…exercise). The more severe the stenosis, the more pronounced the symptoms. Stable angina pectoris is diagnosed by means of exercise stress testing (exercise ECG). The…

…block (BBB) or an intraventricular conduction defect. In severe cases, bradycardia may progress to hemodynamic instability, presenting as shock or cardiac arrest manifesting as bradyarrhythmic…

…infarction Definition and Pathophysiology Stress echocardiography is a functional cardiac imaging technique used primarily to identify inducible myocardial ischaemia and to estimate prognosis in patients…

…Pharmacologic stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic…

…requiring the most rapid BP response. The objective is to reduce aortic wall shear stress and rapidly lower systolic pressure. Renal and microvascular complications Renal…

…C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability, thrombogenic responses and immune activity. Statin intolerance refers to adverse effects attributed to…

…Most cardioinhibitory events are due to sinus bradycardia, though transient atrioventricular (AV) block can also occur. The physiologic response to orthostatic stress is incompletely understood…

…to severe aortic stenosis with uncertain relation to symptoms Tachyarrhythmias with uncontrolled ventricular rates Acquired advanced or complete heart block Hypertrophic obstructive cardiomyopathy with severe…

…is generally similar to that in non pregnant patients, although symptoms may be atypical. Pregnant patients with SCAD may have a more severe presentation than…

…will alleviate the ischemia, improve myocardial function and increase resistance to episodes of more severe myocardial ischemia. Collateral circulation may be very effective in reducing…

…antihistamine for symptoms Anaphylaxis Objective airway, respiratory or circulatory compromise, or a rapidly progressive multisystem reaction Intramuscular adrenaline immediately Severe anaphylaxis Hypoxia, marked bronchospasm, stridor…

…haemorrhage control) planned in advance. A history of a severe transfusion reaction: contact transfusion medicine before transfusing again. Preparation and equipment Compatibility testing Test What…

…Severe atherosclerosis of the axillary or subclavian arteries may increase the risk of embolization. Risk assessment should be individualized. There are no absolute contraindications to…

…treatment; biphasic reactions occur. Everyone must go home with an adrenaline auto injector and written instructions. Patients taking beta blockers may respond poorly to adrenaline…

…with gastrointestinal disorders. Patients with severe kidney disease (glomerular filtration rate < 30 mL/min). Patients with mild to moderate heart failure, kidney or liver…

…or when a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor…

…hypoactivity, hallucinations and marked autonomic hyperactivity Up to 5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness…

…conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe…

…the cessation of contractions leads to a marked reduction in cell metabolism and thus prolongs survival. Myocardial stunning starts to normalize within minutes after the…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…total body water. In hypotonic hyponatraemia the amount of water is too great in relation to the amount of dissolved cations [3]. The first five…

…Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic blood pressure towards 100 to 120 mmHg…

…Significant left main stenosis is generally defined as a diameter reduction of at least 50%. Severe proximal disease of both the proximal left anterior descending…

…with symptomatic orthostatic hypotension, moderate to severe frailty, or very old or frail patients who may not tolerate rapid blood pressure reduction. Initial Combination Therapy…

…infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to VSR. Large infarction, especially for septal or free wall rupture. Free…

…beats/min. The reduction in the combined outcome of cardiovascular death or heart failure hospitalisation was related to the magnitude of heart rate reduction. Ivabradine…

…patients undergoing coronary angiography, with reported prevalence ranging from 18% to 52%. They frequently occur in patients with severe coronary artery disease, defined in the…

…of no blood flow, due to the reduced metabolic rate that accompanies declining body temperature. For every 1°C reduction in body temperature, there is a…

…ruler in the image. A reduction in size of 40% within four weeks predicts healing — failure to shrink should prompt reconsideration of the diagnosis. 3…

…aortic disease is less clearly defined, although triglycerides may contribute to the development and progression of aortic pathology. Severe HTG, especially when associated with chylomicronaemia…

