…the left atrium encounters increased resistance (e.g due to mitral valve stenosis) it becomes enlarged (hypertrophy) which amplifies its contribution to the P wave…

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

…extreme axis deviation Extreme axis deviation is rare. It is most likely due to misplaced limb electrodes. If the rhythm is tachycardia with wide QRS…

…been excluded. Causes of extreme axis deviation Rare. Most likely due to misplaced limb electrodes. If the rhythm is tachycardia with wide QRS complexes, then…

…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…

…which is due to the low sensitivity of the method (details below). Sensitivity and specificity are considerably higher for CT angiography, SPECT, echocardiography, and coronary…

…malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early due to the massive ischemia. Complete LMCA occlusion is typically…

Enalaprilat Enalaprilat is rarely used in hypertensive crisis due to its slow onset, prolonged duration of effect, and significant individual variations in its effect. Drug…

…aortic stenosis, there is increased resistance in the aortic valve itself, due to the reduced area of the valvular orifice. Both aortic stenosis and hypertension…

…only when related to one another. A low blood pressure may be due to low flow, low vascular tone or both, and the appropriate action…

…and blood pressure, thereby simulating the effects of exercise. However, dobutamine is rarely used in current practice due to its less favorable safety profile and…

…relatively difficult to examine, which is due to the location of the ventricle in the thorax. It is localized immediately behind the sternum and thus…

…Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension. Nicardipine Drug Nicardipine Brand…

…Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension. Nicardipine Drug Nicardipine Brand…

…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…

…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.

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

…difficult to palpate apex beat [10]. Despite congestive heart failure, a third or fourth heart sound is rarely heard due to restrictive pathophysiology and impaired…

…challenging to pump blood into the aorta. The most common causes are hypertension (in which the pressure in the aorta is increased) and aortic stenosis…

…reason, R wave peak time may also be prolonged. This prolongation may also be due to myocardial fibrosis which is typical in hypertrophy. Finally, the…

…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…

…occlusion due to embolization. Approximately 30% of all ischemic strokes are caused by cardiac embolism. This figure does not include paradoxical embolism (discussed below) and…

…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…

…when assessing aortic stenosis in the presence of a narrowing of the LVOT (left ventricular outflow tract). Such narrowings are due to septal hypertrophy or…

…increased resistance (due to mitral valve stenosis, mitral valve regurgitation, hypertension, hypertrophic cardiomyopathy) it becomes enlarged (hypertrophy) which enhances its contribution to the P wave…

…left ventricular hypertrophy . This allows the left ventricle to generate greater pressure, thereby overcoming the resistance in the stenosis and maintaining adequate stroke volumes. Thus…

…36 mm 13 17 mm/m2 Aortic arch 22 36 mm Descending aorta 20 30 mm ​Adjustment refers to adjusting for body surface area (BSA)…

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

…reserve (FFR), have been validated against outcomes and shown to outperform visual angiographic guidance in selecting lesions for percutaneous coronary intervention (PCI). Non hyperemic pressure…

…of severe asymptomatic stenosis is low, screening has not been shown to reduce stroke risk, and detection may lead to inappropriate anxiety and invasive procedures…

…epicardial stenosis and without an angiographically evident flow limiting obstruction. Assessment should include: Confirmation that the treated epicardial segment is adequately expanded and not severely…

…assessment should include functional status and walking capacity, because these may reveal “masked” PAD in patients who do not exert themselves sufficiently to provoke symptoms…

…anatomically severe lesion may not identify the patient most likely to benefit from intervention. Conversely, apparently mild lesions may rupture and precipitate myocardial infarction or…

…also identifies non obstructive plaque, which may have important prognostic and preventive implications even when stenosis is not flow limiting. CCTA should be distinguished from…

…epicardial stenosis physiology and does not directly quantify the ability of the myocardial resistance vessels to augment flow. Coronary flow reserve and its relationship to…

…may fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent…

…18% to 52%. They frequently occur in patients with severe coronary artery disease, defined in the source material as stenosis greater than 70%, and are…

…Thrombosis or known stenosis in the target vessel. Coagulopathy or ongoing anticoagulation: choose a compressible vessel (the internal jugular or femoral vein), not the subclavian…

…enough to proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the posterior fossa. Preparation and equipment…

…Physical inability to perform the test safely. Relative: Condition Comment : : Left main stenosis Known — perform the test only on a clear indication and with full…

…stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement causes injury Preparation and…

…3.0 with a modern bileaflet prosthesis and no risk factors Mechanical mitral valve 2.5–3.5 Never switch to a DOAC Antiphospholipid syndrome…

…stenosis. However, intravascular ultrasound has shown that delayed opening of the bridged segment may extend into diastole, so the physiological effect is not limited to…

…substantial atherosclerotic burden but does not, by itself, establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is…

…of thrombosis related to the intravascular foreign body. First generation DES, particularly sirolimus and paclitaxel eluting devices, were associated with increased late and very late…

…proteins in the hepatic LDL receptor pathway. Reduced cellular uptake and clearance of LDL leads to increased circulating LDL C. The principal genetic mechanisms involve:…

…to both ISR and stent thrombosis. Optical coherence tomography (OCT) is currently the most suitable imaging modality for detecting neoatherosclerosis, although its resolution does not…

…these techniques rests on their ability to characterize the anatomy responsible for a stenosis, define plaque morphology, identify occult lesions, and optimize percutaneous coronary intervention …

…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…

…have also been extended to peripheral arterial disease, ischaemic stroke, abdominal aortic aneurysm, and calcific aortic valve stenosis. Lp(a) is not associated with venous…

…Clinical Presentation and Symptoms Symptoms may resemble those of obstructive epicardial coronary disease or vasospastic angina. The clinical presentation is not sufficiently specific to identify…

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

…rate and contractility. In the presence of a flow limiting coronary stenosis, supply cannot increase adequately. Ischaemia begins in the subendocardium, which contributes substantially to…

…drugs predisposing to bleeding and alcohol use. A high bleeding risk score should prompt correction of modifiable risk factors and closer surveillance; it does not…

…DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family history…

…precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain relation to symptoms Tachyarrhythmias…

…Acute regurgitation of blood into the left atrium results in sudden volume and pressure overload in the atrium, leading to increased LAP (left atrial pressure)…

…simulated hemodynamically through exercise or the use of chronotropic and inotropic agents. Radiotracers are employed to evaluate myocardial perfusion by measuring the intensity of their…

…5 m/s, which they generally do in the setting of significant stenoses and regurgitations. Thus, aliasing is exploited to reveal PISA. An optimal assessment…

…to oxygen supplies. Consequently, reduced oxygen supply would not result in ischemia, since the myocardium adapts and downregulates metabolism to avoid developing ischemia. According to…