Academic literature on the topic 'Haemodynamic testing'
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Journal articles on the topic "Haemodynamic testing"
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McClarty, Davis, Maral Ouzounian, Mingyi Tang, Daniella Eliathamby, David Romero, Elsie Nguyen, Craig A. Simmons, Cristina Amon, and Jennifer Chia-Ying Chung. "Ascending aortic aneurysm haemodynamics are associated with aortic wall biomechanical properties." European Journal of Cardio-Thoracic Surgery 61, no. 2 (October 29, 2021): 367–75. http://dx.doi.org/10.1093/ejcts/ezab471.
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Abstract OBJECTIVES The effect of aortic haemodynamics on arterial wall properties in ascending thoracic aortic aneurysms (ATAAs) is not well understood. We aim to delineate the relationship between shear forces along the aortic wall and loco-regional biomechanical properties associated with the risk of aortic dissection. METHODS Five patients with ATAA underwent preoperative magnetic resonance angiogram and four-dimensional magnetic resonance imaging. From these scans, haemodynamic models were constructed to estimate maximum wall shear stress (WSS), maximum time-averaged WSS, average oscillating shear index and average relative residence time. Fourteen resected aortic samples from these patients underwent bi-axial tensile testing to determine energy loss (ΔUL) and elastic modulus (E10) in the longitudinal (ΔULlong, E10long) and circumferential (ΔULcirc, E10circ) directions and the anisotropic index (AI) for each parameter. Nine resected aortic samples underwent peel testing to determine the delamination strength (Sd). Haemodynamic indices were then correlated to the biomechanical properties. RESULTS A positive correlation was found between maximum WSS and ΔULlong rs=0.75, P = 0.002 and AIΔUL (rs=0.68, P=0.01). Increasing maximum time-averaged WSS was found to be associated with increasing ΔULlong (rs=0.73, P = 0.003) and AIΔUL (rs=0.62, P=0.02). Average oscillating shear index positively correlated with Sd (rs=0.73,P=0.04). No significant relationship was found between any haemodynamic index and E10, or between relative residence time and any biomechanical property. CONCLUSIONS Shear forces at the wall of ATAAs are associated with local degradation of arterial wall viscoelastic hysteresis (ΔUL) and delamination strength, a surrogate for aortic dissection. Haemodynamic indices may provide insights into aortic wall integrity, ultimately leading to novel metrics for assessing risks associated with ATAAs.
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Oliveira, Rudolf K. F., Aaron B. Waxman, Manyoo Agarwal, Roza Badr Eslam, and David M. Systrom. "Pulmonary haemodynamics during recovery from maximum incremental cycling exercise." European Respiratory Journal 48, no. 1 (April 28, 2016): 158–67. http://dx.doi.org/10.1183/13993003.00023-2016.
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Assessment of cardiac function during exercise can be technically demanding, making the recovery period a potentially attractive diagnostic window. However, the validity of this approach for exercise pulmonary haemodynamics has not been validated.The present study, therefore, evaluated directly measured pulmonary haemodynamics during 2-min recovery after maximum invasive cardiopulmonary exercise testing in patients evaluated for unexplained exertional intolerance. Based on peak exercise criteria, patients with exercise pulmonary hypertension (ePH; n=36), exercise pulmonary venous hypertension (ePVH; n=28) and age-matched controls (n=31) were analysed.By 2-min recovery, 83% (n=30) of ePH patients had a mean pulmonary artery pressure (mPAP) <30 mmHg and 96% (n=27) of ePVH patients had a pulmonary arterial wedge pressure (PAWP) <20 mmHg. Sensitivity of pulmonary hypertension-related haemodynamic measurements during recovery for ePH and ePVH diagnosis was ≤25%. In ePVH, pulmonary vascular compliance (PVC) returned to its resting value by 1-min recovery, while in ePH, elevated pulmonary vascular resistance (PVR) and decreased PVC persisted throughout recovery.In conclusion, we observed that mPAP and PAWP decay quickly during recovery in ePH and ePVH, compromising the sensitivity of recovery haemodynamic measurements in diagnosing pulmonary hypertension. ePH and ePVH had different PVR and PVC recovery patterns, suggesting differences in the underlying pulmonary hypertension pathophysiology.
