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1

Kreit, John W. Right Ventricular Failure. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0014.

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Right ventricular (RV) failure is common in the ICU. Chronic RV failure is most often due to long-standing left ventricular (LV) systolic or diastolic failure or other causes of chronic pulmonary hypertension. Acute RV failure can result from massive pulmonary embolism, ARDS, RV infarction, and acute LV failure. Finally, acute-on-chronic RV failure can be precipitated by any disorder that leads to an abrupt rise in pulmonary vascular resistance (PVR) and RV afterload. Right Ventricular Failure provides an in-depth review of the adverse hemodynamic effects of mechanical ventilation and PEEP in
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2

Nihoyannopoulos, Petros, Gustavo Restrepo Molina, and André La Gerche. Right ventricular dilatation and function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0048.

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Assessing the right ventricle by any imaging modality is a challenge because of the thin wall and crescent shape that wraps around the left ventricle. Structured echocardiographic examination using two-dimensional imaging provides a detailed regional and global qualitative assessment for routine evaluation. Quantitation is possible using one or more methods including tricuspid annulus plane systolic excursion, fractional area change, and myocardial performance index but speckle tracking deformation imaging and three-dimensional echocardiography are emerging as more robust quantitative methods.
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3

Voilliot, Damien, Jaroslaw D. Kasprzak, and Eduardo Bossone. Diseases with a main influence on right ventricular function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0060.

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As an important and independent predictive factor of morbidity and mortality, right ventricular (RV) function should be carefully assessed in patients with chronic obstructive lung disease, lung fibrosis, liver cirrhosis, or obesity. RV assessment requires a complete study of the ‘RV-pulmonary circulation unit’ with estimation of RV preload, RV intrinsic contractility, and RV afterload. Therefore, estimation of pulmonary arterial pressure, pulmonary vascular resistance, and left ventricular systolic and diastolic function should be included in this evaluation, in addition to conventional RV sy
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4

Maizel, Julien, and Michel Slama. Doppler echocardiography in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0141.

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The capacity of echocardiography to non-invasively identify the major causes of circulatory failure has made it increasingly popular in the intensive care unit (ICU) setting. Assessing cardiac performance in shocked patients is a key point in therapeutic support decision-making. Analysing left and right ventricular function and morphology should be mandatory in the training curriculum of ICU physicians. Haemodynamic evaluation relies on several parameters examining left ventricular systolic and diastolic function, left ventricular filling pressure, fluid responsiveness, and right ventricular f
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5

Vieillard-Baron, Antoine. Right ventricular function in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0135.

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Under normal conditions, the right ventricle (RV) virtually acts as a passive conduit. In critically-ill patients many situations induce uncoupling between the right ventricle and pulmonary circulation, leading to RV systolic dysfunction, then failure. Mechanical ventilation has a major impact by decreasing RV preload, but also significantly increasing RV afterload. RV function should thus always be interpreted and re-evaluated in the light of respiratory mechanics and ventilator settings. RV systolic function is key to the patient’s haemodynamic profile and must be monitored to achieve optima
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6

van den Bosch, Annemien E., Luigi P. Badano, and Julia Grapsa. Right ventricle and pulmonary arterial pressure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0023.

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Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging,
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7

Elliott, Perry, Kristina H. Haugaa, Pio Caso, and Maja Cikes. Restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0044.

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Restrictive cardiomyopathy is a heart muscle disorder characterized by increased myocardial stiffness that results in an abnormally steep rise in intraventricular pressure with small increases in volume in the presence of normal or decreased diastolic left ventricular volumes and normal ventricular wall thickness. The disease may be caused by mutations in a number of genes or myocardial infiltration. Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiac muscle disease associated with sudden cardiac death, ventricular arrhythmias, and cardiac failure. It is most frequently cau
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8

Gonçalves, Alexandra, Pedro Marcos-Alberca, Peter Sogaard, and José Luis Zamorano. Assessment of systolic function. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0008.

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This chapter describes the different modalities for assessment of systolic function by transthoracic echocardiography. Firstly, the basic principles of physiology and the determinants of left ventricular (LV) performance are considered, followed by a systematic appraisal of the methodologies for global LV systolic function assessment. Starting with M-mode echocardiography, passing through the traditional two-dimensional echocardiography evaluation to three-dimensional echocardiography approaches, main strengths and limitations are described. Power Doppler usefulness, regarding stroke volume ca
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9

Elliott, Perry, and Alexandros Protonotarios. Arrhythmogenic right ventricular cardiomyopathy: management of symptoms and prevention of sudden cardiac death. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0361.

