…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…

…in blood flowing back from the pulmonary artery into the right ventricle during diastole. The most common cause of abnormal pulmonary regurgitation is pulmonary hypertension…

…elevated left ventricular filling pressures (Lam et al). PASP is elevated in pulmonary arterial hypertension (PAH). Valve area The continuity equation can be used to…

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

…Hypertensive crisis Hypertensive urgency: markedly raised pressure without organ involvement — lower it orally over days. Hypertensive emergency: raised pressure with acute organ damage (encephalopathy, pulmonary…

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

…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…

…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…

…or pulmonary oedema. Patients may present with chest pain, severe breathlessness, hypoxaemia, rales, or respiratory distress. In patients with HFpEF, acute hypertension is a frequent…

…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…

…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…

…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…

…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…

…Valve function and stress related haemodynamic changes Diastolic function Pulmonary hypertension Coronary flow velocity reserve (CFVR) Pulmonary congestion detected by B lines on lung ultrasound…

…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…

…organ perfusion or frank shock states. In the specific context of perioperative care in patients with pulmonary arterial hypertension (PAH), progression of right heart failure…

…progressive acute target organ damage. Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome…

…Most reports have suggested that comorbidities – e.g. cardiovascular disease, pulmonary disease, advanced age, smoking, diabetes, hypertension, cancer, etc – are the most important risk factors…

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

…strongest risk factor for developing atrial fibrillation is age. Other significant risk factors are as follows: male sex, hypertension, left ventricular hypertrophy, left ventricular dysfunction…

…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…

…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…

…pulmonary hypertension and pulmonary edema. Table 1. Causes of aortic regurgitation Bicuspid aortic valve Rheumatic heart disease Calcified aortic valves Idiopathic aortic dilatation (aneurysm) Hypertension…

…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…

…QUESTIONS COMMENTS Risk factors for the 5 serious etiologies Family history (focus on ischemic heart disease, aortic dissection, pulmonary embolism, pneumothorax). Hypertension. Smoking. Dyslipidemia (hyperlipidemia)…

…Pulm vasoconstriction. Increased pulmonary blood flow. Ventricular arrhythmias Severe hypertension resulting in cerebrovascular hemorrhage Cardiac ischemia Sudden cardiac death Prolonged use may be cardiotoxic. Isoproterenol…

…aetiology is heterogeneous. Chronic heart failure evaluation should therefore seek reversible or treatable causes. The source material identifies coronary disease, hypertension, diabetes, obesity, valvular disease…

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

…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…

…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…

…contraindications: Adenosine, Dipyridamole, Regadenoson : Should be avoided in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize…

…Pulm vasoconstriction. Increased pulmonary blood flow. Ventricular arrhythmias Severe hypertension resulting in cerebrovascular hemorrhage Cardiac ischemia Sudden cardiac death Prolonged use may be cardiotoxic. Isoproterenol…

…5. Pulmonary Hypertension Pain Characteristics: Severe pulmonary hypertension can cause exertional chest pain that mimics angina pectoris [5]. This pain is thought to result from…

…Pulmonary hypertension secondary to left heart disease may occur because elevated left sided filling pressures are transmitted to the pulmonary circulation. Persistent pulmonary vascular disease…

…Additionally, LAD may suggest underlying left heart disease in patients being evaluated for pulmonary hypertension [16]. Causes of Left and Right Axis Deviation Based on…

…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…

…atrial pressure may also propagate backward to the pulmonary circulation, causing pulmonary hypertension (PH). Additionally, pulmonary hypertension can propagate further backward to the right ventricle…

…systemic hypoperfusion. LV failure may produce elevated filling pressures, pulmonary venous hypertension, and pulmonary congestion. Hemodynamic deterioration is more likely with larger infarcts, anterior infarction…

…smoking, coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute chest and/or…

…these findings increase diagnostic confidence. The presence of symptoms alone is insufficient. Anaemia and pulmonary, renal, thyroid or hepatic disease may produce a similar symptom…

…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…

…venous thrombosis – due to risk of embolization Relative contraindications for exercise ECG Severe hypertension (systolic blood pressure 200 mmHg or diastolic blood pressure 110 mmHg)…

…P pulmonale. P mitrale: left atrial enlargement (hypertrophy, dilatation) If the left atrium encounters increased resistance (due to mitral valve stenosis, mitral valve regurgitation, hypertension…

…unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism…

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…

…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…

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

…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…

…unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour…

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

…Palpitations and awareness of an irregular or rapid heartbeat Dyspnoea and worsening pulmonary congestion Reduced exercise capacity Symptoms or signs of heart failure Haemodynamic instability…

…is non idiopathic. Clinical Presentation and Symptoms Dyspnoea is the most frequent symptom and may occur even in the absence of pulmonary congestion. Patients may…

…effects, and the condition is classified as cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other…

…will rapidly propagate to the pulmonary circulation and cause pulmonary edema. Also, left ventricular exhaustion results in diminished cardiac output, potential hypotension and cardiogenic shock…

…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…

…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…

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…

…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)…