…other causes of left axis deviation have been excluded. Causes of extreme axis deviation Extreme axis deviation is rare. It is most likely due to…

…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…

…refer to Evaluation of coronary artery disease and angina pectoris). Yet, exercise stress testing provides a fundamental parameter that cannot be obtained by other imaging…

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

…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…

…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…

…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…

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…

…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…

…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.

…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…

…PAD), and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack (TIA) or stroke…

…procedures overall. It is particularly associated with intervention on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG…

…also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention. Clinical assessment should include functional status and walking capacity…

…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…

…plaque is present but stenosis is minimal or mild, symptoms are also unlikely to be caused by flow limiting epicardial disease, and alternative causes should…

…more likely to affect flow because they supply a larger myocardial territory. The response of the coronary circulation reflects both epicardial stenosis and the coronary…

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

…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…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute…

…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…

…in approximately 0.5–12% of angiographic series and up to 5–75% of CT series; other angiographic descriptions report rates of approximately 5–10…

…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…

…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:…

…of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms…

…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 …

…The severity and location of stenosis Distal bifurcation involvement Coexisting multivessel disease The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities…

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

…vasospastic angina. The clinical presentation is not sufficiently specific to identify the underlying mechanism. Microvascular, vasospastic, and obstructive angina may produce overlapping symptom patterns. Patients…

…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…

…transient ischaemic attack (TIA), mitral stenosis, hypertrophic cardiomyopathy, diabetes mellitus, hypertension, heart failure, older age, vascular disease and renal dysfunction. The commonly used CHA2DS2 VASc…

…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…

…or stenosis. If the ischemia persists for 20 minutes, myocardial infarction ensues, resulting in permanent wall motion abnormalities. Figure 1. Standardized myocardial segmentation and nomenclature…