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Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have arrhythmia-related symptoms or are identified during screening of an affected family. Heart failure symptoms occur late in the disease’s natural history. As strenuous exercise has been associated with disease acceleration and worsening of ventricular arrhythmias, lifestyle modification with restricted athletic activities is recommended upon disease diagnosis or even identification of mutation carrier status. An episode of an haemodynamically unstable, sustained ventricular tachycardia or ventricular fibrillation as well
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10

Romagnoli, Stefano, and Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.

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Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the cri
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11

Mebazaa, Alexandre, and Mervyn Singer. Pathophysiology and causes of cardiac failure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0151.

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Organ congestion upstream of the dysfunctional left and/or right ventricle, with preserved stroke volume, is the most frequkeywordent feature of myocardial failure.Clinical manifestations do not necessarily correlate with the degree of left ventricular systolic dysfunction (i.e. left ventricular ejection fraction).Systolic and/or diastolic dysfunction may be present, with systolic dysfunction usually predominating.Pulmonary oedema is related to left ventricular diastolic dysfunction. Compensatory mechanisms (within the heart and/or periphery) may prove paradoxically disadvantageous on ventricu
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12

De Sutter, Johan, Piotr Lipiec, and Christine Henri. Heart failure: preserved left ventricular ejection fraction. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0028.

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Nearly half of all patients with heart failure present with a preserved left ventricular ejection fraction (HFPEF). HFPEF is a pathophysiologically and clinically heterogeneous disease with an overall similar outcome to heart failure patients with a reduced ejection fraction. It is predominantly seen in elderly patients and comorbidities such as obesity, diabetes, hypertension, a sedentary lifestyle, and myocardial ischaemia play important roles in its development. In this chapter the conventional echocardiographic hallmarks of HFPEF including a preserved ejection fraction, left ventricular hy
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13

Barthélémy, Romain, Etienne Gayat, and Alexandre Mebazaa. Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter). Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0014.

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Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricula
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14

Lancellotti, Patrizio, and Bernard Cosyns. Cardiac Transplants. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0011.

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Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It provides comprehensive information about cardiac structure and function and may be of interest during cardiac biopsy. Precluded by a brief summary of orthotopic and heterotopic cardiac transplantation, this chapter highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart tra
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15

Karatasakis, G., and G. D. Athanassopoulos. Cardiomyopathies. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0019.

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Echocardiography is a key diagnostic method in the management of patients with cardiomyopathies.The main echocardiographic findings of hypertrophic cardiomyopathy are asymmetric hypertrophy of the septum, increased echogenicity of the myocardium, systolic anterior motion, turbulent left ventricular (LV) outflow tract blood flow, intracavitary gradient of dynamic nature, mid-systolic closure of the aortic valve and mitral regurgitation. The degree of hypertrophy and the magnitude of the obstruction have prognostic meaning. Echocardiography plays a fundamental role not only in diagnostic process
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16

Citro, Rodolfo, Laurent Davin, and Daniel Rodriguez Muñoz. Takotsubo syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0046.

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Owing to its dynamic and unique nature, standard echocardiography plays a key role in the diagnostic work-up of patients suspected of takotsubo cardiomyopathy (TTC), providing distinctive features of this peculiar syndrome. Useful information for the early recognition of TTC can be derived from the discrepancy between extensive myocardial dysfunction and a modest increase in troponin levels; the detection of a ‘circumferential pattern’ of left ventricular (LV) wall motion abnormalities, which typically extend beyond the distribution of a single coronary artery; coronary flow assessment in the
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17

Paneni, Francesco, and Massimo Volpe. Co-morbidity (HFrEF and HFpEF): hypertension. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198784906.003.0415_update_001.

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Hypertensive heart disease is a major cause of heart failure (HF) and mortality. Hypertension precedes HF occurrence in 75% of cases, and carries a sixfold increase in HF risk as compared to non-hypertensive individuals. Most importantly, a minority of patients survive 5 years after the onset of hypertensive HF. In hypertensive patients, the heart may present different patterns of adaptive remodelling: concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Although most hypertensive patients are at high risk of developing concentric hypertrophy, a growing proportion of subj
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18

Swanson, Karen L. Neoplastic and Vascular Diseases. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0618.

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Neoplastic and vascular disorders are reviewed. Lung cancer is the most common malignancy and cause of cancer death in both men and women worldwide. The incidence of new lung cancers has continued to decrease in men and increase in women. The risk factors include cigarette smoking, other carcinogens, cocarcinogens, radon exposure, arsenic, asbestos, coal dust, chromium, vinyl chloride, chloromethyl ether, and chronic lung injury. Genetic and nutritional factors have been implicated. Among vascular disorders, pulmonary embolism is most common. Pulmonary embolism (PE) is the cause of death in 5%
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19

D’Andrea, Antonello, André La Gerche, and Christine Selton-Suty. Systemic disease and other conditions: athlete’s heart. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0055.

