…the initial dose should be reduced to 3 mg. Heart transplant patients: Due to denervation, which makes the sinus and AV nodes supersensitive to the…

…In this position, the heart comes closer to the thoracic wall, with less lung tissue covering the heart. Some images in adult TTE are obtained…

…arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size…

…air is substantial enough to compress the superior and inferior vena cava, impeding or halting venous return to the heart. In instances of tension pneumothorax…

…to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering ST T interpretation difficult, including left…

…disease and medications : A wide range of diseases and medications may cause sinus tachycardia; e.g congestive heart failure, lung disease (e.g COPD), fever…

…glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart failure armamentarium. Its use has declined over time due…

…blood supply. Stress increases myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of a flow limiting coronary stenosis, supply cannot…

…g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too few waves to explore the area behind the reflector. This results…

…ECG monitoring D Disability AVPU: Alert Voice responsive Pain responsive Unresponsive Limb movements Pupillary light reflexes Blood glucose E Exposure Identify signs of heart failure…

…trans thoracic echocardiography. Causes of right ventricular hypertrophy Lung disease (with increased pulmonary vascular resistance), congenital heart disease (transposition of the great arteries, pulmonary valve…

…the CHA₂DS₂ VA Score The acronym CHA₂DS₂ VA represents the following parameters: C ongestive Heart Failure (1 point) H ypertension (1 point) A₂ ge ≥75…

…ectopic atrial rhythm Side effect of digoxin. Heart failure. Lung disease (COPD, pulmonary hypertension, etc). Ischemic heart disease (coronary artery disease). Structural heart disease, any…

…is a clinical diagnosis supported by echocardiography: Finding Comment : : Hypotension, distended neck veins, muffled heart sounds Beck's triad; complete in a minority Tachycardia, tachypnoea…

…aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure must be aspirated. Suspected empyema or complicated parapneumonic effusion…

…of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3 Heart rate 100/min 1.5 Immobilisation ≥ 3 days or surgery in…

…major active metabolite. Both the parent drug and its metabolite accumulate extensively in various tissues, including the liver, lung, fat, and skin, with myocardial concentrations…

…pericardiotomy syndrome. Acute transmural myocardial infarction. Rupture of the free ventricular wall. Neoplasms (particularly breast and lung cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…the heart rate, and the resulting QT interval is referred to as corrected QT interval, or simply QTc interval. The primary hazard lies in long…

…Yet, long term survival is slightly better among patients with HFPEF, as compared with patients with HFREF. Table 1. Types of heart failure. Type Description…

…Yet, long term survival is slightly better among patients with HFPEF, as compared with patients with HFREF. Table 1. Types of heart failure. Type Description…

…inhibitors and inducers. Clinical indications Heart failure with reduced ejection fraction Ivabradine is an adjunctive option for selected patients with symptomatic HFrEF. The guideline defined…

…all beta blockers equivalent? Heart Rhythm, 14(1), e41–e44. Schwartz, P. J., Crotti, L., & Insolia, R. (2012). Long QT syndrome: From genetics to man

Echocardiography Pericardial diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…

…to 10% of patients receiving antiarrhythmic agents, and this risk is amplified in the presence of heart failure. Clinical Presentation and Symptoms Patients with acquired…

Echocardiography Cardiac tumors Cardiac tumors are rare. They can occur anywhere in the heart or surrounding tissue. Tumors can be localized in the myocardium, pericardium…

…R. (2017). Beta blocker therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia: Are all beta blockers equivalent? Heart Rhythm , 14(1), e41–e44…

Echocardiography Principles of flows and volumes in the heart If the flow in a cylinder is constant, then flow (Q) is the product of the…

…ESC EACVI Guidelines for Valvular Heart Disease (2018). Filsoufi F, Anyanwu AC, Salzberg SP, Frankel T, Cohn LH, Adams DH. Long term outcomes of tricuspid…

