…measurements permit assessment of the physiological significance of selected stenoses using fractional flow reserve (FFR) and instantaneous wave free ratio (iFR). Other invasive techniques can…

…at least two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis…

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…

…regulate vascular tone, preserve an antithrombotic surface, and control the adhesion and migration of inflammatory cells. Dyslipidaemia, cigarette smoking, hypertension, diabetes mellitus and other adverse…

…and turbulent hemodynamic shear stress. This dysfunction compromises the endothelial barrier, upregulating the expression of vascular cell adhesion molecule 1 (VCAM 1) and intercellular adhesion…

…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…

…are numerous other causes of chest pain, but the other causes are either subacute or non acute. The history taking must be systematic and accurate…

…The magnitude of untreated LDL C elevation. The presence and age of onset of premature CAD or other vascular disease. A history of myocardial infarction…

…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…

…ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures. Both…

…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…

…Other causes of ventricular dilation ( e.g ischemic cardiomyopathy) must be excluded before establishing a diagnosis of DCM. Patient characteristics, clinical features, family history and…

…and hyperthyroidism Systolic blood pressure <90 mmHg, with increased risk of hypotension in patients with autonomic dysfunction, hypovolemia, or severe coronary or valvular disease Recent…

…= Area RVOT • VTI RVOT Continuity equation and valvular regurgitation The continuity equation implies that the amount of blood flowing into the left ventricle (across…

…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…

…in I and aVL as well as qR complex in III and aVF (with QRS duration <0.12 seconds), provided that other causes of right…

…in I and aVL as well as qR complex in III and aVF (with QRS duration <0.12 seconds), provided that other causes of right…

…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…

…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…

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

…of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other…

ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

…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…

…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 imaging technique. Coronary fistulae represent abnormal communications between a coronary artery and a cardiac chamber or vessel. Other congenital anomalies include anomalous origin of…

…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…

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

…LV dysfunction, or other pathology that could affect the safety or interpretation of the examination. Evaluation and Physical Examination Before stress echocardiography, clinical assessment should…

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

…in a mechanical valve prosthesis and in moderate to severe mitral stenosis, where warfarin applies. Apixaban is often preferred, among other reasons because it has…

…defibrillators and other emergency instruments. Personnel conducting the test must be formally trained to assess cardiovascular response, symptoms, and ECG changes. Although the risk of…

…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…

…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…

…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…

…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

…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…

…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…

…the setting of valvular stenosis or regurgitation, the proximal velocity (v 1 ) is very small compared to the distal velocity (v 2 ), and the difference…

…evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of…

…Ischemic heart disease Both acute and chronic ischemic heart disease (including complications) can cause embolisms. Left ventricular aneurysm with thrombus Cardiomyopathies Valve prosthesis Devices (pacemaker…

…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…

…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…

…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…

…is age related degeneration of the valvular apparatus. Age related degeneration affects 2% of the population and leads to gradual prolapse of the valve leaflets…

…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…

…5 Some centres use 2.0–3.0 with a modern bileaflet prosthesis and no risk factors Mechanical mitral valve 2.5–3.5 Never…

…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.

…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…

…evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. In Journal of the American Society of Echocardiography : official publication of…

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

…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…

…of left ventricular failure, the pressure in the pulmonary vessels rises and the pressure rise propagates to the right ventricle. Pulmonary vascular resistance (PVR) Vascular…

…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…

…doses of more than 5 mg/kg should not be given within 24 hours. If conversion to sinus rhythm is not successful, blood pressure 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…

… 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…

…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…

…promote the release of adhesion molecules, inflammatory cytokines, and vasoconstricting mediators, producing abnormal vascular responses and potentially increasing the future risk of obstructive coronary disease…

…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…

…markers for structural and hemodynamic cardiac abnormalities. Right Axis Deviation (RAD) RAD holds significant diagnostic weight in the evaluation of pulmonary vascular and right heart…