…and the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty was initially…

…depend heavily on the amount of viable myocardium supplied by the affected artery. Large areas of jeopardized myocardium, severe baseline stenosis, multivessel coronary artery disease…

…baseline stenosis, multivessel coronary artery disease, or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the absence of a flow limiting epicardial stenosis…

…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…

…Occlusion of the left main coronary artery (LMCA) abruptly interrupts blood flow to both the left anterior descending (LAD) and left circumflex (LCx) coronary artery…

…stenosis severity is a poor surrogate for the hemodynamic significance of a coronary lesion, with anatomic and functional assessment discordant in a substantial minority of…

…with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary syndrome, revascularisation…

…direct measurement of coronary blood flow, providing absolute quantification. The resting myocardium rarely reveals evidence of significant coronary artery stenosis unless the stenosis is severely…

…greater the stenosis, the lower the level of myocardial workload required to elicit ischemia and symptoms. Angina pectoris: the hallmark of coronary artery disease Angina…

…underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and secondary prevention. PCI treats focal stenotic…

…LCX or the right coronary artery (RCA). For details, refer to chapter The Coronary Arteries. Mitral valve disease A wide range of conditions may cause…

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

…significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for individuals without known clinical coronary artery disease…

…for calcification overlap with risk factors for coronary heart disease (atherosclerosis). The average age at diagnosis of aortic stenosis is 75 years in high income…

…STEMI usually results from rapid thrombotic occlusion of a previously atherosclerotic coronary artery. Slowly progressive severe stenoses are less likely to cause STEMI because collateral…

…family history, particularly in the broader assessment of peripheral arterial and aortic disease; planned surgery, especially carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), or…

…beyond identification of focal severe stenoses. Coronary anomalies Coronary artery anomalies are uncommon among the general population but account for a substantial proportion of sudden…

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

…and no obstructive stenosis in a major epicardial coronary artery. Non obstructive disease is generally defined as the absence of a stenosis of 50% or…

…material as stenosis greater than 70%, and are an important reason that patients are referred for coronary artery bypass grafting rather than percutaneous coronary intervention…

…which may have important prognostic and preventive implications even when stenosis is not flow limiting. CCTA should be distinguished from coronary artery calcium (CAC) scoring…

…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…

…principal roles: Defining the anatomical distribution and severity of epicardial coronary artery disease (CAD). Assessing the haemodynamic significance of lesions whose angiographic severity is uncertain…

…TIA (transient ischemic attack), coronary artery occlusion, and peripheral embolization. Stroke is the third leading cause of death in Western countries, and ultrasound studies are…

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

…Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and symptoms in known heart disease…

…and coronary artery disease (CAD) are used interchangeably throughout this text. Wall motion abnormalities in ischemic heart disease In the setting of stable ischemic heart…

…muscle rupture. The risk of rupture is greater for the posteromedial papillary muscle, which only receives blood supply from one coronary artery (Coronary arteries). Chronic…

…four components: Symptoms suggestive of myocardial ischaemia. Objective evidence of myocardial ischaemia. Absence of obstructive coronary artery disease, defined as no stenosis exceeding 50% diameter…

…be suspected if there is significant stenosis ( 75% luminal obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries (Felker et al…

…low density lipoprotein cholesterol (LDL C) from early life and a consequent excess risk of premature atherosclerotic cardiovascular disease (ASCVD), particularly coronary artery disease (CAD)…

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

…to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with…

…by the disease artery. Thus, vasodilators replicate the effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over adenosine…

…genetic variants and coronary artery disease. Associations have also been extended to peripheral arterial disease, ischaemic stroke, abdominal aortic aneurysm, and calcific aortic valve stenosis…

…pattern does not determine the anticoagulation indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure…

…of embolization Relative contraindications for exercise ECG Severe hypertension (systolic blood pressure 200 mmHg or diastolic blood pressure 110 mmHg). Left main coronary artery stenosis…

…cardiac magnetic resonance imaging (cMRI), and echocardiography have enabled detailed functional and anatomical imaging of cardiac anatomy, assessment of coronary artery stenosis, and myocardial ischemia…

…depression has an upsloping ST segment during exercise stress testing. Stable coronary artery disease (atherosclerotic plaque causing 70% stenosis or more) At rest No symp

…syncope Severe coronary artery or structural heart disease High risk features on examination include: Unexplained systolic blood pressure < 90 mmHg Suggestion of gastrointestinal hemorrhage…

…available, PET MPI is recommended in individuals with suspected chronic coronary syndrome and a moderate or high pre test likelihood of obstructive coronary artery disease…

…profile is increasingly driven by the global epidemics of obesity, diabetes mellitus, and metabolic syndrome [58] . Hypertension and coronary artery disease (CAD) remain the most…

…progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental pathophysiological substrate for acute coronary syndromes (ACS), including…

…of restenosis after metallic stent implantation is increased by: Small reference vessel size A small post procedural luminal diameter A high degree of residual stenosis…

…and thrombosis interact to produce focal arterial lesions. Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple…

Info [calc_vernakalant] Indications for vernakalant Vernakalant (Brinavess) is indicated in adults for chemical conversion of recent onset atrial fibrillation to sinus rhythm. Vernakalant is…

…acute coronary syndromes (ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest…

…vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER…

…vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER…

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

…having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased concentrations may result from acute coronary atherothrombosis, oxygen supply…

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

…40 mm Hg in older and obese patients. References Baumgartner et al : Echocardiographic assessment of valve stenosis: EAE/ASE Recommendations for Clinical Practice (2009. JASE).

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

…valves. Importantly, in the setting of valvular stenosis or regurgitation, the proximal velocity (v 1 ) is very small compared to the distal velocity (v 2 )…

…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…

…Causes of right axis deviation Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale (COPD, pulmonary hypertension, pulmonary valve stenosis…

…Causes of right axis deviation Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale (COPD, pulmonary hypertension, pulmonary valve stenosis…

…common serious error is dilating a vessel that turns out to be an artery — everything in the technique is designed to make sure that never…

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