…aortic wall shear stress and rapidly lower systolic pressure. Renal and microvascular complications Renal involvement may manifest as deterioration in renal function and urinary abnormalities…

…elevation Patients may initially stabilize and subsequently develop recurrent angina, recurrent ischaemic ECG changes, biomarker evidence of myocardial necrosis, or severe ischaemia on stress testing…

…limits scale and generalizability. Deep learning offers a way around this: an ECG can be fed directly into a classifier with no human feature extraction…

…patient cannot perform an adequate treadmill test but can undergo pharmacological stress Local expertise and adequate echocardiographic facilities are available Risk stratification is required in…

…heart rate response, arrhythmias and recovery. A patient who stops at a low workload with a fall in blood pressure is a high risk patient…

ECG Exercise stress test Exercise stress test (exercise ECG) protocols & equipment: cycle ergometer (bicycle) vs. treadmill The choice of exercise equipment and protocol depends mainly…

…or similar) may undergo stress testing when their clinical condition is stabilized. This usually takes 2 to 3 days and the patient must not have…

…of the correct term exercise stress test . However, the ECG is only one of the parameters that must be evaluated and the final result of…

…not caused by medications) Stroke within 1 month Preparations for exercise stress testing The laboratory and personnel Exercise stress testing may be conducted by physicians…

…blood pressure, heart rate) during and after exercise, etc. Exercise stress testing may also be referred to as exercise ECG or exercise tolerance test . Because…

…confused: replacement therapy in adrenal insufficiency (which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered in a controlled fashion…

…Genetic and miscellaneous conditions Takotsubo cardiomyopathy (broken heart syndrome, apical ballooning syndrome, stress induced cardiomyopathy) Takotsubo cardiomyopathy (broken heart syndrome) is a rather peculiar and…

…left ventricular pressure. This is explained by the fact that the left ventricle is capable of relaxing and expanding rapidly during diastole. The term compliance…

ECG Exercise stress test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually…

…exercise stress testing, myocardial ischemia and ischemic symptoms Understanding the basic principles of exercise physiology is essential to conduct and evaluate the exercise stress test…

Cardiology Indications for pharmacologic agents Pharmacologic stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such…

…are identified and categorized. A critical aspect of this evaluation is the determination of reversibility , which involves comparing stress and rest images to distinguish between…

…more stress, often corticosteroids, often impaired renal function. Prescribe basal insulin, mealtime insulin and the correction dose as three separate entries on the drug chart…

…and heart failure of ischaemic or cardiometabolic origin. Major clinical presentations The principal outpatient presentations include: Reproducible stress induced angina or ischaemia associated with obstructive…

…minutes for BNP and 90 minutes for NT proBNP. Consequently, plasma concentrations of the two peptides are not interchangeable. Natriuretic peptide concentrations reflect haemodynamic stress…

…100 containing lipoproteins and exert effects beyond LDL C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability, thrombogenic responses and immune activity…

…can also occur. The physiologic response to orthostatic stress is incompletely understood, but redistribution of blood volume and increased ventricular contractility occur consistently. Exaggerated activation…

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

…intima, differentiate into macrophages and participate in a sustained inflammatory response. Lipid accumulation, oxidative stress and immune activation progressively alter the local vascular environment. The…

…or heaviness [7]. Classically, it is initiated by exertion or stress and is relieved by rest or nitroglycerin [4], [6]. Presentation Nuances: While typical angina…

…and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress and subendocardial ischemia. Neurohormonal activation and vascular and…

…flow during stress is inadequate. Structural CMD: resting vascular tone is increased, potentially reflecting capillary rarefaction, fibrosis, or left ventricular hypertrophy. Hypertension, diabetes, and elevated…

…ratio of stress myocardial blood flow to resting myocardial blood flow. It provides an integrated measure influenced by epicardial stenosis, diffuse atherosclerosis, and coronary microvascular…

…stress. Neither procedure, however, reverses the underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and…

…Typical symptoms include: Ischaemic rest pain. Coldness or numbness of the foot and toes. Pain that is worse at night or when the limb is…

