…Pressures in the heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure (MAP) = diastolic + (systolic − diastolic)/3 Cardiac output =…

…care unit or another setting that allows frequent blood pressure measurement and continuous monitoring. An arterial line is often appropriate when very rapid or precise…

…be functionally significant, whereas a severe appearing lesion may not produce demonstrable ischaemia. Functional assessment with pressure or flow measurements, intravascular imaging, or fractional flow…

…left ventricular performance and systemic circulation. Improvement in left ventricular function also lowers pulmonary arterial and pulmonary capillary wedge pressures, thereby reducing the load faced…

…atrial activity. The investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary…

…diastolic reserve becomes evident, with a rise in left atrial and pulmonary pressures that contributes to exertional breathlessness and reduced exercise capacity. Multiorgan and comorbidity…

…is clinically secure and the LVEF measurement is reliable. Nevertheless, these findings increase diagnostic confidence. The presence of symptoms alone is insufficient. Anaemia and pulmonary…

…dilation. Atrial dilation causes a significantly increased risk of atrial fibrillation. The increase in left atrial pressure may also propagate backward to the pulmonary circulation…

…blood pressure: the maximum arterial pulsatile pressure during systole. With auscultatory measurement, it corresponds to the appearance of the first Korotkoff sound. Diastolic blood pressure…

…know by heart is that an arterial line must never be confused with a venous access. Indications Continuous blood pressure monitoring in haemodynamic instability or…

…include consideration of treatable contributors, such as underlying comorbidities, supervised muscle strengthening physiotherapy, exercise, and coordination and balance training. Orthostatic Blood Pressure Measurement Before starting…

…airway, breathing, circulation and level of consciousness. 2. Attach ECG, pulse oximetry and repeated blood pressure measurement when a hypertensive emergency is suspected. 3. Insert…

…dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous oxygen saturation. Repeated blood sampling during intensive care. Exhausted…

…be falsely normal because of medial sclerosis — in that case add toe pressure measurement. Absolute: ABI < 0.5 or toe pressure < 30 mmHg…

…should include: palpation of peripheral pulses; auscultation for carotid, femoral, and abdominal bruits; bilateral brachial blood pressure measurement; cardiac auscultation; inspection of the legs and…

…information. Coronary pressure measurements permit assessment of the physiological significance of selected stenoses using fractional flow reserve (FFR) and instantaneous wave free ratio (iFR). Other…

…across the mitral valve using pulsed Doppler. Estimating left ventricular filling pressure via e' . Measurement of deceleration time (DT) . Diastolic function can be estimated from…

…and with a measurement interval of no more than 30 minutes throughout the 24 hours. Phenotype Office blood pressure ABPM : : : Normotension Normal Normal White coat…

…ability of the coronary arteries to maintain a relatively constant myocardial blood flow despite changes in coronary perfusion pressure, typically within a range of 50…

…least 10 minutes unless promptly treated Severe chest pain, pressure, or discomfort An accelerating pattern of angina, with increasing frequency or severity Symptoms that awaken…

…response of the coronary circulation reflects both epicardial stenosis and the coronary microcirculation. Microvascular dysfunction may impair maximal vasodilation even when the epicardial arteries are…

…an adrenal incidentaloma Hypertension associated with sleep apnoea Hypertension with atrial fibrillation in the absence of an underlying structural cardiac explanation Early onset hypertension or…

…chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the coronary arteries or coronary microcirculation…

…high Lp(a) level may lead to substantial underestimation of cardiovascular risk. Conversely, Lp(a) measurement provides limited additional reclassification beyond currently recommended global risk…

…analyser. Blood gas equipment for arterial sampling. Urinary catheter with hourly urine output measurement — the treatment cannot be guided without reliable measurement of urine output…

…arterial blood gas should be considered. Do not wait for the blood gas result before starting treatment. Clinical assessment History that affects the level of…

