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…

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

…patient denial, often leads to a mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and…

…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…

…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…

…Absolute: Acute coronary syndrome within 48 hours, or ongoing unstable angina. Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or…

…pulmonary embolism, pneumothorax). Hypertension. Smoking. Dyslipidemia (hyperlipidemia). Obesity and/or diabetes. Psychosocial stress. Alcohol abuse. Physical inactivity. Unhealthy diet. Cerebral / peripheral vascular disease. Cancer. Acute…

…thoracic surgery, acute myocardial infarction, pericarditis/myocarditis or pulmonary embolism is often a reversible arrhythmia with low risk of recurrence. Atrial fibrillation in other circumstances…

…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…

…pulmonary embolism, trauma, respiratory causes, drug overdoses, etc.). Among victims in whom the cardiac arrest was caused by VT or VF (e.g acute or…

…of 0 indicates low risk. Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The doses in venous…

…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…

…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…

…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…

…Epidemiology of pulmonary embolism Venous thromboembolism (VTE) is the third leading cardiovascular cause of death worldwide. Only stroke and acute myocardial infarction are more common…

…prolonged. However, most often the cause of the load is the primary problem. Among the causes are pulmonary embolism, pulmonary hypertension, septum defects, etc. Right…

…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…

…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…

…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…

…windows might be feasible, particularly during brief pauses. An enlargement of the right ventricle is suggestive of pulmonary embolism, though its specificity is low. Notably…

…4. Pulmonary Embolism (PE) Pain Characteristics: While dyspnea is the cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction…

…deviations include: Causes of Right Axis Deviation: Pulmonary hypertension (primary or secondary) [9, 16] Severe pulmonary stenosis [8] Right ventricular hypertrophy [8, 17] Pulmonary embolism…

…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…

…forth of the heart in the pericardial space. Note that tachycardia, pulmonary embolism and ischemia may also cause electrical alternans. PQ segment depression. Sinus tachycardia…

…severe aortic stenosis Decompensated heart failure Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis Acute myocarditis or pericarditis Acute aortic dissection Physical disability that…

…of circulatory collapse and arrhythmias Pulmonary embolism in acute phase – due to risk of aggravation of the condition. Pulmonary infarction in acute phase – due to…

…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…

…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…

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…

…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…

…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…

…< 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…

…not given another hour. Indications CPAP: Acute cardiogenic pulmonary oedema with hypoxaemia and marked work of breathing — the strongest indication, with a rapid effect on…

…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…

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

…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…

…care in patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and…

…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…

…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…

…can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can cause a stroke hours to weeks later. Everything else in the…

…other acute organ damage can often be treated more cautiously with oral drugs under careful observation [3,4]. A markedly raised blood pressure without acute…

…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…

Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

…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…

…events per 1000 patient years, compared with 15.0 per 1000 patient years in age matched controls without autoimmune disease. The greatest risks were reported…

…risk anatomical features include an interarterial course between the aorta and pulmonary artery, a slit like orifice, a high coronary origin, acute angle take off…

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

…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…

…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…

…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…

…Less frequently, it may also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline…

…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…