…Antianginal effect. Reduces afterload and preload. Effective in pulmonary edema. Can produce severe hypotension. Time to onset of action 30 seconds to 1 minute Duration…

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

…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…

…by producing a negative sodium and water balance. They can reduce jugular venous pressure, pulmonary congestion, peripheral edema and body weight, often within days. However…

…thrombotic debris may worsen the obstruction. Furthermore, cardiomyocyte swelling, interstitial edema, and tissue inflammation promote extravascular compression, exacerbating myocardial injury. Clinical Presentation and Symptoms In…

…patients present with severe chest pain, diaphoresis, hypotension, pulmonary edema, malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early…

…Compensatory mechanisms may alleviate the condition temporarily, but the elevated left atrial pressure will rapidly propagate to the pulmonary circulation and cause pulmonary edema. Also…

…distal thrombotic debris, cardiomyocyte swelling, interstitial edema, and inflammatory extravascular compression. This impaired tissue perfusion can extend injury beyond the initial ischemic zone and contributes…

…pulsus paradoxus, pericardial friction sounds, tachycardia, tachypnea, weakened peripheral pulses, edema, cyanosis. Cardiac tamponade is seen in Video 1 . Video 1. Cardiac tamponade. The heart…

…a diagnosis. Risk grading in confirmed pulmonary embolism Risk Haemodynamics Right ventricular strain (echo or CT) Troponin Management : : : : : High Unstable Yes Often raised Reperfusion, intensive…

…of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). In European journal of echocardiography : the journal…

…recommended criterion for precapillary PH, partly because this value has been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute…

…factors (see Risk factors below). A significant proportion of cases with pulmonary embolism require thrombolysis to dissolve the occlusion. Administration of thrombolysis requires careful consideration…

…Iatrogenic (e.g complication of catheterization) Congenital dysplasia/aplasia of the pulmonary valve Idiopathic pulmonary artery dilation Pulmonary regurgitation results in right ventricular volume overload…

…the great arteries) Dysplastic, bicuspid or unicuspid pulmonary valve Noonan syndrome : 60% of all individuals with Noonan syndrome have pulmonic stenosis. The stenosis is subvalvular…

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…

Right ventricle and pulmonary artery Normal interval Mildly abnormal Moderately abnormal Severely abnormal RV DIMENSIONS Basal RV diameter (RVD 1), cm 2.0–2.8…

…increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use…

…patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway…

…< 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation…

…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…

…pressure and thereby increases ventilation and lowers the carbon dioxide. Pulmonary oedema calls for the former, a COPD exacerbation with carbon dioxide retention for the…

…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)…

…atrial size 10 cm² or 40% of atrial size Jet orientation central variable excentric Pulmonary vein flow S dominant reduced S wave systolic flow reversal…

…heritable aortopathies, selected congenital heart diseases, pulmonary arterial hypertension and thromboembolic disorders. Most recognised heritable cardiovascular conditions demonstrate autosomal dominant transmission, in which an affected…

…pharmacodynamic mechanisms. These drugs are broadly utilised to augment myocardial contractility, manipulate systemic and pulmonary vascular resistance, and restore adequate end organ perfusion. Dobutamine is…

…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, renal and neurohormonal factors. These factors, which influence cardiac function primarily by affecting ventricular function, include blood pressure, venous return, pulmonary gas exchange efficiency…

…difficulties in visualizing it. Previously, the PA catheter ( Pulmonary Artery Catheter , also called Swan Ganz catheter ) has been the first choice, but today the majority…

…intrathoracic pressure by compressing, decompressing and ventilating. These maneuvers result in arterial blood flowing through the pulmonary, coronary and cerebral circulation, as well as allowing…

…target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and pulmonary embolism differ from the atrial fibrillation doses and include an initial high…

…and anticoagulation status: Tachyarrhythmia with haemodynamic compromise: hypotension, shock, pulmonary oedema, myocardial ischaemia or a falling level of consciousness. Unstable monomorphic VT with a pulse…

…Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis, pericarditis or endocarditis. Acute aortic dissection…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour of the nose, pharynx or…

…the eyes. Postpone the test in: Condition Recommended delay : : Myocardial infarction or unstable angina 1 month Pneumothorax 1 month after resolution Pulmonary embolism, until anticoagulated…

…risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity…

…Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with higher perioperative risk. Clinical Applications Personalized Decision Making : SYNTAX Score II…

…COVID 19 relies on small samples of hospitalized patients. Most reports have suggested that comorbidities – e.g. cardiovascular disease, pulmonary disease, advanced age, smoking, diabetes…

…microvascular dysfunction Myocarditis and pericarditis Coronary or large vessel arteritis Pulmonary arterial vasculopathy and pulmonary hypertension Arterial and venous thrombosis Valvular heart disease Cardiac dysrhythmias…

…categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other cardiopulmonary causes , including myopericardial disease, pulmonary embolism, aortic emergencies, and pneumothorax. Non cardiopulmonary causes , including gastrointestinal…

…Other congenital anomalies include anomalous origin of a coronary artery from the pulmonary artery and anomalous origin of one coronary artery from the opposite aortic…

…diastolic dysfunction Valvular heart disease Pulmonary hypertension Ischaemic heart disease Atrial arrhythmias Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies…

…the pulmonary circulation (normally 15 mmHg in adults). Hence, the pressure in the systemic circulation is many times greater than the pressure in the pulmonary…

…severe right sided failure and cardiogenic shock. The haemodynamic disturbance results from impaired right ventricular contraction and reduced forward flow through the pulmonary circulation. Consequently…

…valve disease, pulmonary pressure, or haemodynamics Stress imaging is not recommended in patients undergoing urgent non cardiac surgery or those with an unstable clinical condition…

…Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale (COPD, pulmonary hypertension, pulmonary valve stenosis). Lateral ventricular infarction. Pre excitation…

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

…under acute coronary syndromes (ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of…

…2), obesity, smoking, obstructive sleep apnea and chronic obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and…

…conditions : Tension pneumothorax Drowning Airway obstruction Hanging Pneumonia High altitude sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular…

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

…and ectopic atrial rhythm Side effect of digoxin. Heart failure. Lung disease (COPD, pulmonary hypertension, etc). Ischemic heart disease (coronary artery disease). Structural heart disease…

…seen in certain causes of cardiac arrest (e.g. pulmonary embolism) or in case of long no flow or low flow periods. Under such circumstances…

…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…

…the pulmonary circulation (normally 15 mmHg in adults). Hence, the pressure in the systemic circulation is many times greater than the pressure in the pulmonary…

…seen in leads I, II and III ( S I S II S III pattern ). P pulmonale is very common. Figure 2. Two ECGs showing left…

…g congestive heart failure, lung disease (e.g COPD), fever, infections, anemia, myocardial ischemia/infarction, pulmonary embolism, pheochromocytoma, hyperthyroidism, hypovolemia, pharmacological substances (alcohol, amphetamine, coffee…

…Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension. Left to right shunt. Right ventricular dysfunction due to pressure/volume overload is…