…is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema…

…of free fluid depth with no bowel in the path of the needle and measure the skin to peritoneum distance. 2. Mark the site. Sterile…

Overview of diagnosis, classification and management of heart failure

…A stimulus delivered during the refractory period should not result in activation because the myocardium is refractory. The most common cause of failure to capture…

…incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart failure…

…incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart failure…

…the Get With The Guidelines Heart Failure (GWTG HF) and the SWEDEHEART registries, demonstrate that while the incidence of HFrEF has stabilized or slightly declined…

…prognosis. Pathophysiology The defining physiological abnormality is heart failure occurring with mildly impaired LV systolic function. The syndrome remains fundamentally one of impaired cardiac performance…

…introduced critical nuances to HF terminology to reflect the dynamic nature of myocardial remodeling. The designation "Heart Failure with improved Ejection Fraction" (HFimpEF) is now…

…between cardiac and renal dysfunction is particularly important. Cardiorenal syndrome may develop during acute decompensated heart failure, but worsening renal function does not necessarily indicate…

…Increased risk of ventilatory failure New drowsiness, confusion or agitation Suspect hypoxaemia or hypercapnia Cyanosis or saturation below target despite oxygen Severe impairment of gas…

…therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure with preserved ejection fraction (HFpEF…

…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…

…medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic ST segment or T wave changes…

…on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical signs…

…access. In patients with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and blood transfusion with radial access…

…e.g. myocardial remodeling in heart failure or after myocardial infarction). Ventricular arrhythmias are easier to induce in the presence of arrhythmogenic substrates. A substrate…

…increased during infections). As noted by Bonow et al, it is also reasonable to believe that patients with heart failure are at increased risk of…

…cardiac conditions (such as renal failure). To establish a diagnosis of MI, acute myocardial injury must be coupled with clinical evidence of acute myocardial ischaemia…

…disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock…

…heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or cardiogenic shock Life threatening arrhythmias or cardiac arrest after presentation Mechanical complications of…

…complementary objectives of initial STEMI management. The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications…

…Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings…

…and respiratory instability, multiorgan failure, infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The CCU may…

…Levosimendan alleviates heart failure symptoms, increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not…

…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…

…fewer than 5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients with acute…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

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…

…and heart failure. There are six main types of cardiomyopathy: Hypertrophic cardiomyopathy (HCM) — This type of cardiomyopathy is characterized by pronounced hypertrophy of the myocardium…

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…

…Active Ingredient(s) Cardiotoxicity Label Section DICT Concern Cardiac side effects Severity of cardiotoxicity Hyaluronic Acid HYALURONIC ACID HYALURONIC ACID NA no no ZYPREXA Relprevv…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…

…of heart failure, coronary artery disease, acute coronary syndromes and stroke ( Steyerberg et al ). Achieving this has been significantly more difficult for the prediction of…

…aortic dissection, acute renal failure, pre eclampsia) — intravenous treatment with a controlled reduction, as a rule no more than 25% during the first hour. The…

Calculators CHA2DS2 VASc Score Calculator Congestive Heart Failure Hypertension Age = 75 years Diabetes Mellitus Stroke/TIA/TE Vascular disease Age 65 74 years Sex…

Info The ECG must always be interpreted systematically. Failure to perform systematic interpretation may actually be detrimental. We have therefore compiled a pocket guide with…

…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…

…in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole…

…is the isovolumetric relaxation time (IVRT) . The ability of the myocardium to relax during IVRT is governed by left ventricular compliance. The greater the compliance…

…of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular failure…

…egg), of which the maximum dose per 24 hours is 1000 mL. Adverse effects Headache. Nausea. Fever. Atrial fibrillation. Worsening of heart failure. Caution • Used…

…lactic acidosis). Fatal outcomes are rare. Renal failure increases risk of cyanide toxicity. Cyanide toxicity requires doses 2 μg/kg/minute. Use the lowest…

…antagonist. In this setting, ivabradine should be considered to reduce the risk of heart failure hospitalisation and cardiovascular death. The recommendation is class IIa, level…

…and a family history of heart failure, ventricular arrhythmias or sudden cardiac arrest is common. The following cardiomyopathies lead to dilation of the ventricle: Dilated…

…the side lying variant of the Dix–Hallpike test. Marked obesity or spinal disease that makes positioning impossible. Severe angina, heart failure or recent myocardial…

…or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

…2,3]. Respiratory complications occur, but untreated convulsive status itself carries a considerable risk of hypoxia and respiratory failure. In placebo controlled trials, respiratory depression…

…forward. Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant…

…fetal bleeding respectively). Marked liver failure with coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to…

…low cost, and reliable screening tool for body composition, risk of type 2 diabetes, metabolic syndrome and specific cancers. BMI and cardiovascular outcomes High BMI…

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

Info Table 1 provides a summary of the indications, contraindications, dosage, administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary…

…the serum creatinine up to 30% is considered acceptable. In the setting of acute heart failure, N terminal pro B type natriuretic peptide (NT proBNP…

…disease, one in five for heart failure and one in five for stroke. Sex and gender are distinct but interacting determinants of cardiovascular health. Sex…

…or visceral, adipose tissue is more closely related to insulin resistance and the risk of diabetes and cardiovascular disease than total adiposity alone. The waist…

Cardiology Substance : Adenosine Brand names : Adenocor Mechanism of action Adenosine works by slowing down the impulse transmission through the atrioventricular (AV) node, thereby interfering with…

…Bradyarrhythmias are discussed in the chapter Management of Bradycardia (Bradyarrhythmia). Initial rhythm and the course of arrhythmias during cardiac arrest The initial rhythm in cardiac…