…can increase the sinus rate, there are generally no reliable and safe drugs available for long term heart rate augmentation without undesirable side effects. Drugs…

…an advanced version of the original SYNTAX Score, designed to improve the prediction of long term outcomes after revascularization. It incorporates both anatomical (from the…

…precipitating factors such as anaemia, uncontrolled hypertension, thyrotoxicosis, tachyarrhythmia, uncontrolled heart failure, and concomitant valvular disease. Risk factor modification, physical activity, dietary and lifestyle measures…

…than a binary distinction between normotension and hypertension. Its long term relationship with cardiovascular risk is therefore graded, although practical clinical care requires diagnostic and…

…transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure…

…cause of heart failure with reduced ejection fraction (HFrEF) in developed countries. New ischemic events are major determinants of subsequent LV deterioration and long term…

…indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular disease. Age…

…Management Definition and Clinical Characteristics Torsades de pointes (TdP) represents a multifactorial clinical entity typically associated with drug induced long QT syndrome (DI LQTS) [1]…

…ventricular dysfunction (heart failure) and arrhythmias. The annual risk of sudden cardiac arrest is <1% and median survival is 3 years. Long term prognosis in…

…de Pointes in Long QT Syndrome) [1] . Underlying Etiologies The etiology of VT is broadly dichotomized into structural heart disease (SHD) and structurally normal hearts…

…Thus, a family history with early onset of heart failure is common among these individuals. The majority of the mutations are inherited in an autosomal…

…orient and display the heart using the long axis of the left ventricle and selected planes oriented at 90° angles relative to the long axis…

…Complete heart block (third degree AV block) and second degree AV block Mobitz type 2. Marked sinus bradycardia, sinus arrest, sick sinus syndrome with long…

…scores (≥33) are typically advised to undergo CABG due to better long term outcomes. Intermediate scores (23–32) require careful consideration by a heart team…

…changes). Related topics ST segment and T wave changes Ischemic and nonischemic ST segment depressions Brugada syndrome Long QT syndrome Author Dr Araz Rawshani, MD…

…coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a…

…is variable. Patients may have: Stable angina or an anginal equivalent Exertional dyspnoea or reduced exercise tolerance Acute coronary syndrome Silent ischaemia Heart failure, particularly…

…heart rate. The length is shortened as heart rate increases and vice versa. Thus, long cycles (i.e. long RR intervals) are associated with long…

…Concurrently, the atrial myocardium undergoes structural remodeling driven by aging, hypertension, heart failure, and the arrhythmia itself. This remodeling manifests as interstitial fibrosis, atrial dilation…

…Although myocardial ischemia may affect every aspect of the ECG – from heart rhythm to QTc interval – the most prominent and reliable ECG changes occur in…

…since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease…

…disease, both at the population and individual levels. Several prediction models have been developed and validated for the prediction of heart failure, coronary artery disease…

…Harmful neurohormonal pathways are activated, similar to those seen in heart failure. A thorough review on the pathophysiology of tachycardia induced cardiomyopathy is provided by…

…heart failure , cardiomyopathy (dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy), valvular disease . Less common causes are arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/ARVD), Brugada syndrome , long QT…

…The basic analgesic; always give it in parallel unless contraindicated NSAID PO According to the preparation Avoid in renal failure, heart failure, a history of…

…QTc interval Bazett's formula is several decades old and has been questioned because it performs poorly at low (<50) and high ( 100) heart rates…

…Its relationship with cardiovascular risk is nonlinear: even light smoking carries a substantial proportion of the excess ischaemic heart disease risk associated with heavy smoking…

…venous pooling, or external stimuli. The underlying pathophysiology is rooted in autonomic dysregulation within a structurally normal heart. During an episode, decreased cardiac output and…

…implies that the left ventricle dilates, which induces irreversible cellular and extracellular processes that ultimately lead to heart failure. This initially results in greater diastolic…