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Kovacs, Gabor, Philippe Herve, Joan Albert Barbera, Ari Chaouat, Denis Chemla, Robin Condliffe, Gilles Garcia, et al. "An official European Respiratory Society statement: pulmonary haemodynamics during exercise." European Respiratory Journal 50, no. 5 (November 2017): 1700578. http://dx.doi.org/10.1183/13993003.00578-2017.
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There is growing recognition of the clinical importance of pulmonary haemodynamics during exercise, but several questions remain to be elucidated. The goal of this statement is to assess the scientific evidence in this field in order to provide a basis for future recommendations.Right heart catheterisation is the gold standard method to assess pulmonary haemodynamics at rest and during exercise. Exercise echocardiography and cardiopulmonary exercise testing represent non-invasive tools with evolving clinical applications. The term “exercise pulmonary hypertension” may be the most adequate to describe an abnormal pulmonary haemodynamic response characterised by an excessive pulmonary arterial pressure (PAP) increase in relation to flow during exercise. Exercise pulmonary hypertension may be defined as the presence of resting mean PAP <25 mmHg and mean PAP >30 mmHg during exercise with total pulmonary resistance >3 Wood units. Exercise pulmonary hypertension represents the haemodynamic appearance of early pulmonary vascular disease, left heart disease, lung disease or a combination of these conditions. Exercise pulmonary hypertension is associated with the presence of a modest elevation of resting mean PAP and requires clinical follow-up, particularly if risk factors for pulmonary hypertension are present. There is a lack of robust clinical evidence on targeted medical therapy for exercise pulmonary hypertension.
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PIÉRARD, L. A., C. BERTHE, A. ALBERT, J. CARLIER, and H. E. KULBERTUS. "Haemodynamic alterations during ischaemia induced by dobutamine stress testing." European Heart Journal 10, no. 9 (September 1989): 783–90. http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a059571.
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Tavernarakis, A., N. Michelakakis, G. Ifantis, S. Dervenagas, D. Sionis, C. Papapioannou, D. Tsigas, and C. D. Michalopoulos. "Ventricular extrasystolic arrhythmias in exercise testing II. Haemodynamic correlations." European Heart Journal 8, suppl D (August 2, 1987): 61–63. http://dx.doi.org/10.1093/eurheartj/8.suppl_d.61.
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Szydzik, Crispin, Rose J. Brazilek, Khashayar Khoshmanesh, Farzan Akbaridoust, Markus Knoerzer, Peter Thurgood, Ineke Muir, et al. "Elastomeric microvalve geometry affects haemocompatibility." Lab on a Chip 18, no. 12 (2018): 1778–92. http://dx.doi.org/10.1039/c7lc01320e.
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Krzesiński, Paweł, Jacek Marczyk, Bartosz Wolszczak, and Grzegorz Gielerak. "Quantitative Complexity Theory Used in the Prediction of Head-Up Tilt Testing Outcome." Cardiology Research and Practice 2021 (September 23, 2021): 1–10. http://dx.doi.org/10.1155/2021/8882498.
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Background. Head-up tilt testing (HUTT), a well-established tool in the diagnosis of vasovagal syncope, is time-consuming, and every provoked vasovagal reaction may result in consolidating the reflex mechanism. Therefore, identification of parameters that could shorten the duration of HUTT and prevent fainting is desirable. Quantitative complexity theory (QCT) may provide holistic information on the cardiovascular reaction in HUTT. The aim of the present article was to evaluate the prognostic value of complexity in comparison with traditional haemodynamic parameters (HR and BP) in predicting the HUTT outcome. Methods. Eighty-one healthy volunteers (74 men; mean age: 37.8 years) were included in this retrospective analysis of data collected within the project realized in Department of Cardiology and Internal Diseases, Military Institute of Medicine between January 2012 and October 2014. The subjects underwent HUTT, with beat-to-beat haemodynamic monitoring with a Niccomo™. The chosen haemodynamic parameters (including BP, HR, stroke volume, cardiac output, systemic vascular resistance) have been used in complexity analysis. Results. HUTT was positive in 54 (66.7%) study participants. The values of complexity were already higher in fainting subjects than those were in nonfainting ones 300 s before HUTT termination (HUTT_end), with a significant upward trend starting 150 s before (pre)syncope. An area under the curve (AUC) over 0.700 was observed for complexity from 120 s before HUTT_end, with a sensitivity of 63% and specificity of 78% at this time point. The prognostic value of complexity was superior to that of the HR and mean arterial pressure (MAP). Conclusions. Complexity has been shown to be a sensitive marker of cardiovascular haemodynamic response to orthostatic stress and proved to be superior over HR and BP in predicting HUTT outcomes.