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The term ‘athlete’s heart’ refers to the structural, functional, and electrical adaptations that occur as a result of habitual exercise training. It is characterized by an increase of the internal chamber dimensions and wall thickness of both atria and ventricles. The athlete’s right ventricle also undergoes structural, functional, and electrical remodelling as a result of intense exercise training. Some research suggests that the haemodynamic stress of intense exercise is greater for the right heart and, as a result, right heart remodelling is slightly more profound when compared with the lef
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20

Cortigiani, Lauro, and Eugenio Picano. Stress echocardiography. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0013.

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Stress echocardiography is a widely used method for assessing coronary artery disease, due to the high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future events. The evaluation of coronary flow reserve by Doppler adds prognostic information to that of standard stress test. Stress echocardiography is indicated in cases when exercise testing is unfeasible, uninterpretable, or gives ambiguous result, and when ischaemia during the test is frequently a false positive response, as in hypertensives, women an
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21

Galderisi, Maurizio, and Sergio Mondillo. Assessment of diastolic function. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0009.

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Modern assessment of left ventricular (LV) diastolic function should be based on the estimation of degree of LV filling pressure (LVFP), which is the true determinant of symptoms/signs and prognosis in heart failure.In order to achieve this goal, standard Doppler assessment of mitral inflow pattern (E/A ratio, deceleration time, isovolumic relaxation time) should be combined with additional manoeuvres and/or ultrasound tools such as: ◆ Valsalva manoeuvre applied to mitral inflow pattern. ◆ Pulmonary venous flow pattern. ◆ Velocity flow propagation by colour M-mode. ◆ Pulsed wave tissue Doppler
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22

Baumgartner, Helmut, Stefan Orwat, Elif Sade, and Javier Bermejo. Heart valve disease (aortic valve disease): aortic stenosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0032.

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Echocardiography has become the gold standard for the assessment of patients with aortic stenosis (AS). It allows morphological assessment of the aortic valve and provides information on the aetiology of the disease. The quantification of AS includes primarily the measurement of transaortic jet velocities and gradients as well as the calculation of the valve area, thus combining flow-dependent and relatively flow-independent variables. Awareness of potential pitfalls is fundamental when assessing these variables. Haemodynamic consequences of AS on left ventricular (LV) size, wall thickness, an
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23

Lee, Jae Myeong, and Michael R. Pinsky. Cardiovascular interactions in respiratory failure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0087.

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Acute respiratory failure not only impairs gas exchange, but also stresses cardiovascular reserve by increasing the need for increased cardiac output (CO) to sustain O2 delivery in the face of hypoxaemia, increased O2 demand by the increased work of breathing and inefficient gas exchange, and increased right ventricular afterload due to lung collapse via hypoxic pulmonary vasoconstriction. Mechanical ventilation, though often reversing these processes by lung recruitment and improved arterial oxygenation, may also decrease CO by increasing right atrial pressure by either increasing intrathorac
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24

Barnard, Matthew, and Nicola Jones. Intensive care management after cardiothoracic surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0368.

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Management of the post-cardiothoracic surgical patient follows general principles of intensive care, but incorporates certain unique considerations. In cardiac surgical patients peri-operative ischaemia, arrhythmias and ventricular dysfunction mandate specific monitoring requirements, and individual pharmacological and mechanical support. Suspicion of myocardial ischaemia should not only lead to pharmacological treatment, but also consideration of urgent angiography to exclude coronary graft occlusion. Ventricular dysfunction may be pre-existing or attributable to intra-operative myocardial ‘s
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25

Orenbuch-Harroch, Efrat, and Charles L. Sprung. Pulmonary artery catheterization in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0133.

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Haemodynamic monitoring is a significant component in the management of critically-ill patients. Flow-directed pulmonary artery catheters (PAC) are a simple and rapid technique for measuring several continuous or intermittent circulatory variables. The PAC is helpful in diagnosis, guidance of therapy, and monitoring therapeutic interventions in various clinical conditions, including myocardial infarction and its complications, non-cardiogenic pulmonary oedema and severely ill patients.The catheter is inserted through a large vein. The PAC is advanced, after ballooninflation with 1.5 mL of air,
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26

Pierard, Luc A., and Lauro Cortigiani. Stress echocardiography: diagnostic and prognostic values and specific clinical subsets. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0015.