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

…NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE ACS (Non ST Elevation Acute Coronary Syndromes) . This chapter deals with the pathophysiology…

…Agent Standard dose in atrial fibrillation Criteria for dose reduction according to FASS : : : Apixaban 5 mg × 2 2.5 mg × 2 if at least two…

…a reduction in mortality. The absolute benefit is greatest in patients with the most severe heart failure. In stable patients, it is advisable to add…

…ICP) and reduction in cerebral blood flow. Caution • Used cautiously in patients with high intracranial pressure or azotemia. • Should not be given to pregnant women…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…reduction. Relevant determinants include: Lesion eccentricity Vessel tortuosity Calcification Plaque rupture or asymmetric filling defects Serial lesions Vessel size The relationship of the lesion to…

…The interval from treatment initiation to restoration of coronary flow. Early reperfusion, reduction of myocardial energy requirements and mitigation of reperfusion injury are complementary objectives…

…condition. It is associated with a two to four fold increase in lifetime cardiovascular disease (CVD) risk and approximately doubles cardiovascular risk on average. Its…

…the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are…

…death. The volume required to produce tamponade depends principally on the rate of accumulation and the compliance of the pericardium. Rapid accumulation may cause tamponade…

…despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction of ventricular volume and subsequently an increase in ejection…

…liver disease. Interpretation of the Agatston Score The score should be interpreted both by its absolute value and in relation to age and sex. A…

…this theory posits that a reduction in $I {Na}$ leaves the transient outward potassium current ($I {to}$) unopposed during phase 1 of the…

…reactive pupil generally indicates an intact brainstem and adequate cerebral perfusion, whereas fixed, dilated pupils can signal severe global ischemia or even herniation of the…

…below). In addition to exercise capacity, stress testing also provides information on electrocardiographic (ECG) reaction, the occurrence of arrhythmias, symptoms, physiological reactions (blood pressure, heart…

…cornea and anterior chamber. Note the pupil size, shape and reaction to light. A teardrop shaped or peaked pupil suggests perforation. Look for hyphaema — blood…

…that leads to the stress test (if that was the reason for conducting the test). Chest pain rated as 6 or above (according to the…

…identifiable underlying cause. Researchers previously believed that this form of hypertension was a physiological reaction that was necessary to maintain normal hemodynamics, hence the term…

…healthy and diseased coronary arteries, allowing ischemia to be detected during imaging. Exercise is the preferred method for inducing myocardial stress, as it provides additional…

…vasovagal reaction, well trained athletes) need not be treated. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG…

…3. Give atropine 0.5 mg intravenously (alternatively glycopyrronium 0.2 mg) to reduce the risk of a cholinergic vagal reaction with bradycardia. Wait 5…

…or cannot reach it with the instruments available. Do not then try "by feel" — refer to ENT. Relative — a low threshold for referral: Marked swelling…

…reaction. Procedure Intramuscular — deltoid 1. Expose the whole shoulder; rolling up a sleeve creates a constriction that distorts the anatomy and tempts the operator to…

…syncope (e.g during intense emotional stress) During vagal maneuvers (Valsalva maneuver, carotid sinus [baroreceptor] stimulation). It is common to discover SB in healthy young…

…food allergies, insect stings, and drug induced reactions. Approximately 90% of anaphylactic cardiac arrests present with pulseless electrical activity (PEA) as the initial rhythm, while…

…distinguishing it from classic allergic reactions. Clinical Presentation and Symptoms ACE Inhibitor Induced Cough ACE inhibitor induced cough occurs in 5% to 30% of patients…

…ST segment depression due to digoxin treatment. Adverse effects of digoxin The incidence of adverse drug reactions is high, owing to the narrow therapeutic index…

…other apoB containing lipoproteins within the arterial wall. This initiates inflammatory reactions that promote plaque formation and progression. As the burden of retained atherogenic particles…

…than an absolute rule. Evaluation of the exercise stress test: Parameters to assess Evaluation of the exercise stress test is based on several parameters wh