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Yozgat, Yilmaz, Cem Karadeniz, Rahmi Ozdemir, Onder Doksoz, Mehmet Kucuk, Utku Karaarslan, Timur Mese, and Nurettin Unal. "Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope." Cardiology in the Young 25, no. 5 (July 15, 2014): 911–17. http://dx.doi.org/10.1017/s1047951114001176.
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AbstractObjective: To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. Methods: Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5–18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns. Results: There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%). Conclusions: In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.
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Sutton, Richard, Artur Fedorowski, Brian Olshansky, J. Gert van Dijk, Haruhiko Abe, Michele Brignole, Frederik de Lange, et al. "Tilt testing remains a valuable asset." European Heart Journal 42, no. 17 (February 24, 2021): 1654–60. http://dx.doi.org/10.1093/eurheartj/ehab084.
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Abstract Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.
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Oliveira, Rudolf K. F., Manyoo Agarwal, Julie A. Tracy, Abbey L. Karin, Alexander R. Opotowsky, Aaron B. Waxman, and David M. Systrom. "Age-related upper limits of normal for maximum upright exercise pulmonary haemodynamics." European Respiratory Journal 47, no. 4 (December 17, 2015): 1179–88. http://dx.doi.org/10.1183/13993003.01307-2015.
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The exercise definition of pulmonary hypertension was eliminated from the pulmonary hypertension guidelines in part due to uncertainty of the upper limits of normal (ULNs) for exercise haemodynamics in subjects >50 years old.The present study, therefore, evaluated the pulmonary haemodynamic responses to maximum upright incremental cycling exercise in consecutive subjects who underwent an invasive cardiopulmonary exercise testing for unexplained exertional intolerance, deemed normal based on preserved exercise capacity and normal resting supine haemodynamics. Subjects aged >50 years old (n=41) were compared with subjects ≤50 years old (n=25). ULNs were calculated as mean+2sd.Peak exercise mean pulmonary arterial pressure was not different for subjects >50 and ≤50 years old (23±5 versus 22±4 mmHg, p=0.22), with ULN of 33 and 30 mmHg, respectively. Peak cardiac output was lower in older subjects (median (interquartile range): 12.1 (9.4–14.2) versus 16.2 (13.8–19.2) L·min−1, p<0.001). Peak pulmonary vascular resistance was higher in older subjects compared with younger subjects (mean±sd: 1.20±0.45 versus 0.82±0.26 Wood units, p<0.001), with ULN of 2.10 and 1.34 Wood units, respectively.We observed that subjects >50 and ≤50 years old have different pulmonary vascular responses to exercise. Older subjects have higher pulmonary vascular resistance at peak exercise, resulting in different exercise haemodynamics ULNs compared with the younger population.
Dissertations / Theses on the topic "Haemodynamic testing"
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Chapman, Gordon. "Feasibility of early cerebral haemodynamic testing in patients undergoing carotid endarterectomy." Thesis, University of Leeds, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446439.
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Meah, Victoria L. "The maternal cardiovascular system at rest and in response to functional haemodynamic testing during healthy pregnancy." Thesis, Cardiff Metropolitan University, 2017. http://hdl.handle.net/10369/10063.
