…mitral regurgitation, ventricular dilatation, myocardial wall stress and subendocardial ischemia. Neurohormonal activation and vascular and renal abnormalities contribute to sodium and water retention. The interaction…

…which must be increased under stress) and pharmacological anti inflammatory treatment (which must be tapered in a controlled fashion). The management is the opposite in…

ECG Evaluation and management of stable coronary artery disease Chronic coronary syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

…causes & management Definition of sinus bradycardia Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute…

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

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…ACS) and non ST elevation acute coronary syndromes (NSTE ACS). The division into STE ACS and NSTE ACS has profound implications for management and treatment…

Cardiology Evaluation and management of stable coronary artery disease Chronic coronary syndromes (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

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…

…attention. The ventricular rate is typically very high (100–250 beats per minute) and cardiac output is affected (i.e reduced) in virtually all cases…

Endokrinologi & metabolism Lathundar An inpatient has a different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal…

…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…

…clinical manifestations that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure…

…a non ischemic ECG (absence of ST T changes) during chest pain caused by myocardial ischemia. This is corroborated by millions of exercise stress tests…

…with a positive P wave in lead II, but the heart rate exceeds 100 beats per minute. Although sinus tachycardia is the most common tachyarrhythmia…

…Urine output 0.5 mL/kg/h Lactate Falling A clearance 10 % per 2 h is a reasonable target ScvO₂ 70–80 % A low value…

…therapy when indicated Oral treatment and prompt follow up Main risk of management Overtreatment may impair autoregulation and cause ischemia Acute rapid reduction may cause…

…ergospirometry (exercise stress testing), and cardiac catheterization. Principles of management of congenital heart disease and GUCH Complex malformations often require intervention (surgical or catheter based…

…pulmonary pressure, or haemodynamics Stress imaging is not recommended in patients undergoing urgent non cardiac surgery or those with an unstable clinical condition. In patients…

…Imaging (coronary CT angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater diagnostic accuracy. Contraindications Absolute: Acute coronary syndrome within 48 hours, or ongoing unstable angina…

…exercise stress testing. Results of treadmill tests are typically described in METs, whereas energy expenditure during bicycle ergometry is typically expressed in kilopond meters per…

…Patients with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial…

…detail. Symptom during exercise stress testing Perceived exertion The patient's perceived exertion is a way of estimating the intensity of the physical activity. It…

…for exercise stress testing The laboratory and personnel Exercise stress testing may be conducted by physicians, nurses, biomedical analysts, or other professionals. A physician is…

…including apparently healthy individuals. Exercise stress testing in the age of non invasive cardiovascular imaging Advances in computerized tomography (CT), cardiac magnetic resonance imaging (cMRI…

…apical ballooning syndrome, stress induced cardiomyopathy) Takotsubo cardiomyopathy (broken heart syndrome) is a rather peculiar and certainly acute condition. Much research has been devoted to…

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

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…

…image quality and patient motion. Alignment : Ensure proper alignment of rest and stress images to accurately compare corresponding myocardial regions, as misalignment can lead to…

…form of physiological stress, but it may also occur at rest or remain clinically silent. The underlying coronary disease may be obstructive or non obstructive…

…plasma concentrations of the two peptides are not interchangeable. Natriuretic peptide concentrations reflect haemodynamic stress, but their release is not specific to left ventricular systolic…

…also reduce production of apoB 100 containing lipoproteins and exert effects beyond LDL C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability…

…a disorder of autonomic reflexes. It typically occurs after attaining an upright posture or following painful stimuli and emotional stress. By the age of 60…

…non invasive technique for detecting and quantifying coronary artery disease (CAD). It offers visual and numerical insights into myocardial blood flow under rest and stress…

…lipids within the intima; recruitment of innate and adaptive inflammatory leukocytes; oxidative stress and persistent local inflammation; smooth muscle cell migration and proliferation; extracellular matrix…

…dyspnea and nausea (anginal equivalents) [7]. Clinicians must consider both cardiac and non cardiac etiologies [1]. Cardiac Causes The primary differential diagnoses include conditions that…

…CMD: resting vascular tone is generally normal, but the increase in coronary blood flow during stress is inadequate. Structural CMD: resting vascular tone is increased…

…Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia may therefore remain undetected unless CT based coronary calcium assessment or another anatomical technique is added…

…can improve coronary flow, exercise capacity and angina related health status, and both can reduce myocardial ischaemia during exertion or emotional stress. Neither procedure, however…

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

…Reduction in plasma volume, preload and afterload Lower left ventricular wall stress Reduced sympathetic nervous system activity Improvement in cardiac metabolic efficiency, including increased oxygen…

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

…Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) stress that the following parameters are of particular importance for the evaluation of diastolic function…

…Stroke Volume, Wall Stress & Frank Starling's law Myocardial Mechanics It is fundamental to distinguish hypertrophic cardiomyopathy from hypertrophy caused by increased loading conditions. The…

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

…is sufficient to provoke overt ischemic signs during stress testing (Bourque et al.). Thus, patients who undergo exercise stress testing must achieve at least 85%…

…dose, together with marked hypertension (caution during non selective beta blockade). Dobutamine Cardiogenic shock. Bradycardia (second line treatment). Stress testing (it increases myocardial oxygen consumption)…

…2. Insert a venous cannula. Wait a few minutes — the venepuncture itself can cause a stress related rise in cortisol. 3. Take the baseline sample…

…Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in myocardial O 2 consumption) Regular : 2.0–20 μg/kg…

…familiar to every electrophysiologist, is that LVEF is both insensitive and non specific for SCD. Most people who die suddenly never had an ejection fraction…

…than asymptomatic lesions. Predisposing conditions Aortic dissection and its variants are associated with conditions that cause medial degeneration or increase aortic wall stress. Relevant associations…

…can produce a transient and reversible mismatch between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another stressor. Manifestations include angina…

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

…Non traditional cardiovascular mechanisms include: Uraemia associated inflammation Oxidative stress Vascular dysfunction Promotion of vascular calcification Albuminuria and proteinuria Neurohormonal activation Plasma volume expansion Myocardial…

…substantial morbidity and mortality, despite often having a greater burden of cardiovascular and non cardiovascular comorbidity than patients with reduced EF. Pathophysiology Abnormal ventricular relaxation…

…A broad spectrum of pharmacologic agents can induce bradycardia or conduction disorders. These include beta blockers, non dihydropyridine calcium channel blockers, antiarrhythmic drugs (amiodarone, dronedarone…

…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…

…troponin elevation, ACS are classified into unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). While the…

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