…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…

…largely independent of resting hemodynamics; guideline reference standard. Requires pressure wire + vasodilator (cost, time, patient discomfort); falsely normal in microvascular dysfunction (diabetes, LVH, aortic stenosis…

…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).

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

…resistance increases, making it more difficult to eject blood into the aorta. In the early stages of aortic stenosis, stroke volume becomes smaller. Reduced stroke…

…activity, mitral stenosis may become symptomatic already at 2.5 cm 2 . A normal mitral valve has an area of 4 to 6 cm 2 …

…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…

…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…

…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…

…Prolapse of mitral valve Aortic stenosis with calcification Mitral disease with calcification Fibrin strands Giant Lambls excrescences Septum Defects — PFO, ASA, ASD SOURCES OF CARDIAC…

…sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14…

…with functional assessment. A central practical principle is that the visual severity of a stenosis does not reliably establish its haemodynamic importance. A lesion that…

…with oxygen demands. Depending on several factors– including the severity of the stenosis/occlusion, microvascular function, myocardial oxygen extraction, presence of collateral circulation, etc –ischemia…

…dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous oxygen saturation. Repeated blood sampling during intensive care. Exhausted…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…mitral stenosis. Idiopathic degeneration (Barlow's disease), degeneration associated with connective tissue disorders (Marfan syndrome, Ehlers Danlos syndrome), osteogenesis imperfecta typically causes prolapse of P2…

…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…

…myocardial perfusion imaging Exercise stress testing is contraindicated in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias…

…PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying the limbs. In adults over 40 years of age…

…rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement or…

…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…

…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.

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

…should be suspected when distal coronary perfusion remains reduced despite successful treatment of the apparent epicardial stenosis and without an angiographically evident flow limiting obstruction…

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

…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…

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…

…the right atrium is commonly a consequence of increased resistance to empty blood into the right ventricle. This may be due to pulmonary valve stenosis…

…for example, pulmonary hypertension or pulmonic stenosis. Heart rate . Synchronicity : Optimal contraction requires the majority of all ventricular myocardium to contract simultaneously. For this to…

…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…

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

…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…

…the relationship between diameter stenosis and haemodynamic significance is weak, particularly for intermediate lesions. Even lesions with a visual diameter reduction of 50–70% may…

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…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…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…

…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…

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

… vascular inflammation; progression of calcific aortic stenosis; enhancement of a prothrombotic state. Its atherogenic and inflammatory effects may be mediated partly by oxidized phospholipids carried…

…edge dissection Incomplete lesion preparation Persistent stenosis within the treated segment Mechanical factors are particularly important because correction of the underlying problem is necessary for…

…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…

…structural stability of the plaque is acutely compromised [7] . Sub group analyses from longitudinal angiographic registries demonstrate that the severity of baseline stenosis does not…

…poor healing Ear canal stenosis or exostoses Narrow and hard to reach Ongoing otitis externa Pain, spread of infection A small or uncooperative child Movement…

…associated with extensive premature and progressive ASCVD; CAD and aortic stenosis may occur before the age of 20 years, with death often occurring before age…

…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…

…occur in patients with severe coronary artery disease, defined in the source material as stenosis greater than 70%, and are an important reason that patients…

…myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of a flow limiting coronary stenosis, supply cannot increase adequately. Ischaemia begins…

…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…

…chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic heart disease : stable angina pectoris…

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

…exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering…

…to calculate the diameter of the orifice. This has fundamental clinical implications as it enables the investigator to calculate the area of stenoses and regurgitations…

…echocardiography. Causes of right ventricular hypertrophy Lung disease (with increased pulmonary vascular resistance), congenital heart disease (transposition of the great arteries, pulmonary valve stenosis, atrial…

…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…

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

…of the Working Group on Echocardiography of the European Society of Cardiology 11 (3), pp. 223–244. DOI: 10.1093/ejechocard/jeq030. Pulmonary valve stenosis…

…without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and…