…measurement of beta hydroxybutyrate has high diagnostic accuracy [2]. A venous blood gas is generally sufficient for the assessment of pH and bicarbonate. An arterial…

…null The current ERC and ESICM recommendation is continuous core temperature measurement and the active prevention of fever — defined as a temperature above about 37…

…establish: The triglyceride concentration and whether the sample was fasting or non fasting. The presence of ASCVD, peripheral arterial disease or aortic disease. Secondary causes…

…disease (ASCVD). Atherosclerosis develops through the progressive deposition and retention of LDL C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory…

…tomographic angiography (CCTA) is a non invasive anatomical examination that depicts the coronary arterial lumen, atherosclerotic plaque, and the severity and distribution of coronary stenosis…

…with its most common waveforms. Important intervals and points of measurement are depicted. ECG interpretation requires knowledge of these waves and intervals. The P wave…

…e.g left ventricular diameter, are evaluated in several views in order to assess the reliability and reproducibility of the measurements. The parasternal and apical…

…hemodynamic parameter used to quantify the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). This measurement is pivotal in diagnosing and managing…

…to restart it after the procedure. Document the restart date in the medical record. Sources ESC Guidelines for the management of atrial fibrillation. Internetmedicin, DOACs…

…gram of tissue (mL/min/g). This technique excels in detecting balanced ischemia. Such ischemia, seen in multivessel disease, exists when all coronary arteries are…

…adult patients with severe pulmonary stenosis, alongside right ventricular hypertrophy (RVH) and right atrial enlargement [8]. RAD is present in most cases of significant RVH…

…representative measurements, it is pivotal to align the M mode line such that it does not overestimate distances; e.g measuring the thickness of the…

…Capnography refers to the measurement of end tidal carbon dioxide (ETCO 2 ) in the respiratory system. ETCO 2 is the partial pressure of carbon dioxide …

…with its most common waveforms. Important intervals and points of measurement are depicted. ECG interpretation requires knowledge of these waves and intervals. The P wave…

…Ejection fraction is routinely examined at rest, which does not reveal the functional (maximum) capacity of the left ventricle, as this would require measuring the…

…25% Normal FS, 2D measurement 18% Advantages of fractional shortening If ventricular geometry is normal and there are no regional wall motion abnormalities, then fractional…

…The Bernoulli principle and pressure gradients using Doppler measurements Continuous wave Doppler and pulsed wave Doppler can measure the velocity of erythrocytes as they travel…

…measurement in evaluating aortic root morphology. Age stratified formulas help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of…

…confirmation by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of office blood pressure Category Systolic…

…the diameter is greatest (usually halfway through systole). Zoom in LVOT to improve the accuracy of the measurement. Flow velocity in LVOT : Velocity is measured…

…with a braked, workload controlled resistance; 12 lead ECG with continuous recording; automated or manual blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and…

…at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist…

…aphasia and radiological changes resembling ischaemic stroke. Glucose measurement is therefore always part of the initial stroke assessment [1]. Treat immediately when there are symptoms…

…of pulmonary involvement in systemic disease, for example rheumatoid arthritis or scleroderma, and during treatment with pulmonary toxic drugs. Contraindications Forced expiration raises the pressure…

…How to measure the QT interval Measurement of the QT interval may be difficult due to T wave changes. Causes of prolonged QTc duration Antiarrhythmics …

…cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within…

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…can be determined since the speed of ultrasound is constant in the body. The investigator specifies where the measurement should be performed by moving the…

…up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of treatment response and measurement of residual disease (MRD). Fever of unknown origin…

…features of acute coronary syndrome. The physical examination should include: Assessment of all major peripheral pulses. Blood pressure measurement in both arms. Cardiac auscultation. Pulmonary…

…contractile function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects of systolic function and their combined…

Echocardiography Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also…

…since they compare electrical currents in two measurement points. The electrophysiological basis of the ECG leads The movement of charged particles generates an electric current…