…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…

…without generating significant reflections. However, when side lobes encounter strong reflectors (calcifications, pericardium, mechanical heart valves, wires, etc ), they may generate significant reflections which are…

…wall movements Chest percussion Lung auscultation Pulse oximetry ( 95%) C Circulation Skin color Sweating Capillary refill time (<2 s) Palpate pulse Heart auscultation Blood pressure…

…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…

…study. Eur Heart J . 2023;45(36):3718 3726. doi:10.1093/eurheartj/ehad456. Stroke Risk Stratification: CHA₂DS₂ VA or CHA₂DS₂ VASc? Heart Lung Circ …

…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…

…it decreases heart rate, systemic vascular resistance, and left ventricular dP/dt. Oral doses sufficient to control arrhythmias do not depress left ventricular ejection fraction…

…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…

…cause: Diminished heart sounds Disappearance of the friction rub Loss of the apical impulse Electrical alternans on the ECG Compression of the left lung base

…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…

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

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

…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…

…an intravenous beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset. Dose reduction in renal failure and in old…

Arrhythmias and arrhythmology Drugs and electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT…

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…

…a dihydropyridine CCB is appropriate for many patients. Long acting nitrates or ranolazine may be added when symptoms persist or when heart rate, blood pressure…

…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…

…persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes. The central therapeutic objective is…

…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…

…a critical marker of arrhythmogenic risk, particularly in the setting of ischemic heart disease or reduced left ventricular ejection fraction (LVEF). Sustained VT: Defined as…

…cardiomyopathy Takotsubo cardiomyopathy Tachycardia induced cardiomyopathy Non compaction cardiomyopathy Peripartum cardiomyopathy Cardiomyopathy secondary to valvular heart disease Long term prognosis varies markedly across these conditions…

…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…

…depending on coronary dominance. Significant left main stenosis is generally defined as a diameter reduction of at least 50%. Severe proximal disease of both the…

…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…

…may also develop tachycardia induced cardiomyopathy (Gopinnathair et al). Long term prognosis is excellent, with the vast majority of patients recovering completely after restoration of…

…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…

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

…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…

…the excess ischaemic heart disease risk associated with heavy smoking. Consequently, reducing the number of cigarettes smoked does not produce a proportional reduction in cardiovascular…

…reflex produces a stereotypic response: an initial increase in heart rate, followed by a drop in blood pressure, and finally a reduction in heart rate…

…compensates by increasing cardiac output (CO); this is achieved by increasing heart rate and producing larger stroke volumes. Failure to increase cardiac output sufficiently will…