Imaging during cardiac interventions

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You are looking at 51-60 of 846 items for: atrial fibrillation women

Imaging during cardiac interventions Luis M. Rincón and José L. Zamorano Print Publication Year: 2015 Published Online: May 2015 Publisher: Oxford University Press ISBN: 9780198703341 eISBN: 9780191772597 DOI: 10.1093/med/9780198703341.003.0009 Item type: chapter

Development and expansion of percutaneous interventional procedures in the catheterization laboratories during the last years have raised the need of imaging techniques capable to identify cardiac structures, guide the procedure, and exclude possible complications. Among different imaging techniques, echocardiography offers the advantage of its mobility and capability to assess different cardiac structures in real time. It has become the preferred method for a wide variety of cardiac procedures before, during, and after these interventions. Electrophysiology has also experienced a major change, as anatomy has proven to play a key role in arrhythmogenesis. This has forced a shift from an electrophysiologically guided procedure to an anatomically guided procedure, where imaging guiding has become essential to ensure an accurate knowledge of intra-cardiac anatomy and complement cardiac electrograms. Echocardiography plays an important function in three aspects for interventional cardiology: prior to the procedure, it provides information for the selection of patients; during the procedure, it can monitor and guide the intervention; and afterwards, it assesses the results. In the last years, 3D-transoesophageal echocardiography (3D-TEE) and intracardiac echocardiography (ICE) have proved their utility and safety, providing information regarding anatomy and physiology in real time. There is no question that the use of imaging techniques can enhance the results and safety of these procedures. The particular features of each intervention and the variety of techniques currently available force cardiologists from the fields of echocardiography, interventional cardiology, and electrophysiology to know the strengths and weaknesses of each imaging modality in order to reach their best performance.

Heart valve disease Michael Henein Print Publication Year: 2010 Published Online: Dec 2014 ISBN: 9780199204854 eISBN: 9780199570973 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199204854.003.1606_update_002

Rheumatic valve disease remains prevalent in developing countries, but over the last 50 years there has been a decline in the incidence of rheumatic valve disease and an increase Page 1 of 7 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 26 January 2017

in the prevalence of degenerative valve pathology in northern Europe and North America. In all forms of valve disease, the most appropriate initial diagnostic investigation is almost always the echocardiogram. Mitral stenosis The most common cause is rheumatic valve disease. Other causes include mitral annular calcification, congenital mitral stenosis, infective endocarditis (very rarely), and systemic lupus erythematosus (SLE) (Liebman–Sachs endocarditis). The important consequences of mitral stenosis are its effect on left atrial pressure, size, and the pulmonary vasculature; it commonly causes atrial fibrillation. Presenting symptoms are typically exertional fatigue and breathlessness; systemic embolism can occur. Characteristic physical signs are irregular pulse, tapping apex beat, loud first heart sound, opening snap, and an apical low-pitched rumbling mid-diastolic murmur. Management—the only medical treatments in mitral stenosis are (1) prophylactic measures against rheumatic fever and endocarditis; (2) anticoagulation to prevent systemic thromboembolism; and (3) diuretics for raised left atrial pressure. Patients who are symptomatic need intervention by either surgical valvotomy or catheter–balloon valvuloplasty, whether or not they have pulmonary hypertension. Early intervention—before the development of atrial fibrillation and an enlarged left atrium—is recommended, provided a conservative operation is possible. Mitral valve replacement is reserved for cases where the mitral valve cannot be repaired. Mitral regurgitation The most common causes are ischaemic myocardial dysfunction, mitral valve prolapse, and dilated cardiomyopathy. Other causes include congenital valve disease, infective endocarditis, endomyocardial fibrosis, and connective tissue diseases (including Marfan’s syndrome). Mitral regurgitation is an isolated volume overload on the left ventricle, providing the physiological equivalent of afterload reduction so that a normal forward cardiac output is maintained by the combination of increased ejection fraction and higher preload. Patients with mild regurgitation may not have any symptoms: those with severe regurgitation are likely to present with dyspnoea. Characteristic physical signs are an apex beat that may be prominent and displaced, an apical pansystolic murmur, and a third heart sound (in severe cases). The loudness of the murmur generally correlates with severity of regurgitation. The cardinal signs of mitral prolapse are a mid-systolic click followed by a murmur. Endocarditis prophylaxis may be recommended to high-risk patients with regurgitation. Patients in atrial fibrillation should be given anticoagulants. The development of symptoms suggests the need for surgical correction to avoid development of irreversible left ventricular dysfunction. Assessment during routine follow-up should identify those likely to need surgical intervention even in the absence of symptoms, with an effective regurgitant orifice of over 40 mm2 being one proposed indication. It is generally considered that a left ventricular end-systolic dimension more than 50 mm indicates a poor prognosis and that surgical intervention is unlikely to be of benefit. If technically possible, mitral valve repair results in a much better clinical outcome than does valve replacement, but mitral replacement by a mechanical valve or bioprosthesis is the only option for irreparable valves. Aortic stenosis