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Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic pop
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27

Galderisi, Maurizio, Juan Carlos Plana, Thor Edvardsen, Vitantonio Di Bello, and Patrizio Lancellotti. Cardiac oncology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0064.

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Cancer therapeutics may induce cardiac damage in the left and the right ventricle. Radiotherapy most frequently induces valvular damage, carotid stenosis, and coronary artery disease. Pericardial disease may be due to both chemo- and radiotherapy. The manifestations of both chemo- and radiotherapy can develop acutely but also become overt years after their performance, in particular after radiotherapy. The main cardiac damage of cancer therapeutics-related cardiac dysfunction (CTRCD) corresponds to the reduction of left ventricular (LV) systolic function. The Expert Consensus document from ASE
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28

Kreit, John W. Cardiovascular–Pulmonary Interactions. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0003.

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Intramural pressures within a tube or circuit determine the rate and direction of flow, whereas the transmural pressure of an elastic structure determines its volume. In Chapter 1, we applied these principles when talking about the pressure needed to overcome viscous forces and elastic recoil during ventilation. In this chapter, we use them to explain changes in blood flow between two portions of the circulatory system and changes in the volume and size of the heart chambers. Cardio–Pulmonary Interactions provides an overview of essential cardiovascular physiology as well as an in-depth discus
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29

Price, Laura, and S. John Wort. Pathophysiology and causes of pulmonary hypertension. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0168.

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Pulmonary hypertension (PH) in the setting of critical illness may reflect the acute syndrome itself (such as acute massive pulmonary embolism or acute lung injury), and/or pre-existing ‘chronic’ causes of PH. To compound this, iatrogenic factors may also contribute to PH including the effects of positive pressure ventilation and certain vasoactive drugs. The presence of PH, especially when complicated by resulting right ventricular (RV) dysfunction and failure, is a poor prognostic feature in all settings. This chapter reviews the pathophysiology of acute PH in critical illness, and pre-exist
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30

Anwar, Ashraf M., and Folkert Jan ten Cate. Tricuspid and pulmonary valves. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0016.

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Right-sided heart valves are complex anatomical structures. Studies describing the morphological and functional assessment of both valves are lacking. Most echocardiographic modalities provide a qualitative rather than quantitative approach.Echocardiography has a central role in the assessment of tricuspid regurgitation through estimation of severity, understanding the mechanism, assessment of pulmonary artery pressure, evaluation of right ventricular function, guidance towards surgery versus medical therapy, and assessment of valve competence after surgery.Transoesophageal echocardiography is
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31

Schairer, John R., and Steven J. Keteyian. Pathophysiology and causes of pericardial tamponade. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0166.

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Pericardial disease leading to pericardial effusion (PEF) is a common clinical disorder. The most common causes are viral infections, metastatic cancer, renal disease, and bleeding disorders. PEF that accumulates slowly can become quite large before haemodynamic embarrassment occurs, while PEF that accumulates rapidly from trauma or aortic dissection can be small,yet cause haemodynamic embarrassment. As the PEF increases in size, the pressure in the pericardial space increases, leading to a decrease in atrial and ventricular chamber sizes, and limiting filling of the chambers. Ultimately, card
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32

Stocchetti, Nino, and Andrew I. R. Maas. Causes and management of intracranial hypertension. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0233.

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Intracranial hypertension may damage the brain in two ways—it causes tissue distortion and herniation, and reduces cerebral perfusion. The many different pathologies that can result in intracranial hypertension include subarachnoid haemorrhage, spontaneous intra-parenchymal haemorrhage, malignant cerebral hemispheric infarction, and acute hydrocephalus. The pathophysiology and specific treatment of intracranial hypertension may be different and depend on aetiology. In patients with subarachnoid haemorrhage a specific focus is on treating secondary hydrocephalus and maintaining adequate cerebra
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33

Rigo, Fausto, Covadonga Fernández-Golfín, and Bruno Pinamonti. Dilated cardiomyopathy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0043.

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Dilated cardiomyopathy (DCM) is characterized by a globally dilated and dysfunctioning left ventricle (LV). Therefore, echocardiographic diagnostic criteria for DCM are a LV end-diastolic diameter greater than 117% predicted value corrected for age and body surface area and a LV ejection fraction less than 45% (and/or fractional shortening less than 25%). Usually, the LV is also characterized by a normal or mildly increased wall thickness with eccentric hypertrophy and increased mass, a spherical geometry (the so-called LV remodelling), a dyssynchronous contraction (typically with left bundle
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