…classification comprises five groups: Group 1: Pulmonary arterial hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung disease…

…a paraneoplastic syndrome that occurs due to carcinomas secreting kallikrein and serotonin. In the heart, this can lead to thickening of the pulmonary valve and…

…Rheumatic heart disease. Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension. Left to right shunt. Right ventricular dysfunction due to pressure…

…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…

…follows: male sex, hypertension, left ventricular hypertrophy, left ventricular dysfunction, valve disease, coronary artery disease, cardiomyopathy, congestive heart failure, congenital heart disease, diabetes mellitus (both…

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

…s, provided that other causes of left axis deviation have been excluded. Causes of extreme axis deviation Rare. Most likely due to misplaced limb electrodes…

…contraction. The direction of the depolarization (and thus the electrical axis) is generally alongside the heart's longitudinal axis (to the left and downwards). Figure…

…pulmonary hypertension or pulmonic stenosis. Heart rate . Synchronicity : Optimal contraction requires the majority of all ventricular myocardium to contract simultaneously. For this to be possible…

…be due to low flow, low vascular tone or both, and the appropriate action differs fundamentally between these cases. Pressures in the heart and pulmonary…

…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…

…diaphoresis, hypotension, pulmonary edema, malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early due to the massive ischemia. Complete…

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

…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…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

…This is due to the swinging back and forth of the heart in the pericardial space. Note that tachycardia, pulmonary embolism and ischemia may also…

…pulmonary regurgitation is a normal echocardiographic finding that requires no further investigation. Table 1. Causes of pulmonary regurgitation Pulmonary hypertension Endocarditis Myxoma Carcinoid heart disease…

…Nipride RTU ®, Nitropress ®. Indications Pulmonary edema, congestive heart failure. Angina pectoris. Hypertension, hypertensive crisis/emergency. Pulmonary hypertension. Blood pressure control. Mechanism of action…

…gives a falsely high reading The cuff at heart level Measure in both arms at the first visit; a difference 15 mmHg suggests vascular disease…

…molecular testing. The approach is particularly relevant to cardiomyopathies, channelopathies, heritable aortopathies, selected congenital heart diseases, pulmonary arterial hypertension and thromboembolic disorders. Most recognised heritable…

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

…include: Severe hypertension, defined as blood pressure ≥160/110 mmHg Headache that does not respond to medication Visual disturbance Persistent severe epigastric pain Pulmonary oedema…

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

…not specific to left ventricular systolic dysfunction. Levels may also rise with: Left ventricular diastolic dysfunction Valvular heart disease Pulmonary hypertension Ischaemic heart disease Atrial…

…to identify inducible myocardial ischaemia and to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left…

…of hypotension, end organ hypoperfusion, shock states, and pulmonary congestion. In pregnant patients presenting with suspected acute heart failure, urgent hospital admission and referral to…

…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…

…small samples of hospitalized patients. Most reports have suggested that comorbidities – e.g. cardiovascular disease, pulmonary disease, advanced age, smoking, diabetes, hypertension, cancer, etc – are…

…venous pressure, pulmonary congestion, peripheral edema and body weight, often within days. However, diuretic treatment has not been shown formally to reduce heart failure mortality;…

…diabetes mellitus, and metabolic syndrome [58] . Hypertension and coronary artery disease (CAD) remain the most potent population attributable risk factors. Furthermore, the "obesity paradox"—whereby…

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

…and progressive neurohormonal activation. The therapeutic rationale for disease modifying treatment is to reduce mortality, prevent recurrent hospitalization for worsening heart failure, and improve symptoms…

…rupture causes abrupt severe MR. Its typical presentation is: Sudden severe dyspnoea. Acute pulmonary oedema. Hypotension. Progressive heart failure. Cardiogenic shock. Complete transection of a…

…venous hypertension with relatively modest left sided congestion—is an important clinical clue. Haemodynamic severity The presentation may range from mild right ventricular impairment to…

…to systemic inflammation [7] . The dominant risk factors for HFpEF include hypertension (present in 80% of cases), obesity, type 2 diabetes mellitus, chronic kidney disease…

…complete heart block Hypertrophic obstructive cardiomyopathy with severe resting gradient Recent stroke or transient ischemic attack Mental impairment with limited ability to cooperate Resting hypertension…

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

…valvular disease. Increasing severity of mitral regurgitation is associated with worse outcomes. Pulmonary hypertension secondary to left heart disease may occur because elevated left sided…

…equal to 30 degrees [11]. Additionally, LAD may suggest underlying left heart disease in patients being evaluated for pulmonary hypertension [16]. Causes of Left and…

…Additionally, pulmonary hypertension can propagate further backward to the right ventricle and right atrium, leading to right heart hypertrophy, dilation and ultimately right heart failure…

…septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac output…

…associated with advanced age, smoking, coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms…

…regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability…

…pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in STEMI and suggests pericarditis instead…

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

…hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease…

…Hypotension can be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g…

…contraindicated, for example in asthma Contraindicated in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or…

…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…

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

…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…

…its relationship to symptoms and haemodynamic status Whether heart failure is present and whether left ventricular systolic function is depressed or preserved Whether hypotension is…

…with initially limited symptoms because the pericardium has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively insensitive…

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

…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…

…reduction in left ventricular preload lead to a cascade of hemodynamic alterations which may culminate in cardiac arrest. Pulmonary embolism is causally related to deep…

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…

…neuromuscular disease. Hypercapnic failure in cardiogenic pulmonary oedema that does not improve with CPAP alone. As ceiling therapy where intubation has been judged not to…

…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)…