…pain, pulmonary congestion, a new cardiac murmur, or jugular venous distension in the days after MI should prompt immediate consideration of a mechanical complication. Clinical…

…pulmonary oedema, hepatic complications, renal impairment, and cerebrovascular accidents. HELLP syndrome is associated with substantial morbidity and mortality. Pregnancy related hypertension also influences obstetric management…

…Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial loading dose: 300–500 mg as soon…

…approximately 5–10%. Only about 10% of patients who develop shock present with it at hospital admission; approximately 90% deteriorate during hospitalization. Patients who develop…

…onset during hyperthyroidism (thyrotoxicosis), alcohol overdose, thoracic surgery, acute myocardial infarction, pericarditis/myocarditis or pulmonary embolism is often a reversible arrhythmia with low risk of…

…of stroke and the possibility of thrombolytic treatment. Cardiac and pulmonary complications Acute hypertension may precipitate myocardial ischemia or infarction, acute heart failure, or pulmonary…

…heartbeat Dyspnoea and worsening pulmonary congestion Reduced exercise capacity Symptoms or signs of heart failure Haemodynamic instability Myocardial ischaemic symptoms or electrocardiographic changes Thromboembolic complications…

…and subject preparations. We will also discuss the relevance of withholding specific cardioactive medications during exercise testing (exercise ECG). Indications for exercise stress test Indications…

…of the leaflets and thus causes mitral regurgitation. The term coaptation is used to describe how well the leaflets meet and close the valve during…

…hypertension coexists in approximately 70% of patients with aortic dissection. PAU is particularly associated with advanced age, smoking, coronary artery disease, chronic obstructive pulmonary disease…

…Causes of pulmonary regurgitation Pulmonary hypertension Endocarditis Myxoma Carcinoid heart disease Tetralogy of Fallot Marfan syndrome Takayasu's arteritis Iatrogenic (e.g complication of catheterization…

…of the mitral valve Acute mitral regurgitation Acute mitral regurgitation is relatively rare. The most common causes are as follows: Endocarditis Papillary muscle rupture (complication…

…stroke volumes. Failure to increase cardiac output sufficiently will result in the following compilations: Pulmonary edema develops due to rising LAP and LVEDP. Cardiogenic shock…

…Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg…

…regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow…

…disease is the most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure. In some patients…

…pulmonary embolism overlap with risk factors for DVT; immobilisation, surgery, hypercoagulability, and pregnancy are common risk factors (see Risk factors below). A significant proportion of…

…setting of pulmonary valve stenosis, the pressure in the right ventricle rises, which results in right ventricular hypertrophy. The valve is usually thickened and during…

Cardiology Emergency medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and…

…regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep deceleration, early termination of diastolic flow…

…onset of action : 1 minute. Duration of action : <10 minutes. Effects Potent blood pressure lowering. Antianginal effect. Reduces afterload and preload. Effective in pulmonary edema…

…and (3) modulation of sarcolemmal and mitochondrial potassium ATP channels. Levosimendan alleviates heart failure symptoms, increases cardiac output, and lowers pulmonary artery pressure without increasing…

…pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway, work of breathing, level of consciousness…

…of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary…

…and the appropriate action differs fundamentally between these cases. Pressures in the heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure…

…of care and on whether intubation is appropriate, documented before treatment begins. Procedure 1. Treat the underlying cause in parallel. Nitroglycerin and diuretics in pulmonary…

…The shunt fraction (Qp/Qs) is a critical hemodynamic parameter used to quantify the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs)…

…of atrial size 4 10 cm² or 20 40% of atrial size 10 cm² or 40% of atrial size Jet orientation central variable excentric Pulmonary…

…Trinipatch ® Indications Pulmonary edema, congestive heart failure. Angina pectoris. Hypertension, hypertensive crisis/emergency. Pulmonary hypertension. Blood pressure control. Mechanism of action Nitroglycerin provides nitric…

…scope Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular…

…manipulate systemic and pulmonary vascular resistance, and restore adequate end organ perfusion. Dobutamine is a synthetic catecholamine that functions as an agonist of both beta1…

…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…

…pulmonary gas exchange efficiency, the concentration of catecholamines, angiotensin, hemoglobin, etc. A vivid example of how cardiac function can be affected by targeting peripheral mechanisms…

…the PA catheter ( Pulmonary Artery Catheter , also called Swan Ganz catheter ) has been the first choice, but today the majority of patients can only be…

…flowing through the pulmonary, coronary and cerebral circulation, as well as allowing for gas exchange in the lungs. A large number of experimental and observational…

…Drug Standard dose Reduced dose and criterion : : : Apixaban 5 mg twice daily 2.5 mg twice daily if at least two of: age ≥80 years…

…Indications Emergency, irrespective of duration and anticoagulation status: Tachyarrhythmia with haemodynamic compromise: hypotension, shock, pulmonary oedema, myocardial ischaemia or a falling level of consciousness. Unstable…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…to an arrhythmia unit. Assessment of the effect of adenosine, which can be given during the recording and unmask the atrial activity. The investigation is…

…of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic disease, for example rheumatoid arthritis or scleroderma, and during treatment with pulmonary…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…pulmonary disease, advanced age, smoking, diabetes, hypertension, cancer, etc – are the most important risk factors for poor outcomes. The vast majority of infections with COVID…

…prevalence of conventional cardiovascular risk factors. Smoking and insulin resistance are associated with both RA and cardiovascular risk. Dyslipidaemia may be difficult to interpret during…

…investigations. The emergency differential also reflects distinct mechanisms of acute cardiopulmonary disease: Pulmonary embolism and spontaneous pneumothorax may produce abrupt chest pain and respiratory distress…

…from the pulmonary artery and anomalous origin of one coronary artery from the opposite aortic sinus. Pathophysiology Myocardial bridging During systole, contraction of the overlying…

…diastolic dysfunction, or both. The clinical consequences of extracellular volume expansion include elevated cardiac filling pressures, pulmonary congestion, systemic venous hypertension, and peripheral interstitial edema…

…clinical state during treatment with an angiotensin receptor–neprilysin inhibitor. Clinical Applications Natriuretic peptides have three principal roles: Supporting or excluding the diagnosis of HF…

…during the fetal period. This is explained by the configuration of the fetal circulation; pulmonary resistance is high (which means that resistance in the pulmonary…

…preservation of adequate right ventricular preload while supporting left ventricular performance and systemic circulation. Improvement in left ventricular function also lowers pulmonary arterial and pulmonary…

…treatment LV function requires evaluation in the setting of suspected ischaemia or previous infarction Dyspnoea requires assessment of dynamic LV function, valve disease, pulmonary pressure…

…is an integral part of ECG interpretation. The electrical axis reflects the average direction of ventricular depolarization during ventricular contraction. The direction of the depolarization …

…Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings…

…ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the…

…sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular diseases Anemia The natural course of asphyxia Should ventilation be…

…of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical conditions (pulmonary…

…also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine states…

…the circulation. ECMO use during cardiac arrest (referred to as ECPR [extracorporeal CPR] ) requires the immediate establishment of veno arterial ECMO (VA ECMO) . A peripheral…

…LV) filling pressures, defined invasively as a pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg during exercise [4] . This hemodynamic criterion…

…exceptions. Prior to the Doppler era, hemodynamic assessments were performed by means of right heart catheterization (with Swan Ganz catheter [ pulmonary artery catheter ]). However, hemodynamic…