…physical inactivity, and alcohol consumption. Additional considerations include psychosocial stress, obstructive sleep apnoea, social determinants of health, air pollution, family history, ethnicity, and frailty. Primary…

…preload and afterload Lower left ventricular wall stress Reduced sympathetic nervous system activity Improvement in cardiac metabolic efficiency, including increased oxygen delivery and beta hydroxybutyrate…

…changes occur. Hypertension and oestrogen exposure. Emotional or chronic mental stress. Fibromuscular dysplasia (FMD), which may produce arterial wall abnormalities and intramural haematomas. Inherited connective…

…Imaging (EACVI) stress that the following parameters are of particular importance for the evaluation of diastolic function: The ratio between E wave and A wave…

…expected maximum heart rate (age adjusted). To determine this it is necessary to perform an exercise stress test, during which it is fundamentally important that…

…and treatment strategies have been updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery…

…to the reduced area of the valvular orifice. Both aortic stenosis and hypertension result in increased ventricular load, which the ventricle counteracts by developing hypertrophy…

…stress agents have specific contraindications: Adenosine, Dipyridamole, Regadenoson : Should be avoided in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and…

Arrhythmias and arrhythmology ECG Sinus bradycardia: ECG, causes & management Definition of sinus bradycardia Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate…

…spontaneous depolarization) in the sinoatrial node is increased during physical activity, stress, and nervousness. This is due to altered tone in the autonomic nervous system…

…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…

…and treatment strategies have been updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery…

…ECG) become apparent. In contrast, modalities like echocardiography and ECG typically identify ischemia at later stages, when functional or electrical alterations are evident. Subjective symptoms…

…option). 10.0–20.0 μg/kg/min ++++ ++++ ++ +++++ High dose dopamine additionally induces α1 stimulation and thereby vasoconstriction with a marked rise in SVR…

…< 20 kPa (150 mmHg), and permissive hypercapnia as long as the pH stays above about 7.20. Different targets apply when the intracranial pressure…

…a stress related rise in cortisol. 3. Take the baseline sample : cortisol and plasma ACTH. The ACTH sample is taken before the injection and handled…

…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…

…increase aortic wall stress. Relevant associations include: Systemic hypertension Marfan syndrome Loeys–Dietz syndrome Ehlers–Danlos syndrome Inflammatory aortitis, including Takayasu arteritis and giant cell…

…coronary microcirculation. These abnormalities can produce a transient and reversible mismatch between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another…

…Disruption of intracellular signalling and protein synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease…

…Uraemia associated inflammation Oxidative stress Vascular dysfunction Promotion of vascular calcification Albuminuria and proteinuria Neurohormonal activation Plasma volume expansion Myocardial remodelling and fibrosis These processes…

…while nitrosative stress and abnormalities of cellular and molecular myocardial function may further impair contraction and relaxation. Structural and vascular consequences Common structural consequences include…

…assess AV conduction and may include the infusion of agents to stress the AV node and His Purkinje system, such as isoproterenol and/or procainamide…

…with variable inflammation and oxidative stress. Metabolic dysfunction associated fatty liver disease affects approximately 10% of non obese individuals and up to 65% of patients…

…myocardial injury. Clinical Presentation and Symptoms In up to one half of STEMI cases, a precipitating factor such as vigorous physical exercise, emotional stress, or…

…of cases. Reported precipitants include vigorous physical activity, emotional stress, and an intercurrent medical or surgical illness. Events may occur at any time, although clustering…

…plateau phase. These two factors are the reason why the ST segment is flat and isoelectric (i.e in level with the baseline). Displacement of…

…Mechanically, wall stress (the load on individual muscle fibers) increases while the contractile function worsens. Chronic aortic regurgitation also leads to increasing LVEDP and LAP…

…stress and coronary artery perfusion. These changes gradually lead to insufficient coronary perfusion (i.e myocardial ischemia and angina pectoris), ventricular dysfunction (heart failure) and…

…dissection, pulmonary embolism, pneumothorax). Hypertension. Smoking. Dyslipidemia (hyperlipidemia). Obesity and/or diabetes. Psychosocial stress. Alcohol abuse. Physical inactivity. Unhealthy diet. Cerebral / peripheral vascular disease. Cancer…