…Screening of family members is justified, including a 12 lead ECG, echocardiography, clinical examination and a pedigree. Studies show that approximately 30% of family members…

…Introduction to ECG interpretation 1. Which of the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family history…

…Family history also increases risk, particularly among first degree relatives, with siblings appearing to be especially affected. The principal determinant of adverse outcome is aneurysm…

…in the absence of an underlying structural cardiac explanation Early onset hypertension or cerebrovascular accident at a young age in the patient or family Hypertensive…

…may indicate underlying arrhythmias. Age : Younger patients are generally at higher risk of SCD due to the progressive nature of HCM. By combining these factors…

…the syndrome – which was named the Brugada syndrome – appeared to be hereditary, since many patients reported a family history of the same symptoms and events…

…the absence of pupillary light reflex immediately post cardiac arrest is more equivocal. Various pharmaceutical agents, including epinephrine—administered to the vast majority of cardiac…

…of mechanical cardiac function. Results in loss of consciousness, cessation of breathing, and absence of a palpable pulse. Ventricular contraction has ceased or unable to…

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…Initial evaluation of bradycardia according to ABCDE. Symptoms of bradycardia Bradycardia may be an incidental and asymptomatic finding. The absence of symptoms indicates that the…

…radiotracers emit gamma photons directly. These gamma rays are detected by gamma cameras to create tomographic images of the left ventricle. In PET (Positron Emission…

…delayed, partly due to autopsy studies demonstrating an absence of coronary thrombi in a significant proportion of deceased patients. Historically referred to as coronary thrombosis…

…and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial ischaemia…

…should be available within the recommended interval before elective surgery. In the absence of malfunction, a pacemaker should have been checked within the preceding 12…

…infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest…

…amplitude of Q waves may also diminish over time. Moreover, magnetic resonance imaging has suggested that pathological Q waves may also arise due to extensive…

…of myocardial infarction The Fourth Universal Definition separates MI into five principal types. Type Mechanism or setting Type 1 Acute atherothrombotic MI, usually related to…

…to glide out of position due to the gel. One or two fingers may be placed gently on the skin to fix the position of…

…presence or absence of an acute coronary occlusion, rather than rigid ECG thresholds. Several machine learning models for ECG interpretation have been developed to differentiate…

…Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or…

…the anterior axillary line. Thoracostomy This method is generally deemed safer than using a needle due to reduced risk of injury. Thoracostomy should be performed…

CPR Cardiac arrest due to trauma In cases of traumatic cardiac arrest, addressing reversible etiologies takes precedence over chest compressions. If trauma is not definitively…

…be disproportionate to the angiographic appearance of the treated epicardial artery, because the defining abnormality is inadequate distal perfusion in the absence of a major…

…kg Body weight 50 kg: Adult dosage. Adverse effects Adverse effects typically persist <10 seconds due to the short half life of adenosine. Anxiety Chestpain…

…but account for a substantial proportion of sudden cardiac death in young athletes. Clinically, they may be categorized according to whether they are: Not associated…

…a large change in TSH. During acute illness the TSH can be falsely low or high in the absence of thyroid disease; repeat it once…

…Absence of an adequate collateral circulation. A first or anterior infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to VSR…

…and multiple organ failure. In the absence of treatment, approximately 1 in 100 cases of preeclampsia may progress to eclampsia. Clinical presentation and symptoms The…

…to anaerobic metabolism. This is possible because cardiac myocytes store glycogen (a storage form of glucose) which can be used to produce ATP in absence…

…degree heart block in the absence of a pacemaker. Use of intravenous rhythm control antiarrhythmics (class I and class III) within 4 hours prior to…

…Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular hypertrophy or left…

…despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography…

…non obstructive coronary anatomy. Such patients require a mechanism based assessment rather than reassurance based solely on the absence of obstructive CAD. Evaluation and Physical…

…or the administration of contrast medium Skin symptoms are absent in approximately 10 to 20 percent of anaphylactic reactions. The absence of urticaria must therefore…

…body reaching the stroma or deeper. The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury…

…Abrupt withdrawal of treatment with an ACE inhibitor may lead to clinical deterioration and should be avoided in the absence of life threatening complications (e…

…or cold exposure. The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes…

…precisely, FFR compares the pressure driving flow distal to a stenosis with the pressure that would be available in the absence of that stenosis. The…

…syndrome of breathlessness, fatigue and oedema. The underlying mechanisms are not uniform across the HFmrEF population. Some patients have a pathophysiological profile closer to HFrEF…

…myocardial pathology) [3] Absence of Q waves in I, V5, and V6 [3] ST T Waves Usually opposite in direction to the QRS complex [3…

…Symptoms Symptoms may resemble those of obstructive epicardial coronary disease or vasospastic angina. The clinical presentation is not sufficiently specific to identify the underlying mechanism…

…cause of increased flow are appropriate. Exercise PH is defined by an mPAP/cardiac output slope greater than 3 mmHg/L/min from rest to…

…profound driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke and systemic embolism. The contemporary understanding of AF has…

…duration (measured in milliseconds). The amplitude and duration of the pulse must be optimized to ensure depolarization while minimizing battery consumption. Amplitudes are normally below…

…waves (in absence of bradycardia) may indicate ischemia. If U waves were present on previous recording, the amplitude must be increased in order to suggest…

…in some series, is reported in up to approximately one third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion…

…a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed by direct transfer to a PCI centre…

…stents. In acute ACS, aspirin should be administered as soon as possible in the absence of contraindications, using a loading dose followed by maintenance treatment…

…impairment of right and left sided filling, reduced stroke volume, diminished cardiac output, falling arterial pressure, and, if untreated, death. The volume required to produce…

…Brief coronary occlusion or relatively prolonged moderate ischemia may produce post ischemic stunning. In the absence of infarction, contractile recovery can occur rapidly after reperfusion…

…or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the absence of a flow limiting epicardial stenosis. It is associated particularly with intervention…

…function. The benefit of reperfusion is strongly time dependent. The interval from symptom onset to reperfusion is determined by patient recognition and help seeking, pre…

…older age, drugs predisposing to bleeding and alcohol use. A high bleeding risk score should prompt correction of modifiable risk factors and closer surveillance; it…

…ST segment depression related to fixed disease, together with rest angina and ST segment elevation caused by spasm. The absence of obstructive disease generally indicates…

…and in selected cases of paroxysmal supraventricular tachycardia. Due to its profound pro arrhythmic effects and lack of compelling data regarding morbidity and mortality benefits…

…arrest due to idiopathic ventricular fibrillation. The combination of early repolarization pattern on ECG and ventricular fibrillation or sudden cardiac arrest is referred to as…

…ST T changes; the absence of such changes should lead to suspicion of ischemia (if the patient has symptoms consistent with ischemia). The same is…

…the patient has persistent or progressive disease suggestive of an advanced phenotype. Particular attention should be paid to potentially reversible causes and associated cardiovascular conditions…

…leg raising with an increase in stroke volume 10%, or inferior vena cava variability . In the absence of responsiveness, fluid does more harm than good.

…main clinical rule Two questions determine the initial management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2…