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Aortic stenosis may be at subvalvar, valvar, or supravalvar level, the commonest being valvar stenosis. Age-related degenerative calcific disease is the commonest cause in Western Europe and the United States of America. Other causes include congenital bicuspid aortic valve and rheumatic disease (always associated with aortic regurgitation, ‘mixed aortic valve disease’, and usually with rheumatic mitral disease). With the increase in outflow tract resistance in aortic stenosis, left ventricular wall stress increases and hypertrophy develops, preserving overall ventricular systolic function, but potentially at the expense of subendocardial ischaemia. Patients with mild disease may be asymptomatic, and even severe stenosis may be silent, but breathlessness, angina, and syncope are typical. Characteristic physical signs are a slowly rising, low-amplitude pulse, a narrow pulse pressure, a sustained apex beat, and a long and harsh ejection systolic murmur that is loudest at the base (second right intercostal space, also known as the aortic area) of the heart, and in most cases radiates to the carotids (where a thrill may be palpable). Management—patients with moderate or severe disease should be advised to avoid strenuous exercise. Prophylaxis against endocarditis may be recommended to high-risk patients. Asymptomatic patients with mild or moderate aortic stenosis require follow-up; those with severe disease (pressure gradient >70 mmHg) need aortic valve replacement. Aortic regurgitation Aortic regurgitation is caused by leaflet disease or aortic root dilatation, the commonest causes being isolated medionecrosis, rheumatic disease, infective endocarditis, and Marfan’s syndrome. The left ventricular stroke volume is significantly increased, which is accommodated by an increase in left ventricular cavity size. As disease progresses, end-systolic volume increases out of proportion to stroke volume, and eventually these changes lead to irreversible damage. The onset of symptoms, particularly breathlessness, coincides with the onset of left ventricular disease. Characteristic physical signs of chronic severe aortic regurgitation are a large amplitude ‘collapsing’ pulse (which when severe can induce pulsations in many parts of the body), a low diastolic blood pressure (80 mmHg), an apex beat that is sustained and/or displaced, and an early diastolic, decrescendo murmur, loudest at the left sternal border. Acute aortic regurgitation causes the patient to be cold and shut down, with tachycardia, hypotension, and a short early diastolic murmur that is easily missed. Management—medical treatment of chronic aortic regurgitation includes angiotensin converting enzyme (ACE) inhibitors and/or calcium channel blockers to reduce afterload. Patients with a dilated aortic root should be given ##-blockade with ACE inhibition/ angiotensin receptor blockers. Prophylaxis against endocarditis may be recommended to high-risk patients. Although patients with severe chronic aortic regurgitation may remain asymptomatic, valve replacement should be offered when there is progressive increase in left ventricular end-systolic dimension, which should not be allowed to reach more than 40 mm. Right heart valve disease Many of the conditions that cause right-sided valve diseases are congenital, and are excluded from further discussion here (see Chapter 16.12). Tricuspid stenosis—this is rare, but most often caused by rheumatic disease that almost invariably simultaneously affects the mitral valve. Symptoms include fatigue, dyspnoea, Page 3 of 7 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 26 January 2017