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Healthy pregnancy results in significant maternal cardiac adaptation to match the increased circulatory demands of the developing fetoplacental unit. Specifically, cardiac output, heart rate (HR), stroke volume (SV) and end-diastolic volume (EDV) increase, whereas mean arterial pressure and systemic vascular resistance decrease. Despite a large body of research, there is a lack of consensus over the magnitude and timing of these adaptations in pregnancy. Additionally, previous studies have reported reduced systolic function in the late stages of pregnancy, indicating that gestation may negatively influence left ventricular pumping capacity. Testing the ability of the maternal heart to respond to additional physiological challenge may elucidate how cardiac function is affected by healthy pregnancy. This thesis investigated cardiovascular adaptation and functional responses before, during and after healthy pregnancy. Firstly, a series of meta-analyses were completed to characterise global cardiac function across healthy gestation. These analyses showed that resting cardiac output is elevated during pregnancy, peaking late in the third trimester but reducing towards term. Secondly, a comprehensive assessment of cardiac structure and function was completed in healthy nonpregnant, pregnant and postpartum females at rest. The significantly greater cardiac output in pregnant females was result of significantly higher HR and SV. The greater SV was result of significantly higher EDV and systolic functional parameters (longitudinal and circumferential left ventricular strain), the latter of which may be linked to greater sympathetic activity. Finally, the functional cardiovascular responses of the aforementioned groups to sustained isometric handhold and submaximal aerobic exercise were tested. During both challenges, systolic function of pregnant females remained significantly greater. In conclusion, healthy pregnancy alters the function of the maternal heart through lower afterload, greater preload and enhanced systolic function. Additionally, healthy pregnant females in the late second trimester have adequate functional responses to increased demand and altered haemodynamic load.
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Thomson, Stephen D. "Exercise testing and non-invasive haemodynamics in the assessment and monitoring of pulmonary hypertension : novel submaximal and peak exercise variables." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8918/.
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Pulmonary hypertension is a disease characterised by progressive pulmonary vascular remodelling and obliteration with consequent development of right heart failure and ultimately death. First described many decades ago with a median survival of less than 3 years and no available treatments, the development of disease specific pulmonary vasodilator therapy has led to only modest improvements in survival and it remains an almost universally fatal disease. One of the key symptoms of pulmonary hypertension is exercise intolerance, primarily a consequence of the underlying right ventricular failure and an inability to augment stroke volume on exercise. The gold standard diagnostic test is right heart catheterisation but this is unattractive as a tool for ongoing monitoring as it is invasive and not without risk, albeit that risk is small. As a result most monitoring of disease progression and of treatment response is carried out using surrogate markers, often exercise based such as the 6 minute walk test. Increasing attention is focused on the role of exercise both in that monitoring of patients and also in helping to understand better the pathophysiology. The work presented in this thesis therefore aimed to explore novel exercise derived variables and noninvasive haemodynamic measurement as tools to improve our understanding of the disease limitation, to enhance our monitoring of treatment response and to give additional prognostic information. In Chapter 3 the role of peripheral muscle oxygen extraction and exercise limitation was explored by performing right heart catheterisation on exercise with measurement of mixed venous oxygen saturation. This demonstrated that patients with pulmonary hypertension demonstrate no evidence of impaired oxygen extraction and that they appear to extract at least as much oxygen on exercise as healthy individuals have been shown to in other studies. This indicates that impairment of oxygen extraction is not a cause of exercise limitation in pulmonary hypertension. 3 Chapter 4 describes a series of studies evaluating the potential role of the oxygen uptake efficiency slope in pulmonary hypertension. This variable derived from the oxygen consumption and ventilation across an incremental cardiopulmonary exercise test has demonstrated promise as a potential submaximal measure of exercise performance and predictor of survival in left heart failure. The studies conducted demonstrated that this variable is a measure of peak exercise performance in pulmonary hypertension, that it can be measure on submaximal levels of exercise and that it predicts survival in patients with Group 1 and Group 4 disease. The studies described in Chapter 5 investigated the rates of recovery of heart rate and oxygen consumption after exercise and found that both could predict survival. In particular the rate of recovery of heart rate after exercise was demonstrated to be a strong predictor of survival on multivariate analysis, thus providing a further method of assessing prognosis with exercise. Finally the ability of noninvasive measures of stroke volume to predict outcome was explored in the studies detailed in Chapter 6. The underlying haemodynamic abnormalities are not assessed when surrogate measures such as exercise testing are employed in patient follow up. Standard practice is to review patients 3 to 4 months after any change in treatment and to assess them using these surrogate measures. Acute haemodynamic changes are able to be detected invasively immediately after administration of pulmonary vasodilator therapy. This study therefore investigated the ability of two noninvasive methods of measuring stroke volume, inert gas rebreathing and cardiac MRI, to detect treatment response after only 2 weeks and assess how this related to functional improvement at the standard 4 months. The study found that haemodynamic changes were able to be detected at 2 weeks and these appeared to relate to changes in 6 minute walk distance at the same time point but did not appear to relate to 6 minute walk distance at 4 months. This study however did not reach its recruitment target and therefore further work is needed in this area.
