Cardiology Pharmacology & dosing Definition and pathophysiology Congestion is a central expression of the heart failure syndrome and reflects excessive retention of sodium and water, with…

…therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure with preserved ejection fraction (HFpEF…

…abnormality is heart failure occurring with mildly impaired LV systolic function. The syndrome remains fundamentally one of impaired cardiac performance, in which the heart cannot…

…Calculate Score CHA2DS2 VASc Score Result function calculateScore() { var score = 0; if (document.getElementById('congestiveHeartFailure').checked) { score += 1; } if (document.getElementById('hypertension').checked) {…

…rate parameters. Clinical Presentation and Symptoms Acute heart failure necessitating inotropic or vasopressor support typically manifests in patients with left ventricular systolic dysfunction, low cardiac…

…10]. Despite congestive heart failure, a third or fourth heart sound is rarely heard due to restrictive pathophysiology and impaired ventricular relaxation [10]. There is…

…irregular or rapid heartbeat Dyspnoea and worsening pulmonary congestion Reduced exercise capacity Symptoms or signs of heart failure Haemodynamic instability Myocardial ischaemic symptoms or electrocardiographic…

…predominantly by atrial tissue; its midregional pro ANP assay may provide information comparable to BNP and NT proBNP in heart failure (HF). The biologically active…

…Obesity and heart failure Obesity increases the risk of HF and is common among patients with established HF, particularly HFpEF. Assessment of congestion may be…

…aortic dissection Myocardial free wall rupture after infarction Anticoagulant associated bleeding Renal failure Systemic inflammatory disease Catheter based electrophysiological and structural cardiac procedures In patients…

…heart failure, older age, vascular disease and renal dysfunction. The commonly used CHA2DS2 VASc score incorporates the following variables: Risk factor Points Congestive heart failure…

…ventricular dysfunction, valve disease, coronary artery disease, cardiomyopathy, congestive heart failure, congenital heart disease, diabetes mellitus (both type 1 and type 2), obesity, smoking, obstructive…

…pressure and evidence of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical…

…haemodynamic congestion produces a characteristic clinical phenotype of breathlessness, fatigue and oedema. This definition does not depend on left ventricular ejection fraction (LVEF). Heart failure…

…natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within this spectrum, Heart Failure with Reduced Ejection Fraction (HFrEF) is specifically…

…Unstable myocardial ischaemia. Ventricular arrhythmia or sudden cardiac arrest. Chronic coronary dissection presenting as heart failure, although this is described as uncommon. In pregnancy associated…

…of contractile myocardium, with reduced cardiac output and systemic hypoperfusion. LV failure may produce elevated filling pressures, pulmonary venous hypertension, and pulmonary congestion. Hemodynamic deterioration…

…LV systolic function LV contractile reserve Valve function and stress related haemodynamic changes Diastolic function Pulmonary hypertension Coronary flow velocity reserve (CFVR) Pulmonary congestion detected…

…systemic insults, including hypovolemia, hypoxia, cardiac tamponade, tension pneumothorax, preexisting acidosis, drug overdose, hypothermia, and hyperkalemia. When bradycardia occurs in the context of inflammatory heart…

…a broad range of conditions, including gout, vasculitis, systemic sclerosis, myositis, mixed connective tissue disease, Sjögren syndrome, SLE and APS. Some patient groups have a…

…Figure 2). It is important to note that the apex of the heart is fixed to the diaphragm via pericardium and connective tissue. Therefore the…

…separate catalogue of symptom patterns. The severity of right ventricular involvement should be considered when inferior infarction is accompanied by disproportionate systemic venous congestion, hypotension…

…adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. In European heart journal cardiovascular Imaging 16 (3), pp…

…in subsequent chapters. Stroke volume (SV) Stroke volume is the volume of blood pumped from the left ventricle into the aorta during systole. It is…

…Calculation of fractional shortening. Fractional shortening is a rather poor measure of left ventricular systolic function. This is due to the following reasons: Left ventricular…

Echocardiography Echocardiographic assessment of regional contractile function Systolic ventricular function is one of the strongest predictors of total and cardiovascular mortality. Previous chapters have discussed…

…heart failure is particularly common among people with diabetes, hypertension, overweight/obesity, and the elderly ( Pieske et al ). Figure 1. Myocardial motion during (A) systole…

…fraction <55%. This implies that left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection…

Echocardiography Size and mass of the left ventricle Left ventricular mass is a flawed proxy for ventricular systolic function and load. The mass is, however…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…

…the first hour. The exception is aortic dissection, where a systolic pressure below 120 mmHg and a heart rate below 60 are the immediate goals.

…heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure (MAP) = diastolic + (systolic − diastolic)/3 Cardiac output = stroke volume × heart…

…a stable pulmonary embolism is a diagnostic pathway. The unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor)…

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency)…

…and vascular resistance. Advantages of measuring MAP over systolic blood pressure While systolic blood pressure (SBP) indicates the maximum pressure during heart contraction, it does…

…0,9 0,9 Vena contracta (cm) not defined < 0,7 0,7 Liver vein flow S dominant Reduced S wave systolic flow reversal…

…thresholds. The 2024 European guideline defines hypertension as an office systolic blood pressure (SBP) of ≥140 mmHg or diastolic blood pressure (DBP) of ≥90 mmHg…

…Ongoing or newly recognized LV systolic dysfunction. A patient may also present because of complications of the underlying infarction or LV remodeling, including heart failure…

…and excess cardiovascular risk. The European definition requires failure to reduce office systolic and diastolic blood pressure to below 140 mmHg and 90 mmHg, respectively…

…Thus, a family history with early onset of heart failure is common among these individuals. The majority of the mutations are inherited in an autosomal…

…Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency)…

…sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In contrast, modalities…

…muffled heart sounds Beck's triad; complete in a minority Tachycardia, tachypnoea, cold periphery Almost always Pulsus paradoxus above 10 mmHg A fall in systolic…

…atrial size 10 cm² or 40% of atrial size Jet orientation central variable excentric Pulmonary vein flow S dominant reduced S wave systolic flow reversal…

…FUNCTION (MEASURED IN A4C) RV diastolic area, cm2 11–28 29–32 33–37 38 RV systolic area, cm2 7.5–16 17–19 20…

…patients with cardiovascular disease, including heart failure and ischaemic heart disease. Ageing is associated with progressive increases in systolic blood pressure (SBP), while diastolic blood…

…Heart failure (HF) symptoms may result from several overlapping processes: Recurrent or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction…

…is variable. Patients may have: Stable angina or an anginal equivalent Exertional dyspnoea or reduced exercise tolerance Acute coronary syndrome Silent ischaemia Heart failure, particularly…

…The lifetime burden of CVD is related to the number and severity of cardiovascular risk factors. Five modifiable factors—systolic blood pressure, non HDL cholesterol…

…incomplete because the ventricles cannot expand normally. This leads to diastolic heart failure. The systolic function is usually unaffected, but the shock volume and ejection…

…tailored to each patient. Optimal blood pressure Optimal blood pressure is 115 mm Hg systolic and 75 mm Hg diastolic (115/75 mm Hg). Thus…

…to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering ST T interpretation difficult, including left…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…mask the expected tachycardia. Aids to assessment The shock index is calculated as the heart rate divided by the systolic blood pressure. A value of…

…intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure, impaired consciousness, or a need for a vasopressor After initial…

…cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium…

…adjustments are necessary. Contraindications to vernakalant Severe aortic stenosis Systolic blood pressure < 100 mm Hg. Heart failure with NYHA class III–IV. Prolonged QT…

…rates and the loss of the atrial kick. The rapid ventricular response can lead to a reversible depression of systolic function. If the tachycardia persists…

…and age related changes in left ventricular filling contribute to susceptibility. Heart failure with preserved ejection fraction is regarded as a multifactorial systemic illness involving

…and peripheral arterial disease. Heart failure is also considered established clinical CVD in the risk based approach to elevated BP. Risk categories In apparently healthy…