…has been a major therapeutic target. This concept is clinically relevant because cardiovascular risk may persist despite appropriate lipid lowering and other guideline directed therapies…

…brainstem integrity and cerebral perfusion. During cardiac arrest, circulation to the brain is severely compromised or absent, leading to rapid brainstem hypoxia. As a result…

…without structural heart disease (reduced left ventricular function is considered a structural heart disease). AVNRT, AVRT (WPW syndrome) and other conditions involving an accessory pathway…

…only a minority with symptoms having all of the traditional aggravating and relieving characteristics of angina; many patients report less characteristic symptoms, while others present…

…as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, early repolarization. Electrolyte disorders, acidosis, hypoxemia and…

…pulseless electrical activity (PEA), and asystole can all occur in one patient. The typical depiction of sudden cardiac death as a gradual transition from sinus…

…elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions (such as bundle branch blocks)…

…tissue and high retention, with a linear relationship between myocardial blood flow and measured tracer activity over a wide range (Murthy et al.). As evident…

…An ECG lead is a graphical description of the electrical activity of the heart and it is created by analyzing several electrodes. In other words…

…from each other. This condition is referred to as atrioventricular (AV) dissociation. Importantly, for the ventricles to have any electrical (and thus pumping) activity at…

…a meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other…

…blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive…

…Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather…

…and multiple vessel spasm during provocation testing is also reported more frequently in East Asian populations. VA can occur as part of a more generalized…

…responds to hypoxia by downregulating metabolism and thus contractility (a consistent finding in acute coronary syndromes). Between 3 8 minutes, pulseless electrical activity (PEA) develops…

…to simply as atrial tachycardia or atrial rhythm, depending on the ventricular response. The ECG in ectopic atrial rhythm and atrial tachycardia A regular rhythm…

…the activity of the autonomic nervous system and changes in the automaticity of the sinoatrial node. Rhythm Normal rhythm A rhythm is defined as three…

…i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable…

…risk plaques may coexist within one coronary tree, and inflammatory activity may be widespread rather than confined to a single lesion. Plaque composition is heterogeneous…

…progress to bradyarrhythmic arrest or pulseless electrical activity (PEA), presenting as cardiovascular collapse and cardiac arrest. Evaluation and Physical Examination The source material does not…

…presents as various arrhythmias, ranging from bradycardias related to enhanced vagal effect to life threatening tachyarrhythmias. Evaluation and Physical Examination Physical examination of a patient…

…considered as a bridge. Clinical Presentation and Symptoms Symptoms of STEMI The usual symptom is severe, prolonged ischemic discomfort. It is commonly described as heavy…

…Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during exertion, the symptoms generally do not resolve simply with cessation of activity…

…Conduction disease and the need for pacemaker therapy may be more frequent in T2DM, although management follows the same principles as in patients without diabetes…

…that delivers a stimulus when failure to capture is confirmed. Oversensing Oversensing occurs when the pacemaker detects electrical activity that it incorrectly interprets as atrial…

…clear difference in mortality when comparing rate and rhythm control. However, rhythm control conveys risks (most antiarrhythmic drugs have a pro arrhythmic effect as well)…

…sum of ventilation, metabolic activity, and perfusion. Increased aerobic metabolism, perfusion, and ventilation result in a higher end tidal carbon dioxide level. Continuous ETCO 2…

…tachycardia is defined as the subjective perception of a rapid heart rate. These terms are often used interchangeably both in clinical practice and in the…

…perfusion, which manifest as less intense or absent uptake, are identified and categorized. A critical aspect of this evaluation is the determination of reversibility , which…

…ECGs. Being able to assess pacemaker function and perform troubleshooting should be considered a basic clinical skill. Pacing activity may be visible or invisible, depending…

…are as follows: Normal (physiologic) sinus tachycardia: The automaticity (rate of spontaneous depolarization) in the sinoatrial node is increased during physical activity, stress, and nervousness…

…A benzodiazepine in a sufficient and repeated dose , titrated against clinical effect. 2. Parenteral thiamine early , preferably before or at the same time as carbohydrate…

