…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…

…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…

…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…

…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…

…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…

Cardiology Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health…

…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…

…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…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…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…

…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…

…dysfunction, side effects of medications and acute myocardial infarction. Holter ECG is useful to determine the frequency, severity and situational dependence of sinus bradycardia. If…

…and Pathophysiology Angiotensin converting enzyme (ACE) inhibitors are foundational therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart…

…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…

…of uric acid and may contribute to hyperuricaemia. Uric acid may promote hypertension through effects on the endothelium. Increased asymmetric dimethylarginine, an endogenous inhibitor of…

…there are generally no reliable and safe drugs available for long term heart rate augmentation without undesirable side effects. Drugs, With Doses and Practical Co

…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…

…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…

…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…

…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…

…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…

… progression of calcific aortic stenosis; enhancement of a prothrombotic state. Its atherogenic and inflammatory effects may be mediated partly by oxidized phospholipids carried on the…

…it binds the MR, which translocates to the nucleus and induces expression of aldosterone responsive genes. Although the kidney is a major target—where MR…

…heart failure, atrial fibrillation and peripheral artery disease. Prognosis is generally worse when diabetes coexists with these conditions. However, the cardiovascular effects of SGLT2 inhibitors…

…His Purkinje system. The underlying pathophysiology varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by…

…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…

…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…

…effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of its high blood flow and…

…heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and peripheral artery disease (PAD). Figure 1 (below) shows weight loss effects of novel…

…that either affect the automaticity of the sinoatrial node or block the impulse from reaching the atria. Disturbed automaticity and blocked impulses lead to arrhythmias…

…and A3 receptors is responsible for the side effects of heart block, wheezing, and peripheral vasodilation, respectively. Pharmacokinetics and Administration Technique Adenosine is extensively and…

…the complexity of defining an appropriate treatment target, particularly when a lower DBP, orthostatic hypotension, or impaired autonomic compensation limits tolerability. Evidence Base and Its…

…regards to their effects and hazards. For example, high HDL cholesterol levels appears to be beneficial, whereas triglyceride levels seem to be of little or…

…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…

…by myocardial ischemia (affecting the sinoatrial node), sinus node dysfunction or side effects of digoxin treatment. If the rhythm becomes completely regular when holding the…

…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…

…underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and secondary prevention. PCI treats focal stenotic…

…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…

…or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on multiple…

…or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on multiple…

…than men after approximately 65 years of age. Hypertension related left ventricular hypertrophy, concentric remodelling, reduced longitudinal strain and heart failure with preserved ejection fraction…

…adverse hemodynamic effects, and the condition is classified as cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous…

…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…

…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 …

…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…

…intrapericardial pressure due to the tamponade. The increased pressure causes compression of the atria and the ventricles (particularly the former). Even small pressure elevations on…

…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…

…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…

…most common of these are hypotension, low cardiac output and sensitivity to drugs that reduce preload. Posterolateral (posterior, inferobasal) STEMI (STE ACS) The heart is…

…the first hour. The exception is aortic dissection, where a systolic pressure below 120 mmHg and a heart rate below 60 are the immediate goals.

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

…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…

…Hemodynamic effects of constrictive pericarditis Diastolic heart failure and right heart failure The rigid pericardium prevents all four heart chambers from dilating adequately during diastole…

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

…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…