Books on the topic "Haemodynamic testing"
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Prout, Jeremy, Tanya Jones, and Daniel Martin. Cardiovascular system. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0001.
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This chapter covers the assessment and investigation of perioperative cardiac risk, the principles of perioperative haemodynamic monitoring and physiological changes in cardiac comorbidity with their relevance to anaesthetic management. Perioperative cardiovascular risk includes assessment of cardiac risk factors, functional capacity and evidence-based guidelines for preassessment. Cardiovascular investigations such as cardiopulmonary exercise testing and scoring systems for cardiac risk are included. Management of the cardiac patient for non-cardiac surgery is detailed. Invasive monitoring with arterial, central venous and pulmonary artery catheters is described. Cardiac output measurement systems including dilution techniques, pulse contour analysis and Doppler are compared. The physiological changes, management and implications for anaesthesia of common cardiac comorbidity including ischaemic heart disease, heart failure, valvular heart disease, pacemakers and pulmonary hypertension are described.
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Sinagra, Gianfranco, Marco Merlo, and Davide Stolfo. Dilated cardiomyopathy: clinical diagnosis and medical management. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0356.
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Dilated cardiomyopathy (DCM) is a relatively rare primary heart muscle disease with genetic or post-inflammatory aetiology that affects relatively young patients with a low-risk co-morbidity profile. Therefore, DCM represents a particular heart failure model with specific characteristics and long-term evolution. The progressively earlier diagnosis derived from systematic familial screening programmes and the current therapeutic strategies have greatly modified the prognosis of DCM with a dramatic reduction of mortality over recent decades. A significant number of DCM patients present an impressive response to pharmacological and non-pharmacological evidence-based therapy in terms of haemodynamic improvement with subsequent left ventricular reverse remodelling, which confer a favourable long-term prognosis. However, in some DCM patients the outcome is still severe. This prognostic heterogeneity is possibly related to the aetiological variety of this disease. Maximal effort towards an early aetiological diagnosis of DCM, by using all diagnostic available tools (including cardiovascular magnetic resonance imaging, endomyocardial biopsy, and genetic testing when indicated), as well as the individualized long-term follow-up appear crucial in improving the prognostic stratification and the clinical management of these patients.
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_002.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_003.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
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Rajagopalan, Ram E. Management of corrosive poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0329.
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Corrosive poisoning, typically with household chemicals, is a common problem in children and adults. As ingestion by adults is often intentional, they are usually associated with larger volumes of strong agents and have the potential to create more severe injury than that observed in the accidental ingestions commonly seen in children. The goal of acute care in these cases is to stabilize acute compromise of haemodynamics and to ensure patency of the injured airway. Blind placement of nasogastric tubes and attempts at dilution or neutralization of the ingested chemical are potentially hazardous and should be avoided. Early identification of oesophageal or gastric perforation by clinical evaluation and radiological testing will lead to early and appropriate surgical interventions for these complications. The primary focus after initial stabilization is to evaluate the extent of gastrointestinal injury by early endoscopy. The application of a standardized score to grade the injury allows risk stratification, the planning of nutritional support and referral for appropriate management of the chronic sequelae of scarring and stenosis of the injured gastrointestinal tract. No specific medical therapy can attenuate the extent of damage acutely nor alter the progression of chronic changes.