…and increases with age. STEMI may present as sudden onset breathlessness. Other less common presentations, with or without pain, include sudden loss of consciousness, a…

…ventricular fibrillation and sudden cardiac arrest at any age. Palpitations, syncope or cardiac arrest–particularly during physical activity–in a young adult with T wave…

…hypovolemia and other etiologies of hypotension remain the predominant causes of cardiac arrest. Should cardiac arrest occur postpartum, hemorrhage must be promptly considered as a…

…and the American College of Cardiology (ACC). Definition of heart rhythm A rhythm is defined as three consecutive heartbeats displaying identical waveforms on the ECG…

…cases, the likelihood of ROSC is higher as compared to other etiologies and presentations. Asystole and pulseless electrical activity (PEA) often have other etiologists, but…

…to a complex fibroatheroma. Smooth muscle cells (SMCs) migrate from the tunica media into the intima, driven by platelet derived growth factor (PDGF) and other…

…As mentioned in the previous paragraph, idioventricular rhythm is very typical during reperfusion and in that scenario it is a good prognostic marker because it…

…re entry or triggered activity. All types of myocardial cells may be engaged in initiation and maintenance of this arrhythmia. As mentioned above VT causes…

…as it belongs to atrial activity. The second vector: the ventricular (interventricular) septum The ventricular septum receives Purkinje fibers from the left bundle branch and…

…is hypoxaemic. Oxygen is not a treatment for dyspnoea as such and must not be given uncontrolled simply because the patient feels breathless. Excessive oxygen…

…in NSTEMI and a corresponding decrease in unstable angina in the past two decades (many of those who would previously have been classified as unstable…

…a safe and effective alternative to alteplase and is simpler to administer, since the whole dose is given as a bolus [1,2]. In a…

…as seven hours. Never irrigate and never instil fluid onto a battery — the moisture drives the reaction. The battery must come out immediately, with a…

…general anaesthesia for other reasons. Extubate as soon as it is safe to do so after the endoscopy. Fluid and monitoring Use a balanced crystalloid…

…reproduce prolonged activity or environmental stresses such as heat, humidity, altitude or wind. A gradual progression is particularly important in previously sedentary individuals and those…

…His Purkinje system, and ventricle. It extends the A H interval, which serves as an index of AV nodal conduction, but does not significantly alter…

…the mouth as needed and place the patient in the recovery position when this is practicable. Give oxygen if hypoxaemic. Use a bag and mask…

…hypertension associated with pheochromocytoma; treatment of dermal necrosis after extravasation of drugs with á adrenergic effects. Phentolamine doses and administration in hypertension (hypertensive crisis/emergency).

…and Pathophysiology Atrial flutter is defined by a macroreentrant atrial circuit, which manifests on the electrocardiogram (ECG) as organized, continuous atrial electrical activity. This activity…

…activity Limit recurrent myocardial infarction, cardiovascular morbidity, and mortality The modern concept of rehabilitation has evolved from early post infarction physical activity programmes into a…

…<1.4 mmol/L (<55 mg/dL) , and A reduction of at least 50% from baseline . The treatment sequence is generally: High intensity statin therapy…

…insect stings, and drug induced reactions. Approximately 90% of anaphylactic cardiac arrests present with pulseless electrical activity (PEA) as the initial rhythm, while the remainder…

…The likelihood of achieving spontaneous cardiac activity is a function of the duration of circulatory standstill and the underlying cause, as elaborated in earlier chapters …

…ECG as usual and record a resting ECG of the arrhythmia before the electrode is inserted. 2. Disconnect the V5 electrode from the chest and…

…depends on plasma volume and plasma renin activity. Volume depletion and high plasma renin activity increase the effect of enalaprilat, and may cause severe hypotension…

…systemic and pulmonary vascular resistance, and restore adequate end organ perfusion. Dobutamine is a synthetic catecholamine that functions as an agonist of both beta1 and…

…Endocrinology & metabolism Pharmacology & dosing Definition and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering…

Cardiology Pharmacology & dosing Definition and pathophysiology Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol…