Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Post infarction mechanical complications are structural disruptions of acutely infarcted myocardium occurring most often during the first…

…fluids in the human body. Sound waves arise when a sound source generates mechanical vibrations in the particles of the medium. These vibrations continue to…

…foundation for understanding subsequent chapters. SCA (Sudden Cardiac Arrest) : Sudden and unexpected cardiac arrest with loss of mechanical cardiac function. Results in loss of consciousness…

…this sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In contrast…

…target INR 2.0 3.0 A mechanical valve may require a higher target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and…

…cardiac arrest. Repeated blood gases, for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients…

…contraindicated, for example in asthma Contraindicated in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or…

…EMG about 95 %). Contraindications Known hypersensitivity to edrophonium. Mechanical obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade…

…whoever starts the drug is responsible for the first week. Indications A mechanical valve prosthesis — warfarin is mandatory, and direct oral anticoagulants (DOACs) are contraindicated…

…dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support, including extracorporeal membrane oxygenation (ECMO)…

…mid QRS in at least two left facing leads [7]. These stricter parameters correlate more closely with abnormal LV mechanical function and the potential benefit…

…or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow…

…heart failure, malignant arrhythmias, or mechanical complications. Risk assessment is intended to identify patients most likely to benefit from early coronary angiography and revascularization, while…

…more patients survive with severe, diffuse CAD that is no longer amenable to additional mechanical revascularization. Despite treatment with antianginal drugs and PCI or CABG…

…shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect…

…two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure and cardiogenic shock. Most out of hospital deaths occur…

…treat (NNT) for the ACLS specific interventions is much higher or uncertain, meaning that the efficacy of these interventions is much lower or uncertain. Indeed…

…dysfunction, and hypercoagulability [1] [2] . Mechanical stasis in AF is most pronounced in the left atrial appendage (LAA). The LAA is a highly trabeculated, windsock…

…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…

…determinants of survival in cardiac arrest. All subsequent actions require trained professionals (e.g endotracheal intubation, mechanical chest compressions, targeted temperature management, etc.) and are…

…ultrasound waves, they begin to vibrate and these mechanical vibrations are converted into electric current that is sent back to the ultrasound machine, where the…

…Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and evidence demonstrating long…

…Anticoagulation before cardioversion After cardioversion the atrium does not regain its mechanical function until days to weeks have passed — atrial stunning — which means that the…

…Started within 48 h where possible Thromboprophylaxis Low molecular weight heparin unless contraindicated Head of the bed 30–45° Stress ulcer prophylaxis During mechanical ventilation…

…close to the upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing…

…known thrombosis in the target vein. With a mechanical tricuspid prosthesis the lead must not be passed through the valve. The order of management in…

…If oral anticoagulation is indicated, NOACs should be chosen except in patients with moderate to severe mitral stenosis or mechanical heart valves; for these patients…

…instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction…

…while inflammatory cell proteinases degrade matrix constituents. The balance between synthesis and degradation influences plaque architecture and mechanical stability. Atherosclerotic lesions commonly arise at sites…

…adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal…

…are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both…

…frequent cause of PCI failure, despite its substantially lower incidence with drug eluting stents (DES) than with bare metal stents (BMS). Clinical ISR is generally…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…and calcium, as well as through the direct activation of voltage sensitive calcium channels. At lower doses, dobutamine stimulates beta2 and alpha receptors, inducing vasodilation…

…small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge…

…associated with roughly one in five strokes. Thrombus formation is most commonly related to the left atrial appendage, although competing mechanisms such as large artery…

…the rhythm [4]. Mechanical Support : Extracorporeal membrane oxygenation (ECMO) or intra aortic balloon pump (IABP) may be required for hemodynamic support [4]. Advanced Therapies : Consideration…

…cardiac arrest presenting with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) can be defibrillated to restore an organized rhythm and thus mechanical cardiac function…

…processes that lead to cell contraction. The spread of an electrical impulse is therefore directly coupled to a mechanical event; this is referred to as…

…The primary composite outcome included in hospital mortality, resuscitated cardiac arrest, cardiac transplantation or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke…

…the ventricles. First degree AV block is rarely serious and may be left untreated in the vast majority of cases (exceptions are discussed later). Second…

…the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications, is much less common in the acute phase. The chain of care…

…cardiac arrest is 2.5%. As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest…

Echocardiography Structure and contractile function of myocardial fibers The left ventricular wall can be subdivided into several layers. These layers are similar to those seen…

…myocardial mechanics. This section covers all clinically relevant aspects of myocardial mechanics, with emphasis on echocardiographic aspects. The bulk of the discussion concerns left ventricular…

…genes encoding desmosomal proteins . The desmosome is a component of the intercalated disc that connects myocardial cells mechanically and electrically. Most mutations are inherited in…

…clinical syndrome characterized by the cardinal symptoms and signs of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of ≥50%…

…left ventricular hypertrophy under normal loading conditions. Recommended reading Ventricular Pressure Volume Relationship: Preload, Afterload, Stroke Volume, Wall Stress & Frank Starling's law Myocardial Mechanics…

…the left ventricle decreases and when it is lower than left atrial pressure, the mitral valve opens, which results in blood flowing into the left…

…start cardiac monitoring at a plasma potassium above 6.0 mmol/L, and at lower values if the rise is rapid, the patient has symptoms…

…volume overload. Unfortunately, adaptation implies that the left ventricle dilates, which induces irreversible cellular and extracellular processes that ultimately lead to heart failure. This initially…

…actual contraction but are also capable of transmitting the action potential, albeit at a much lower speed than the conduction cells. The terms contractile myocardium …

…thickness. Strain imaging is also used routinely to visualize regional myocardial function and mechanics. Loading conditions and heart rate may affect left ventricular function. Transesophageal…

…as ejection fraction may provide easily obtained parameters, but fail to provide important insights into left ventricular mechanics. Regional differences in contractile function are of…