[
  ", GCA is classed as a large vessel vasculitis; these are the most common causes of inflammation of the aorta (aortitis).",
  "- HRS: frequent symptoms on standing, an increase in heart rate of ≥30 bpm when moving from a recumbent to a standing position held for more than 30 seconds (≥40 bpm at 12 to 19 years of age), and the absence of orthostatic hypotension (a fall in systolic blood pressure of more than 20 mm Hg).",
  "14; left atrial volume index > 34 mL/m²; systolic dysfunction, LV longitudinal strain",
  "According to MSD, the disordered myocardial architecture and associated microvascular abnormalities lead to fibrosis, which predisposes to systolic and diastolic heart failure and to ventricular tachyarrhythmias; stasis in the deep recesses predisposes to thromboembolic events.",
  "According to the 2025 ESC guideline, direct oral anticoagulants (DOACs) are not recommended in patients with AF and rheumatic MS with an MV area ≤2.0 cm² (class III, level B).",
  "According to the Russian Ministry of Health guideline, diabetes is an independent risk factor for ASCVD; it raises the risk of CHD 2–4-fold, and the prevalence of CVD in people with type 2 diabetes is 2–4 times that in people without diabetes.",
  "After a heart attack, heart failure develops more often in people with diabetes.",
  "An ICD in combination with beta-blockers is recommended for survivors of cardiac arrest (ESC IB) and for patients with syncope and/or VT on an adequate dose of beta-blockers (ESC IIaC).",
  "An implantable cardioverter-defibrillator is considered in patients with risk factors for sudden cardiac death, which include recent unexplained syncope, HCM-related sudden death in a close relative, extensive late gadolinium enhancement on MRI and massive LVH (more than 30 mm).",
  "An inotrope steepens the ESPVR: the ventricle empties to a smaller end-systolic volume at the same afterload, so SV and EF rise.",
  "Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) if an episode of palpitations comes with fainting, feeling faint (sudden darkening of vision, weakness, dizziness, cold sweat) or a drop in blood pressure (the upper, systolic, reading below 100 mm Hg).",
  "Cardiovascular disease is the main cause of death in people with type 2 diabetes.",
  "Catheter ablation of the ventricular ectopic beats that trigger VF/VT and/or of the epicardial substrate of the right ventricular outflow tract is recommended for recurrent ICD shocks refractory to drug therapy (ESC IIaC).",
  "Causes of high levels other than heart failure: age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia (including pulmonary embolism), renal dysfunction (eGFR less than 60 ml/minute/1.73 m²), sepsis, COPD, diabetes and cirrhosis of the liver.",
  "Cholesterol is lowered with statins first, and blood pressure is measured regularly to find and treat hypertension in time.",
  "Contraindications to PMC in rheumatic MS listed by the 2025 ESC guideline include an MV area greater than 1.5 cm², LA thrombus, more than mild mitral regurgitation, severe or bi-commissural calcification, and absence of commissural fusion.",
  "Criteria for severe primary MR in the Russian Ministry of Health guideline: central jet area more than 40% of the LA or a holosystolic eccentric jet, vena contracta ≥0.7 cm, regurgitant volume ≥60 mL, regurgitant fraction ≥50% and effective regurgitant orifice area (EROA) ≥0.40 cm².",
  "ESC 2021: smoking causes 50% of all avoidable deaths in smokers, half of them due to ASCVD; a lifelong smoker has a 50% probability of dying from smoking and loses on average 10 years of life.",
  "ESC 2022: it is recommended that SQTS is diagnosed with a QTc ≤ 360 ms and at least one of a pathogenic mutation, a family history of SQTS, or survival from a VT/VF episode without heart disease (I C).",
  "ESC 2023: prioritise glucose-lowering agents with proven CV benefit, followed by agents with proven CV safety (I C); SGLT2 inhibitors and GLP-1 receptor agonists with proven CV benefit are recommended in type 2 diabetes with ASCVD to reduce CV events, independent of baseline or target HbA1c and of concomitant glucose-lowering medication (I A).",
  "ESC 2025: target BP in pregnancy below 140/90 mmHg (I B); in gestational hypertension, drug treatment is started at BP ≥140/90 mmHg (I B); systolic BP ≥160 or diastolic BP ≥110 mmHg in a pregnant woman is an emergency, and treatment in hospital is recommended (I C).",