Book chapters on the topic "Haemodynamic testing"
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Samir, T., A. A. El-Fattah, and S. Mokhtar. "Haemodynamic Effects of Different Modes of Positive-Pressure Mechanical Ventilation." In Advances in Critical Care Testing, 96–97. Berlin, Heidelberg: Springer Berlin Heidelberg, 1997. http://dx.doi.org/10.1007/978-3-642-60735-6_21.
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Palatini, Paolo. "Haemodynamics of Exercise Testing and Sports Activities." In Exercise, Sports and Hypertension, 1–19. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-07958-0_1.
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Guazzi, Marco, and Paolo Emilio Adami. "Protocols of exercise testing in athletes and cardiopulmonary testing: assessment of fitness." In The ESC Textbook of Sports Cardiology, edited by Antonio Pelliccia, Hein Heidbuchel, Domenico Corrado, Mats Börjesson, and Sanjay Sharma, 87–97. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198779742.003.0010.
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Exercise and cardiopulmonary exercise testing are essential in the evaluation of the cardiovascular response to exercise. They are clinically used to evaluate the subject’s capacity to tolerate increasing work loads. Throughout the tests electrocardiographic, haemodynamic, and symptomatic responses are monitored to assess ischaemic, hypertensive, and arrhythmic manifestations of disease. Ventilatory expired gas analysis may also be performed, as it provides fundamental information, particularly in patients with congestive heart failure or other exercise-induced limitations.
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Wei, Janet, and C. Noel Bairey Merz. "General considerations." In ESC CardioMed, edited by Vera Zagrosek-Regitz, 2847–50. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0685.
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Given the increased morbidity and mortality in pregnant women with cardiovascular disease, it is important for clinicians to understand how to manage cardiovascular disease during pregnancy. This chapter discusses epidemiology, haemodynamic, haemostatic, and metabolic alterations during pregnancy, genetic testing and counselling, cardiovascular diagnosis in pregnancy, and infective endocarditis.
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Clark, Andrew L. "What is heart failure?" In Oxford Textbook of Heart Failure, edited by Andrew L. Clark, Roy S. Gardner, and Theresa A. McDonagh, 3–8. Oxford University Press, 2022. http://dx.doi.org/10.1093/med/9780198766223.003.0001.
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This chapter provides an overview of heart failure. The term ‘heart failure’ is usually used freely between clinicians to describe what is wrong with individual patients, yet despite the fact that heart failure is so very common, it is very difficult to define it satisfactorily. Some difficulties arise because of the effects of modern treatment: while it might be reasonable to define acute heart failure in terms of some haemodynamic variable, the situation becomes very different in chronic treated heart failure. Ultimately, heart failure is a clinical syndrome characterized by a constellation of symptoms and signs, and not a discrete diagnosis. The chapter then highlights the importance of natriuretic peptide testing in diagnosing heart failure. It also looks at how the clinical pattern of heart failure can be viewed as a consequence of mammalian evolution, and considers some older descriptions of heart failure. Finally, the chapter details the clinical course of heart failure and identifies three models—the haemodynamic model, neurohormonal model, and peripheral model—which are helpful in thinking about the pathophysiology of heart failure and in suggesting avenues for therapeutic development.
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Sinagra, Gianfranco, Marco Merlo, and Davide Stolfo. "Dilated cardiomyopathy: clinical diagnosis and medical management." In ESC CardioMed, 1474–79. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0356_update_001.
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Dilated cardiomyopathy (DCM) is a relatively rare primary heart muscle disease with genetic or post-inflammatory aetiology that affects relatively young patients with a low-risk co-morbidity profile. Therefore, DCM represents a particular heart failure model with specific characteristics and long-term evolution. The progressively earlier diagnosis derived from systematic familial screening programmes and the current therapeutic strategies have greatly modified the prognosis of DCM with a dramatic reduction of mortality over recent decades. A significant number of DCM patients present an impressive response to pharmacological and non-pharmacological evidence-based therapy in terms of haemodynamic improvement with subsequent left ventricular reverse remodelling, which confer a favourable long-term prognosis. However, in some DCM patients the outcome is still severe. This prognostic heterogeneity is possibly related to the aetiological variety of this disease. Maximal effort towards an early aetiological diagnosis of DCM, by using all diagnostic available tools (including cardiovascular magnetic resonance imaging, endomyocardial biopsy, and genetic testing when indicated), as well as the individualized long-term follow-up appear crucial in improving the prognostic stratification and the clinical management of these patients.