and fluid retention. On auscultation at the left or right sternal edge, a mid-diastolic murmur is heard and a tricuspid opening snap may be present. Diuretics can help to minimize fluid retention. Severe tricuspid stenosis needs surgical repair, or replacement if additional regurgitation is present. Tricuspid regurgitation —significant disease is most commonly secondary to pulmonary hypertension and/or right heart dilatation; the commonest noncongenital primary cause is infective endocarditis. Symptoms include fluid retention and hepatic congestion. A raised venous pressure with prominent V-wave is expected. Other signs include a pansystolic murmur at the left or right sternal edge (in one-third of cases), expansile pulsation of the liver (in most), and peripheral oedema/ascites. Diuretics and ACE inhibitors may reduce systemic venous pressure and right ventricular size, even restoring valve competence in some cases. Valve repair or replacement may be advised in some cases. Pulmonary stenosis—a rare condition usually caused by rheumatic disease or carcinoid syndrome. Fatigue and dyspnoea are the main symptoms. Characteristic physical signs are a prominent venous ‘a’ wave in the neck and an ejection systolic murmur loudest at the upper left sternal edge. Balloon valvuloplasty is the procedure of choice if intervention is warranted. Pulmonary regurgitation—significant disease is rare, but usually caused by rheumatic disease, carcinoid, and endocarditis. The characteristic physical sign is a soft early diastolic murmur in the left upper parasternal region. Arrhythmia or progressive right ventricular dilatation are indications for surgery, using homograft or conduit and valve.

Acquired heart disease Linzi Peacock and Rachel Hignett Print Publication Year: 2016 Published Online: Oct 2016 ISBN: 9780198713333 eISBN: 9780191819759 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780198713333.003.0041

Heart disease in pregnancy is a leading cause of maternal death worldwide. In the United Kingdom and United States, heart disease in pregnancy is the commonest cause of maternal death. In Europe, over 1% of maternal deaths are attributable to structural heart disease. In addition, heart disease in pregnancy is a significant cause of severe maternal and fetal morbidity. Whilst the vast majority of women with heart disease in pregnancy have underlying congenital heart disease, most maternal deaths are due to acquired heart disease (AHD). As the risk factors for AHD become ever more prevalent, the expectation is that disease burden from AHD in pregnancy will also increase. Women with AHD benefit from preconception or early assessment in pregnancy by a multidisciplinary team including obstetricians, cardiologists, and obstetric anaesthetists. Risk assessment using the modified World Health Organization classification of cardiac disease in pregnancy will inform frequency of review in pregnancy. A detailed plan for delivery should be agreed in the third trimester. Where possible, a vaginal delivery is advised: caesarean delivery is reserved for women with obstetric indications or with specific severe underlying cardiac conditions. Slow incremental epidural analgesia is usually recommended to reduce the cardiorespiratory work of labour and an assisted second-stage delivery will limit exertion due to pushing. Neuraxial anaesthesia for operative delivery is becoming a more familiar Page 4 of 7 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 26 January 2017

approach and techniques such as low-dose spinal component combined spinal–epidural or slow incremental epidural top-up maximize haemodynamic stability. Invasive monitoring is often beneficial. Post-delivery care is safely delivered in a high dependency or intensive therapy setting. This chapter looks at the general principles of management of women with AHD, and then examines in detail ischaemic heart disease, arrhythmias, cardiac transplantation, aortic pathology and aortic dissection, cardiomyopathy, valvular heart disease, and infective endocarditis.

Epidemiology Hugh Markus, Anthony Pereira, and Geoffrey Cloud Print Publication Year: 2010 Published Online: Oct 2011 ISBN: 9780199218776 eISBN: 9780191726095 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199218776.003.0009

Introduction 2 Definitions for epidemiological studies 3 Stroke subtyping 4 Incidence and prevalence 8 Stroke mortality 10 Economic cost of stroke care 11 Determining risk 14 Stroke risk factors 18 Non-modifiable stroke risk factors 20 Major modifiable stroke risk factors 24 Minor modifiable stroke risk factors ...

Cardiovascular disease Anthea Hatfield Print Publication Year: 2014 Published Online: Apr 2014 ISBN: 9780199666041 eISBN: 9780191771484 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199666041.003.0018

Cardiovascular disease is common and patients coming to recovery room with any of these common problems will need special care. The essential signs and symptoms of hypertension, cardiac failure, ischaemic heart disease, and valvular heart disease are outlined. The actions and side-effects of the drugs that these patients take to control their symptoms are described. Recognizing and treating hypotension and myocardial ischaemia are very important and relevant, and they are fully discussed in this chapter.

The Electrocardiogram Francisco G. Cosío, José Palacios, Agustín Pastor, and Ambrosio Núñez Print Publication Year: 2009 Published Online: Aug 2009 Publisher: Oxford University Press ISBN: 9780199566990 eISBN: 9780199572854 DOI: 10.1093/med/9780199566990.003.002

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Item type: chapter

Stroke Douglas J. Gelb Print Publication Year: 2016 Published Online: Jun 2016 ISBN: 9780190467197 eISBN: 9780190467227 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780190467197.003.0004

This chapter focuses on the primary causes and preventions of stroke. Ischemic stroke occurs when a localized area in the nervous system is deprived of glucose and oxygen because of inadequate cerebral blood flow. The severity of injury is a function of how much the blood flow has been reduced and for how long. In most cases, strokes can be diagnosed purely on the basis of the history and examination. After a stroke occurs, it will continue to manifest as a region of impeded diffusion (also referred to as “restricted diffusion”) on MRI for about two weeks, but MRI scans are unnecessary when the history and examination provide compelling evidence of a stroke and the mechanism of stroke is apparent. Some studies have shown that early rehabilitation allows stroke patients to recover more quickly and perhaps to a higher level of function. Stroke prevention will continue to be the cornerstone of stroke management. Primary prevention is directed toward the early recognition and treatment of risk factors that predispose to the development of cerebrovascular disease.

Primary prevention of stroke Anna M. Cervantes-Arslanian and Sudha Seshadri Print Publication Year: 2014 Published Online: Mar 2014 ISBN: 9780199641208 eISBN: 9780191757341 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199641208.003.0023

Stroke is a major cause of disability and death worldwide. Primary prevention of stroke is of paramount importance and a key element in the United Nations’ effort towards prevention and management of non-communicable disease. Prevention of stroke requires thorough understanding of the non-modifiable risk factors that place an individual at elevated risk as well as the potentially modifiable risk factors for which prevention and management strategies can be targeted. In this chapter non-modifiable risk factors are discussed, including age, sex, race, and family history. Risk factors which are potentially modifiable are also addressed including hypertension, dyslipidaemia, diabetes mellitus, smoking, atrial fibrillation, alcohol, sickle cell disease, post-menopausal hormone therapy, oral contraceptives, elevated homocysteine, sleep disordered breathing and sleep apnoea, obesity, poor nutrition, inadequate physical inactivity, metabolic syndrome, chronic kidney disease, and inflammation and infection. The literature on pharmacological primary prevention of stroke with aspirin and statins is also reviewed. Finally, the public health approach to stroke prevention is addressed. This strategy is twofold, targeting both the individual, via risk stratification and management, and the community, via primordial prevention of development of risk factors. Stroke incidence and mortality vary both Page 6 of 7 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 26 January 2017

geographically and socioeconomically. As the burden of disease now shifts from highincome nations to the middle- and low-income nations, cost-effective strategies towards primary prevention are more important than ever.

Cardiac consultations and emergencies Andrew J. Stewart Coats Gregory Y.H. Lip (ed.) , and Hung-Fat Tse (ed.) Print Publication Year: 2011 Published Online: Oct 2011 ISBN: 9780199568093 eISBN: 9780191725784 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199568093.003.0011

Perioperative evaluation for cardiac surgery - Perioperative evaluation for noncardiac surgery - Perioperative cardiac arrhythmias - Anaesthesia and the patient with cardiovascular disease - Cardiogenic shock - Cardiopulmonary resuscitation

Cardiovascular assessment and care Christine Spiers Print Publication Year: 2010 Published Online: May 2013 Publisher: Oxford University Press ISBN: 9780199564385 eISBN: 9780191768378 DOI: 10.1093/med/9780199564385.003.003 Item type: chapter

Chapter 3 examines the normal anatomy of the heart and vascular system, physiological mechanisms which control the cardiovascular function, cardiovascular assessment, cardiovascular monitoring, cardiovascular management of the patient with chest pain/ acute coronary syndromes/heart failure, cardiogenic shock, and an overview of different types of shock.

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