  "ESC 2026: with eGFR ≥ 30 mL/min/1.73 m² and confirmed office BP ≥ 130/80 mm Hg, intensified BP control is recommended, with a systolic target of 120–129 mm Hg if tolerated.",
  "ESC: transthoracic echocardiography (TTE) is the first-line imaging technique in thoracic aortic disease (I B); when a TAA is identified, assessment of the aortic valve, especially for a bicuspid valve, is recommended (I C); CT or MRI is recommended to confirm TTE measurements (I C).",
  "Echocardiographic criteria for DCM in the Russian Ministry of Health guideline: LV end-diastolic volume index ≥75 mL/m² in men and ≥62 mL/m² in women; LVEF ≤40% or 41–49%.",
  "Echocardiography: marked unexplained biventricular wall thickening, LV wall >12 mm in the absence of hypertension, HCM, \"athlete's heart\" and other causes, moderate pericardial effusion, valve thickening, apical sparing, left atrial dilatation; LV contractility may be preserved or reduced.",
  "Even if the person has come round, NICE (for people over 16) treats the following as red flags after a blackout: an ECG abnormality (including any ST segment or T wave abnormality and signs of Brugada syndrome), a blackout during exertion, and a family history of sudden cardiac death in people younger than 40 or of an inherited heart condition.",
  "Familial hypercholesterolaemia is looked for with a blood cholesterol test and the family history.",
  "For replacement of the aortic root and/or ascending aorta in BAV, guidelines name a diameter of ≥ 55 mm (ACC/AHA: class 1; Russian Ministry of Health; ESC: I B), and for the root phenotype ESC names ≥ 50 mm (I B).",
  "High LVEDP → high left-atrial pressure → pulmonary congestion.",
  "ICD implantation is recommended for patients who survived cardiac arrest and/or have documented spontaneous sustained VT (ESC IC), and for patients with a spontaneous type 1 pattern and a history of syncope probably of arrhythmic origin (ESC IIaC); it may be considered if VF is induced by programmed ventricular stimulation with up to two extrastimuli (ESC IIbC).",
  "In CKD with type 2 diabetes, an SGLT2 inhibitor is recommended with eGFR ≥ 20 mL/min/1.73 m² irrespective of glycaemic control, and a non-steroidal MRA with eGFR ≥ 25 mL/min/1.73 m² and uACR ≥ 3 mg/mmol; SGLT2 inhibitors and GLP-1 receptor agonists are first-line glucose-lowering agents in type 2 diabetes with CKD.",
  "In a newborn with a murmur, cyanosis, abnormal pulses or signs of heart failure, CHD is confirmed with echocardiography; in selected cases cardiac MRI or CT angiography clarifies the anatomy, and cardiac catheterisation with angiocardiography is occasionally needed and is generally done for therapeutic purposes (MSD data for CHD in general).",
  "In familial PAH, mutations in the BMPR2 gene are found in 75% of cases.",
  "In hypertension in patients with peripheral arterial and aortic diseases, ESC recommends an SBP target of 120–129 mm Hg if tolerated (I A), proposes ACE inhibitors (ACEIs) or ARBs as first-line (IIa B), and says statins may be considered to reduce growth and rupture of TAA (IIb B).",
  "Indications for surgery are NYHA class III–IV symptoms despite optimal medical therapy, syncope due to LVOT obstruction, or a gradient above 50 mm Hg; septal myectomy reduces the obstruction immediately.",
  "Ischaemia disrupts the mucosal barrier: bacteria, toxins and vasoactive mediators cause myocardial depression, a systemic inflammatory response, multi-organ failure and death; mediators may be released even before bowel infarction.",
  "NICE distinguishes stage 1 (clinic BP 140/90 to 159/99 mm Hg and ABPM daytime average or HBPM average 135/85 to 149/94 mm Hg), stage 2 (clinic BP 160/100 mm Hg or higher but less than 180/120 mm Hg and ABPM daytime average or HBPM average 150/95 mm Hg or higher) and severe hypertension (clinic systolic ≥180 or diastolic ≥120 mm Hg).",
  "NICE suggests considering referral for intervention in asymptomatic severe AS if any of the following is present: peak aortic jet velocity more than 5 m/s, aortic valve area less than 0.6 cm², left ventricular ejection fraction less than 55%, BNP or NT-proBNP more than twice the upper limit of normal, or symptoms unmasked on exercise testing.",
  "OH in treated hypertension: intensive antihypertensive treatment may increase the risk of OH, and in people with OH and risk factors for falls the ESC advises avoiding aggressive BP lowering.",
  "Provided that no valve replacement is required, intervention at any level is recommended regardless of symptoms in severe obstruction (Doppler peak gradient above 64 mm Hg; I C).",
  "Proximal to the coarctation there is pressure overload (left ventricular hypertrophy and hypertension in the upper part of the body, including the brain); distal to it there is hypoperfusion of the abdominal organs and lower extremities; collaterals develop via intercostal, internal mammary, scapular and other arteries.",
  "Risk factors by type of occlusion (MSD): for embolism, coronary artery disease, heart failure, valvular heart disease, atrial fibrillation and a history of arterial emboli; for arterial thrombosis, generalised atherosclerosis; for venous thrombosis, hypercoagulable states, inflammation (pancreatitis, diverticulitis), trauma, heart failure, renal failure and portal hypertension; for NOMI, low-flow states (heart failure, shock, cardiopulmonary bypass) and splanchnic vasoconstriction (vasopressors, cocaine).",
  "Risk factors for heart failure in diabetes according to ESC 2023: cardiac, namely ischaemic heart disease, myocardial infarction, hypertension, valvular heart disease and arrhythmias; non-cardiac, namely age, chronic kidney disease, increased body mass index, longer duration of diabetes, smoking and alcohol excess.",
  "Russian Ministry of Health guideline: CHD in diabetes is often asymptomatic, and type 2 diabetes is characterised by a high frequency of low-symptom (painless) and atypical CHD and MI.",
  "Russian Ministry of Health thresholds for HMOD: LVH, LV mass/BSA > 115 g/m² in men and > 95 g/m² in women, or LV mass indexed to height to the power 2.7 > 50 g/m",
  "SQTS should be considered with a QTc ≤ 320 ms (IIa C); with a QTc of 320–360 ms, it should be considered after arrhythmic syncope (IIa C) and may be considered if a relative died suddenly before the age of 40 (IIb C).",
  "Screening for PA by renin and aldosterone measurements should be considered in all adults with confirmed hypertension (≥140/90 mmHg; IIa B).",
  "Severe high-gradient AS according to ACC/AHA: aortic Vmax ≥4 m/s or mean gradient ≥40 mm Hg; aortic valve area is typically ≤1.0 cm² (or indexed ≤0.6 cm²/m²) but is not required to define severe AS.",
  "Severe hyperkalaemia can precipitate life-threatening arrhythmias, muscle weakness or paralysis.",
  "Signs of severe chronic AR in the table of the Russian Ministry of Health guideline: vena contracta >6 mm, pressure half-time less than 200 ms, regurgitant volume >60 mL per beat, regurgitant fraction >50%, effective regurgitant orifice area >0.30 cm², and LV size usually enlarged.",
  "Stabilisers stabilise circulating TTR tetramers, inhibiting TTR misfolding and fibril formation; TTR gene silencing with antisense RNA or RNA interference blocks translation of TTR mRNA and reduces serum TTR levels.",
  "Steepen it and the loop must reach a higher pressure to eject.",
  "The 2024 ESC guidelines define three categories of office BP: non-elevated (below 120/70 mm Hg), elevated (systolic 120–139 or diastolic 70–89 mm Hg) and hypertension (confirmed systolic ≥140 or diastolic ≥90 mm Hg).",
  "The 2026 ESC heart failure guideline gives a different, simplified set of echocardiographic criteria supporting a diagnosis of HF with preserved EF: LV hypertrophy, LV mass index ≥ 95 g/m² in women and ≥ 115 g/m² in men or relative wall thickness > 0.42; LA dilatation, volume indexed to BSA > 34 mL/m² in sinus rhythm and > 40 mL/m² in AF; E/e′ > 9 at rest; estimated systolic pulmonary artery pressure > 35 mm Hg or tricuspid regurgitation velocity at rest > 2.8 m/s.",
  "The ESC and the Russian Ministry of Health guidelines grade an effusion as mild (less than 10 mm), moderate (10–20 mm) or large (more than 20 mm).",
  "The ESC classifies an effusion by onset (acute, up to 4 weeks; subacute, over 4 weeks and up to 3 months; chronic, over 3 months), size (mild, moderate, large), distribution (circumferential or loculated) and composition (transudate or exudate).",
  "The ESC recommends multimodality imaging to differentiate RCM from hypertrophic (HCM) or dilated (DCM) cardiomyopathy with restrictive physiology (class I).",
  "The MSD Manual grades stenosis as moderate with a valve area of more than 1.5 and up to 2.5 cm², and as severe with an area of 1.5 cm² or less.",
