Cardiology Key points Levosimendan alleviates heart failure symptoms, increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of…

…adequately increase heart rate Chronotropic incompetence is an independent predictor of overall and cardiovascular mortality. The condition is very common among individuals with heart failure…

…sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered …

…administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for…

…medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care…

…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…

…symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other thromboembolic events. Subclinical cerebral injury may contribute…

…haemorrhages, cotton wool spots, and papilloedema. Associated complications may include encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast…

…disease (ASCVD), coronary artery disease (CAD), myocardial infarction, stroke, heart failure (HF), atrial fibrillation (AF), aortic disease, and peripheral artery disease (PAD). Diabetes also substantially…

…makes positioning impossible. Severe angina, heart failure or recent myocardial infarction. Red flags — investigate further instead Finding Suggests : : Nystagmus that is purely vertical, downbeating or…

…acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100…

…concentric remodelling, reduced longitudinal strain and heart failure with preserved ejection fraction are more frequent in women. Diabetes confers greater cardiovascular risk in women than…

…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…

…Commonly, patients with bradycardia have a strong indication for drugs that aggravate or cause bradycardia (e.g. beta blockers in heart failure). In such scenarios…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…heart failure, myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree AV block Mobitz…

…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…

…arrhythmias, and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical…

…treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular disease, including heart failure and ischaemic heart disease. Ageing…

…disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms…

…predominantly by atrial tissue; its midregional pro ANP assay may provide information comparable to BNP and NT proBNP in heart failure (HF). The biologically active…

…includes: Symptom burden and functional limitation Evidence of heart failure Haemodynamic stability Diabetes status Renal dysfunction and other important comorbidities Frailty Liver cirrhosis Cognitive function…

…is associated with cardiac hypertrophy, myocardial fibrosis, diastolic dysfunction and heart failure. Compared with patients with primary hypertension matched for age, sex and blood pressure…

…including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic kidney disease Cardiomyopathy Stroke or subarachnoid haemorrhage Takotsubo syndrome Pulmonary embolism Recent coronary revascularization Infiltrative…

…Other significant risk factors are as follows: male sex, hypertension, left ventricular hypertrophy, left ventricular dysfunction, valve disease, coronary artery disease, cardiomyopathy, congestive heart failure…

…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…

…in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole…

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

…For example, left ventricular size, measured as its inner diameter, is strongly related to heart failure, ventricular tachyarrhythmias, and overall mortality. Ventricular dimensions are measured…

…pressure and evidence of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical…

…other iatrogenic cardiovascular procedures Acute aortic disease, particularly ascending or type A aortic dissection Myocardial free wall rupture after infarction Anticoagulant associated bleeding Renal failure…

…ischemia, parasympathetic and sympathetic tone) while others take months or years to develop (e.g. myocardial remodeling in heart failure or after myocardial infarction). Ventricular…

…cardiac arrest is the mechanism of death for about half of all individuals with heart failure ( Packer et al ) and 30% of people with diabetes…

…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…

…even if symptoms have subsided, particularly with continuing ischaemia, heart failure, electrical instability or a large area of myocardium at risk. Over 48 hours: urgent…

…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…

…0.5 or toe pressure < 30 mmHg. Decompensated heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute…

…dynamic ECG abnormalities, myocardial necrosis, haemodynamic deterioration, heart failure, malignant arrhythmias, or mechanical complications. Risk assessment is intended to identify patients most likely to benefit…

…limitation to acute coronary syndrome (ACS), ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease, the principal symptomatic indication for revascularization is angina…

…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…

…by ischemia/infarction : There are numerous causes of LBBB, such as heart failure, structural heart disease, fibrosis of the conduction system and acute myocardial infarction …

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

…tachycardia . The vast majority of patients with ventricular tachycardia either have coronary artery disease (ischemic heart disease), heart failure, cardiomyopathy or valvular heart disease. In…

…forward. Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant…

…et al, it is also reasonable to believe that patients with heart failure are at increased risk of decompensation if infected with COVID 19. Moreover…

…and peripheral arterial disease. Heart failure is also considered established clinical CVD in the risk based approach to elevated BP. Risk categories In apparently healthy…

…In cardiogenic shock, the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when…

…adverse events is increased by: advanced age; diabetes mellitus; chronic kidney disease or renal failure; congestive heart failure; prior stroke; emergency coronary angiography or PCI…

…the presence of substantial pre existing CKD, particularly when congestive heart failure or other causes of ischaemic AKI coexist. Risk assessment Patient related risk factors…

…and pre existing diabetes, previous myocardial infarction, or heart failure. Mechanical disruption must be considered whenever abrupt circulatory collapse occurs after STEMI. Rupture may involve…

…Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus, renal failure, heart failure, hypercoagulability, prior brachytherapy Antiplatelet therapy Nonadherence or discontinuation of clopidogrel…

…clinical presentations can be heterogeneous. In the context of acutely decompensated heart failure, shortness of breath is the cardinal symptom and may act as an…

…required for evidence of: Ongoing or recurrent chest discomfort. Haemodynamic instability. Electrical instability or arrhythmia. Heart failure. Cardiogenic shock. Recent myocardial infarction. Important alternative diagnoses…

…etc.). Among victims in whom the cardiac arrest was caused by VT or VF (e.g acute or chronic myocardial ischemia, heart failure, etc.), it…

…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…

…Decompensated heart failure – due to the risk of circulatory collapse and arrhythmias Pulmonary embolism in acute phase – due to risk of aggravation of the condition…

…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…

…tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction sounds…

…tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock and cerebral or visceral malperfusion. Type B disease may produce rupture, renal, mesenteric…

…other ECG changes (see below) should lead to a suspicion of ARVC. The gradual loss of myocardium leads to ventricular dilation and right heart failure…