…which the pressure in the aorta is increased) and aortic stenosis (in which the narrowing of the opened aortic valve orifice makes it difficult for…

Cardiology Clinical medicine Definition and pathophysiology Peripheral artery disease (PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying…

…occurs when there is insufficient oxygen available. Insufficient oxygen supply results in diminished ATP production and subsequently disruption of cellular metabolism. In case of ischemia…

…stenosis) requires intervention. Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and…

…overcoming the resistance in the stenosis and maintaining adequate stroke volumes. Thus, ventricular hypertrophy is a compensatory mechanism, the purpose of which is to maint

…non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non…

…phase – due to risk of arrhythmias Severe aortic stenosis – due to risk of syncope, ischemia, and arrhythmias Endocarditis – due to risk of embolization Deep venous…

…risk of rebound. The referring physician should have made this decision; document which applies. Nitroglycerin is continued; note it in the report. Shaving and careful…

…some patients present with severe LMCA stenosis exacerbated by other conditions, and these must also be recognized. Prompt identification of LMCA involvement is therefore critical…

…flow preserved by the stenosis. Cutoff ≤ 0.80. Deepest outcome trial evidence base of any physiological index; lesion specific and largely independent of resting hemodynamics…

…For asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14.6%, and revascularisation may be beneficial in appropriately selected…

…of mitral stenosis Mitral stenosis hinders atrial emptying. This results in an increase in left atrial pressure (LAP), which gradually leads to atrial hypertrophy and…

…primarily angiographic and clinical. No reflow should be suspected when distal coronary perfusion remains reduced despite successful treatment of the apparent epicardial stenosis and without…

…can refine interpretation. Coronary plaque and future events Angiographic stenosis severity is an imperfect predictor of future myocardial infarction or sudden death. Lesions causing only…

…of necrotising otitis externa Anticoagulant treatment Bleeding into the ear canal Previous radiotherapy to the head and neck Fragile skin, poor healing Ear canal stenosis…

…of a stenosis of 50% or more in any potential infarct related artery. MINOCA is not a definitive disease diagnosis. It is a descriptive and…

…defined in the source material as stenosis greater than 70%, and are an important reason that patients are referred for coronary artery bypass grafting rather…

…in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole…

…they supply a larger myocardial territory. The response of the coronary circulation reflects both epicardial stenosis and the coronary microcirculation. Microvascular dysfunction may impair maximal…

…and progressive ASCVD; CAD and aortic stenosis may occur before the age of 20 years, with death often occurring before age 30. Clinical presentation and…

…or stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if there is suspicion of syncope due to an arrhythmia or underlying cardiac…

…PE) ↓ ↑ ↑ ↓ Vital signs and measures of perfusion Parameter Normal Comment : : : Heart rate 50–100/min MAP 70–105 mmHg Target ≥ 65…

…electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors…

…diastole, distinguishing myocardial bridging from a fixed coronary stenosis. However, intravascular ultrasound has shown that delayed opening of the bridged segment may extend into diastole…

…atherosclerotic plaque, and the severity and distribution of coronary stenosis. Modern cardiac CT can acquire a three dimensional cardiac dataset within approximately 5–15 seconds…

…lumen Substantial residual stenosis Long lesions Diabetes mellitus Untreated edge dissection Components and mechanisms of DES A conventional durable polymer DES consists of: A balloon…

…diameter A high degree of residual stenosis Long lesion length Diabetes Untreated edge dissection DES have reduced restenosis compared with BMS, and newer generation DES…

…sectional and longitudinal information about the artery. The clinical value of these techniques rests on their ability to characterize the anatomy responsible for a stenosis…

…suggestive of myocardial ischaemia. Objective evidence of myocardial ischaemia. Absence of obstructive coronary artery disease, defined as no stenosis exceeding 50% diameter reduction and/or…

…in the absence of a flow limiting epicardial stenosis. It is associated particularly with intervention on degenerated saphenous vein grafts, rotational atherectomy, and acute MI…

…leads. Left ventricular hypertrophy (LVH) The most common causes of left ventricular hypertrophy are aortic stenosis, aortic regurgitation, hypertension, cardiomyopathy and coarctation of the aorta…

…electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors…

…up to 40 mm Hg in older and obese patients. References Baumgartner et al : Echocardiographic assessment of valve stenosis: EAE/ASE Recommendations for Clinical Practice…

…The test presupposes that the patient has spontaneous nystagmus at the time of examination and that the examiner is experienced with the head impulse test…

…valve stenosis. Lp(a) is not associated with venous thromboembolism in prospective epidemiological studies. Its biological effects appear to differ from those of LDL, and…

…and coronary blood supply. Stress increases myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of a flow limiting coronary stenosis…

…stenosed. Plaque rupture Plaques prone to rupture characteristically contain a large lipid pool, numerous macrophages or foam cells, and a thin fibrous cap. Disruption of…

…the ratio of stress myocardial blood flow to resting myocardial blood flow. It provides an integrated measure influenced by epicardial stenosis, diffuse atherosclerosis, and coronary…

…of Echocardiography : official publication of the American Society of Echocardiography 30 (4), pp. 303–371. DOI: 10.1016/j.echo.2017.01.007. Aortic stenosis…

… } Interpretation of CHADS VASc score and decisions on anticoagulation Men Women Points Recommendation Evidence Recommendation Evidence 0 No treatment Low No treatment High 1 Oral…

…Bernoulli principle can be used to calculate pressure gradients across valvular stenoses and regurgitations. The equation is agnostic to the direction of the blood flow…

…coronary artery stenosis. Stress can be induced pharmacologically with coronary vasodilatory agents or simulated hemodynamically through exercise or the use of chronotropic and inotropic agents…

…the severity of baseline stenosis does not reliably predict the site of future STEMI; rather, it is the biological composition and inflammatory activity of the…

…presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular disease. Age and sex category. Renal and hepatic…

…and revascularisation recommendations are not restricted to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the…

…stenosis, particularly the low flow, low gradient phenotype, or those undergoing aortic valve replacement [1, 5, 10]. A history of increasing frequency of hospitalizations and…

…1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left ventricle is enhanced in LVH…

…establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for individuals without…

…Link Tricuspid valve stenosis Mean pressure gradient ≥ 5 mmHg Valve area according to the continuity equation (cm²) ≤ 1 cm² ZTime velocity integral of the tricuspid…

…The ECG contour of the normal P wave, P mitrale (left atrial enlargement) and P pulmonale (right atrial enlargement) Abnormal P waves: atrial enlargement If…

…oxidative stress and immune activation progressively alter the local vascular environment. The extracellular matrix is an active component of lesion development rather than merely a…

…it bulges into the artery lumen and causes stenosis (reduction of the artery lumen). The reduction of the artery lumen causes limitations to the blood…

…with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension.

…Definition and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of…

…threatening causes of chest pain: Ischemic heart disease : stable angina pectoris, unstable angina pectoris, acute myocardial infarction (AMI). Note that unstable angina pectoris and acute…

…and release from an early cytosolic pool have all been associated with detectable troponin. High sensitivity assays may therefore identify a continuum of myocardial injury…

…mitral valve stenosis) it becomes enlarged (hypertrophy) which amplifies its contribution to the P wave. The second hump in lead II becomes larger and the…

…Warfarin has a narrow therapeutic index, a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…adult patients with severe pulmonary stenosis, alongside right ventricular hypertrophy (RVH) and right atrial enlargement [8]. RAD is present in most cases of significant RVH…