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Colreavy, Frances. "Hypotension." In Oxford Textbook of Advanced Critical Care Echocardiography, edited by Anthony McLean, Stephen Huang, and Andrew Hilton, 265–74. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198749288.003.0018.
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In critically ill patients it is imperative to resolve and treat the cause of haemodynamic shock as quickly as possible in order to save lives and minimize end-organ damage. Intensive Care doctors trained to perform echocardiography can rapidly diagnose and effect management changes in hypotensive patients. A goal-directed approach is required seeking to urgently identify and differentiate distinct clinical syndromes that may occur in this setting. Such an approach utilizes the primary transthoracic echocardiographic subcostal, parasternal, and apical windows and identifies the key issues that can be addressed in the available views. Key to the success of goal-directed echocardiography is the integration of clinical and echocardiographic data in each individual patient. Keeping an open mind regarding the coexistence of more than one cause of hypotension and the need for more comprehensive echocardiography testing is important. Specific situations such as papillary muscle rupture, localized tamponade following cardiac surgery and prosthetic valve malfunction are more reliably diagnosed using the transoesophageal approach. Some diagnoses, such as aortic dissection, acute mitral or aortic regurgitation and acute cardiomyopathy require a multidisciplinary approach and immediate consultation with Cardiology and cardiothoracic services will be required. The simultaneous interpretation of echocardiographic images and the institution of active management are what distinguish critical care echocardiography.
Conference papers on the topic "Haemodynamic testing"
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García Mozos, Luis, Devonjit Saroya, Yannick Roelvink, Naël dos Santos D'Amore, Stefano Gabetti, Jorge Galván Lobo, Catarina Lobo, et al. "Artery in Microgravity (AIM): Assembly, integration, and testing for a student payload for the ISS." In Symposium on Space Educational Activities (SSAE). Universitat Politècnica de Catalunya, 2022. http://dx.doi.org/10.5821/conference-9788419184405.097.
Full textAbstract:
The Artery in Microgravity (AIM) project was the first experiment to be selected for the “Orbit Your Thesis!” programme of the European Space Agency Academy. It is a 2U cube experiment that will be operated in the International Commercial Experiment (ICE) Cubes facility onboard the International Space Station. The experiment is expected to be launched on SpaceX-25 in mid-2022. The project is being developed by an international group of students from ISAE-SUPAERO and Politecnico di Torino. The objective of the experiment is to study haemodynamics in the space environment applied to coronary heart disease. The outcomes of this testbench will contribute to understanding the effects of radiation and microgravity on the circulatory system of an astronaut, specifically the behaviour in long-term human spaceflight. It will also help to ascertain the feasibility of individuals suffering from this kind of disease going to space someday. The cornerstones of the experiment are two models of 3D-printed artificial arteries, in stenotic and stented conditions respectively. Blood-mimicking fluid composed of water and glycerol is circulated
through the arteries in a closed hydraulic loop, and a red dye is injected for flow visualisation. Drops of pressure and image analysis of the flow will be studied with the corresponding sensors and camera. The pH of the fluid will also be monitored to assess the effect of augmented radiation levels on the release of particles from the metallic stent. Some delays were experienced in the project due to the COVID-19 pandemic and to implement design improvements. Improvements were made to several aspects of the design including mechanics (e.g. remanufacturing the reservoir with surface treatment against corrosion, leak prevention measures), software (e.g. upgrading to Odroid-C4 and migrating the code to
Python), and electronics (e.g. several iterations of the interface PCB design). This iterative process of identifying areas of concern and designing and implementing solutions has resulted in many lessons learned. The paper will outline in detail Phase D – Qualification and Production of the AIM experiment cube, with special insight on the implementation of the improvements. Previously, at the Symposium on Space Educational Activities in 2019 in Leicester, the initial phases of the design and development of the cube were presented. This year, the final flight model and the results of validation testing before launching on SpaceX-25 are presented. Lessons learned throughout the course of the project are also highlighted for students embarking on their own space-related educational activities.