…of the parameters that must be evaluated and the final result of the test depends on an integrated assessment of six components: Symptoms Exercise performance…

…obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked…

…are elevated. The syndrome is therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure…

…AV nodal refractoriness. Its electrophysiologic effects on the His Purkinje system and ventricular muscle are minimal, except in cases of toxic concentrations. In most patients…

…clinical practice report muscle symptoms. This discrepancy reflects, at least in part, the nocebo effect : negative expectations, contextual cues and attribution of pre existing symptoms…

…muscle rupture causes abrupt severe MR. Its typical presentation is: Sudden severe dyspnoea. Acute pulmonary oedema. Hypotension. Progressive heart failure. Cardiogenic shock. Complete transection of…

Procedurer A dislocation is reduced with muscle relaxation, not with force. The methods that work best exploit time, gravity and slow movement; those that fail…

ECG Troponin is a protein complex expressed in cardiac and skeletal muscle. The complex consists of troponin I (TnI) , troponin C (TnC) and troponin T…

…older people with lost muscle mass (where a normal BMI may conceal sarcopenia), in oedema and ascites, and in people under 18 years of age…

…with a low muscle mass — the elderly, the undernourished, amputees, patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic kidney…

…calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent distal to the obstruction…

…of the P wave. The P wave is a small, positive and smooth wave. It is small because the atria make a relatively small muscle…

…seen in arteries throughout the circulatory system (Figure 1). The ventricular wall consists of an inner lining (endocardium), a thick muscle layer (myocardium) and an…

…subendothelial accumulation of apolipoprotein B containing lipoproteins, macrophage infiltration, smooth muscle cell proliferation, and extracellular matrix deposition, ultimately leading to the formation of atherosclerotic plaques…

…between the muscle fibers in these layers, which collectively produces a highly efficient pumping mechanism. Figure 1A 2C. The orientation of myocardial muscle fibers results…

…adrenergic receptors: expressed in vascular smooth muscle. Activation results in vasodilatation. D1 and D2 (dopamine receptors): activation of D1 and D2 in the kidneys and…

…does not distinguish between fat, muscle, and bone mass. It does not indicate the types or distribution of body fat. It may not be accurate…

…primarily consisting of individuals with CKD, limiting its accuracy when applied to healthy populations or those with acute kidney injury. Influence of Muscle Mass and…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…minutes. Administer sodium thiosulfate (cyanide into thiocyanate) and terminate infusion of nitroprusside if cyanide toxicity is suspected. Adverse effects • Nausea. Vomiting. Agitation. Muscle spasm. Sweating…

…cigarette smoking, hypertension and diabetes mellitus—disturb endothelial function and favour the accumulation of fat, smooth muscle cells, fibroblasts and extracellular matrix beneath the endothelium…

…87 95% confidence interval: 0.79–0.96 P = .004 Other summaries of the trial describe a 14% reduction in the same composite outcome…

…utility is frequently limited by its inability to distinguish between muscle mass and various fat depots, or to identify the precise location of excess adiposity…

…larger (ventricular volume and muscle mass) than the right ventricle. Refer to Figure 1 . Figure 1. Cross sectional view of ventricular wall thickness in children…

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…

…that should prompt assessment include: Hypertension Dyspnoea Exercise intolerance Congestive HF CAD Palpitations or suspected atrial fibrillation OSA or daytime symptoms suggestive of sleep disordered…

…Assessment Before Prescription Physical activity should be assessed and prescribed using the components of: Frequency Intensity Time or duration Type Progression The prescription should be…

…transport—MRs are also present in cardiac myocytes, vascular smooth muscle, endothelial cells, macrophages, neurons and other tissues. This distribution helps explain why PA produces…

…accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral…

…muscle cells, leading to a white, platelet rich thrombus. Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of…

…coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection…

…flow limitation. The mechanisms are incompletely defined. Proposed contributors include hypercontractility or hypersensitivity of coronary vascular smooth muscle to vasoconstrictor stimuli, including adrenergic agonists, leukotrienes…

…a genetic mutation in the RYR1 receptor, resulting in persistent muscle contraction upon administration of halogenated anesthetic agents. As an idiosyncratic response to substances such…

…etc . The purpose of such changes is simply to enable the cardiopulmonary system to increase its delivery of oxygen to skeletal muscle and myocardium. The…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…follows: [...] Of every 10 such victims, the heart in 6 or 7 showed no recent disease in coronary arteries or in heart muscle. In other…

…larger (ventricular volume and muscle mass) than the right ventricle. Refer to Figure 1 . Figure 1. Cross sectional view of ventricular wall thickness in children…

…syndrome), osteogenesis imperfecta typically causes prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or the connected myocardium may cause mitral prolapse, and…

…Echocardiographic assessment of mitral stenosis includes visual and 2D imaging, as well as Doppler measurements to assess the degree of stenosis and evaluation of complications…

…a parent or other personnel. Distracting the child during ECG recording may be recommended to reduce muscle disturbances. To further reduce muscle disturbances it can…

…refers to inflammation of the myocardial (muscle) tissue. However, it is often difficult to differentiate pericarditis and myocarditis, and they tend to accompany each other…

…coronary blood flow by relaxing vascular smooth muscle. They are contraindicated in patients with bronchospastic lung disease, or a history of significant reactive airway disease…

…the aorta. Afterload affects myocardial muscle fibers during systole and diastole. Afterload is a function of the following three variables: Aortic resistance (pressure). Left ventricular…

…which supplies the inferior wall of the left ventricle, determines the coronary artery dominance. A right dominant system implies that the PDA is supplied by…

…Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood…

…shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded…

…or raised Other Moderate work of breathing Accessory muscle use Cyanosis, exhaustion, hypotension or collapse The classification is based on a combination of clinical findings…

…apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis, where a long half life…

…test to be conclusive. For assessment of function and prognosis, arrhythmia evaluation, known coronary artery disease and evaluation of treatment effect, the medication is continued…

…an arm with a dialysis fistula. Preparation and equipment Hand disinfection; gloves where there is a risk of blood contact. An alcohol or chlorhexidine swab…

…slightest suspicion of septic arthritis. If the picture is unclear — aspirate, send a culture, await the result and inject later. Preparation and equipment Chlorhexidine in…

…artery, which runs on the posterior aspect of the rectus muscle along its lateral border and is the commonest source of serious bleeding after paracentesis…

…Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age alone. Assessment should include: Degree of frailty, preferably using validated clinical…

…of deconditioning Psychological status, including depression and anxiety Social support and practical barriers to participation Occupational and sporting goals Current pharmacological treatment Early assessment of…

…are components of the myocardial contractile apparatus and are expressed predominantly in cardiac muscle. Troponin I is highly specific for myocardial injury. Interpretation of troponin…

…loss of independence. Identification of PAD also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention. Clinical assessment should…

…and the development of myocardial fibrosis. Contractile dysfunction further aggravates the regurgitation (the regurgitation volume increases). Mechanically, wall stress (the load on individual muscle fibers)…

…Hypertrophy manifests on the ECG as increased amplitudes of the QRS complexes. The explanation is straightforward: myocardial muscle mass is increased and therefore it generates…