  "The QRS width of 140 ms and the direction and size of the late wave are model choices, since the sources give no numbers.",
  "The Russian Ministry of Health guideline describes PPCM as a separate subsection of DCM; the ICD-10 code is O90.3 \"Cardiomyopathy in the puerperium\".",
  "The Russian Ministry of Health guideline recommends, in non-diabetic CKD with GFR ≥ 20 mL/min/1.73 m², an SGLT2 inhibitor with proven efficacy in addition to an ACEI or ARB; the hyperkalaemia risk with a non-steroidal MRA is lower than with other aldosterone antagonists but should be taken into account.",
  "The Russian guideline makes the diagnosis when ST elevation of this shape is 2 mm (0.2 mV) or more in V1 or V2; the model raises it by 0.3 mV (3 mm).",
  "The Van Praagh classification distinguishes type A (with a VSD) and the very rare type B (without a VSD); type A4 has an interrupted aortic arch or coarctation.",
  "The large arteries of the neck and the branches of the aorta are checked for bruits.",
  "The mechanisms are gain of function of repolarising potassium channels, or loss of function of depolarising sodium or calcium channels or of the Cl⁻/HCO₃⁻ exchanger.",
  "The risk factors are the same as for atherosclerosis in general: smoking, diabetes, high cholesterol and high blood pressure.",
  "There is no single threshold for the zone of overlap: according to ESC 2020 it is 12–15 mm in some male athletes, while female athletes rarely have a wall thicker than 12 mm; according to the Russian Ministry of Health HCM guideline (283_2), differential diagnosis is needed at 13–15 mm; according to MSD, the zone of overlap is 13–15 mm in men and 11–13 mm in women.",
  "Thresholds for surgery differ between guidelines. 2025 ESC: AV surgery is recommended in symptomatic patients with severe AR regardless of LV function (class I, level B), and in asymptomatic patients with LVESD >50 mm, LVESDi >25 mm/m² (especially in patients with small body size, BSA less than 1.68 m²) or resting LVEF ≤50% (class I, level B).",
  "To rule out acute HF, NICE uses different thresholds: BNP below 100 ng/L and NT-proBNP below 300 ng/L (1 ng/L equals 1 pg/mL).",
  "Ventilation/perfusion lung scintigraphy is recommended to exclude CTEPH.",
  "What distinguishes Ebstein anomaly from other TV anomalies is apical displacement of the septal leaflet of ≥ 8 mm/m² body surface area relative to the mitral annulus, measured on transthoracic echocardiography in the apical four-chamber view; the ESC gives the same threshold for adults (≥ 0.8 cm/m²) for the septal or posterior leaflet.",
  "What is the apo(a) kringle homologous with plasminogen thought to do?",
  "With risk factors for dissection (see above), guidelines allow surgery from 50 mm (ACC/AHA: class 2a; Russian Ministry of Health; ESC: IIa C for the ascending phenotype at low surgical risk, with its own list of factors), and in patients undergoing aortic valve surgery from 45 mm (ACC/AHA: 2a; ESC: IIa C; Russian Ministry of Health: above 45 mm).",
  "Without screening, the diagnosis of type 2 diabetes may be delayed by 7–9 years from onset; in 20–30% of patients the first manifestation is MI, stroke, loss of vision or another complication, and more than half already have CHD when type 2 diabetes is diagnosed.",
  "abdominal organs: the coeliac trunk and the superior and inferior mesenteric",
  "and very rare: in European data, about 1 person in 160,000–300,000.",
  "ischaemia of the heart and acute heart failure, aortic dissection, and acute kidney",
  "receptor (RYR2); a rarer form is recessive, with a mutation in the gene for calsequestrin",
  "select Impella and watch the loop shrink and unload; select VA-ECMO and watch afterload and LV pressure climb.",
  "{count, plural, one {# article on causes, diagnosis and treatment} other {# articles on causes, diagnosis and treatment}}",
  "{count, plural, one {# article on causes, symptoms and treatment} other {# articles on causes, symptoms and treatment}}",
  "{count, plural, one {# article on how heart disease is found} other {# articles on how heart disease is found}}",
  "{count, plural, one {# topic and a 3D heart model} other {# topics and a 3D heart model}}",
  "| 400–2,000 ng/litre (47–236 pmol/litre) | specialist assessment and transthoracic echocardiography within 6 weeks |"
]