. Patients with structural heart disease or reduced left ventricular function are not eligible. Effects of propafenone and flecainide…

…with heart failure, atrial fibrillation, atrial flutter, and in selected cases of paroxysmal supraventricular tachycardia. Due to its profound pro arrhythmic effects and lack of…

…and parasympathetic withdrawal. Sinus tachycardia secondary to disease and medications : A wide range of diseases and medications may cause sinus tachycardia; e.g congestive heart…

…Causes of ectopic atrial tachycardia and ectopic atrial rhythm Side effect of digoxin. Heart failure. Lung disease (COPD, pulmonary hypertension, etc). Ischemic heart disease (coronary…

…not surprising given the adverse effects of long periods of tachycardia and desynchronized atrial and ventricular activity. Fortunately, the treatment of atrial fibrillation has come…

…hypernatremia) and decreased (hyponatremia) sodium levels do not have any effect on the ECG, nor cardiac rhythm, or impulse conduction. 2. Calcium Hypercalcemia Causes of…

…patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in…

…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…

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

…action and pharmacokinetics to nitroprusside, although the latter is more potent. Effects Antihypertensive. Antianginal. Time to onset of action 2 to 5 minutes Duration of…

…Starling mechanism is amplified by the positive inotropic effects of the sympathetic stimulation. Increased stroke volume and increased heart rate lead to increased cardiac output …

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…Bolus doses of 300 μg/kg can be repeated during infusion. Adverse effects Flushing. Nausea. Bronchospasm. AV block. Caution • Avoid in acute heart failure…

…arterial disease, heart failure, depression, dementia and osteoporosis. It also improves functional capacity, skeletal health, muscular strength, quality of life and psychological well being. Physical…

…guide the development of a pharmacological agent that can alleviate ischemia by inducing the same effect. Nevertheless, the mechanisms underlying ischemic preconditioning, and whether the…

…gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the test is helpful. A…

…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…

…for mor than 10 minutes. Administer sodium thiosulfate (cyanide into thiocyanate) and terminate infusion of nitroprusside if cyanide toxicity is suspected. Adverse effects • Nausea. Vomiting…

…the heart) are appropriate investigative options. Three dimensional (3D) echocardiography is likely to have increased significance in these studies in the future. Hemodynamic effects of…

…to onset of action: 5 minutes. Effects Lowers blood pressure, reduces heart rate, myocardial oxygen consumption and myocardial contractility. Time to onset of action 5…

…Figure 2). It is important to note that the apex of the heart is fixed to the diaphragm via pericardium and connective tissue. Therefore the…

…effect; it is part of the treatment itself. Indications Salicylate poisoning with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and…

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

…The effect of cricoid pressure and gastric insufflation remains uncertain ( Panchal et al ). Nasopharyngeal airways ("trumpets") should be inserted carefully. The risk of epistaxis (nosebleed…

…second attempt). Vasoactive infusions Drug Dose range Primary effect Used in : : : : Noradrenaline 0.05–0.5 µg/kg/min α₁ — vasoconstriction Septic and distributive shock