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  <head>
    <title>012-02 Bedside haemodynamics, test selection, and longitudinal cardiovascular inference</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Bedside haemodynamics and test selection">
      <outline text="Symptoms as physiological stress tests">
        <outline text="Demand exposes limited reserve"/>
        <outline text="Exertional pressure: flow cannot meet demand"/>
        <outline text="Exertional dyspnoea">
          <outline text="Filling pressure, output, pulmonary limitation"/>
          <outline text="Anaemia and deconditioning"/>
        </outline>
        <outline text="Ask what the patient has stopped doing"/>
        <outline text="Pillow count is not a diagnosis"/>
        <outline text="Nocturnal dyspnoea: delay, severity, need to sit"/>
        <outline text="Abrupt onset suggests an electrical transition"/>
        <outline text="Gradual acceleration suggests sinus tachycardia"/>
        <outline text="Capturing rhythm during symptoms is decisive"/>
      </outline>
      <outline text="Perfusion and congestion">
        <outline text="Temperature, refill, pulse volume, mentation, urine"/>
        <outline text="Cold hands or warm skin can both mislead"/>
        <outline text="Trends and coherence over single signs"/>
        <outline text="Venous pressure is not total body fluid">
          <outline text="High: right failure, tamponade, constriction, pulmonary hypertension"/>
          <outline text="Low value supports reduced central filling"/>
        </outline>
        <outline text="Venous waveform">
          <outline text="a wave: atrial contraction, absent in fibrillation"/>
          <outline text="Large a wave against resistance or a closed valve"/>
          <outline text="v wave prominent in tricuspid regurgitation"/>
        </outline>
        <outline text="Hepatojugular test: can the right heart accept more"/>
        <outline text="Oedema names fluid, not its cause">
          <outline text="Unilateral swelling: venous, lymphatic, infection, injury"/>
        </outline>
      </outline>
      <outline text="Pulses, murmurs and manoeuvres">
        <outline text="Delayed low-amplitude upstroke: aortic obstruction"/>
        <outline text="Severe low output flattens every pulse"/>
        <outline text="Murmur timing localises the gradient">
          <outline text="Ejection murmurs rise and fall with flow"/>
          <outline text="Holosystolic while a pressure difference persists"/>
        </outline>
        <outline text="Manoeuvres change loading">
          <outline text="Standing and strain reduce venous return"/>
          <outline text="Squatting raises return and resistance"/>
          <outline text="Handgrip raises afterload"/>
          <outline text="Inspiration fills the right heart"/>
        </outline>
        <outline text="Unreliable in tachycardia, low output, obesity"/>
        <outline text="Fever or embolic signs: suspect valve infection"/>
        <outline text="New murmur after infarction: mechanical complication"/>
        <outline text="Urgency follows physiology, not elegance"/>
      </outline>
      <outline text="Electrocardiography and rhythm capture">
        <outline text="Confirm identity, time, calibration, speed, leads"/>
        <outline text="Lead reversal imitates axis change and infarction"/>
        <outline text="Compare with prior tracings"/>
        <outline text="Rate and rhythm before morphology">
          <outline text="Is atrial activity present and related"/>
          <outline text="Narrow or broad ventricular activation"/>
        </outline>
        <outline text="Monitoring duration matched to event frequency"/>
        <outline text="Patient-triggered devices need consciousness"/>
        <outline text="Loop recorders capture pre-event rhythm"/>
        <outline text="Single-lead wearables cannot replace twelve leads"/>
      </outline>
      <outline text="Imaging by clinical question">
        <outline text="Echocardiography answers structure and filling"/>
        <outline text="Windows, loading, rhythm and geometry limit it"/>
        <outline text="Ejection fraction must not eclipse the rest"/>
        <outline text="Computed tomography defines coronary anatomy"/>
        <outline text="Calcification, motion and kidney function limit it"/>
        <outline text="Stenosis does not prove flow limitation"/>
        <outline text="Stress tests examine functional reserve"/>
        <outline text="Inadequate stress weakens a negative result"/>
        <outline text="Magnetic resonance: scar, oedema, infiltration"/>
      </outline>
      <outline text="Biomarkers and serial inference">
        <outline text="Troponin: myocardial injury"/>
        <outline text="Natriuretic peptide: myocardial wall stress"/>
        <outline text="C-reactive protein: inflammation without a source"/>
        <outline text="Creatinine and potassium shape treatment safety"/>
        <outline text="No marker replaces causal assessment"/>
        <outline text="Serial change outweighs a single value"/>
        <outline text="Rising creatinine during diuresis has several causes"/>
        <outline text="Read markers with volume, pressure, urine output, symptoms"/>
      </outline>
      <outline text="Exercise capacity as a vital sign">
        <outline text="Standardised walk, stairs, rehabilitation workload"/>
        <outline text="Cardiopulmonary testing separates limitations">
          <outline text="Circulatory, ventilatory, muscular, motivational"/>
        </outline>
        <outline text="Peak oxygen uptake and ventilatory efficiency"/>
        <outline text="Repeat only when protocol and state match"/>
        <outline text="Specialist interpretation for high-stakes decisions"/>
      </outline>
      <outline text="Closing the loop">
        <outline text="Every investigation ends in an action statement"/>
        <outline text="Which dangerous alternative remains"/>
        <outline text="Proportionate follow-up for incidental findings"/>
        <outline text="State stability, rhythm, perfusion, congestion, trajectory"/>
        <outline text="Name the next test and what changes the plan"/>
      </outline>
    </outline>
  </body>
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