…possible to define an upper reference limit . Any value above the upper reference limit is considered elevated (abnormal) and thus indicates myocardial necrosis. The upper…

…where it is stated that it is extremely uncommon to have a non ischemic ECG (absence of ST T changes) during chest pain caused by…

…under acute coronary syndromes (ACS). Aortic dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

…with myocardial infarction. Cardiac troponin identifies injury to myocardial cells, but infarction requires additional clinical evidence that the injury resulted from acute myocardial ischaemia. Thus…

…electrodes more proximally (closer to the trunk): leg electrodes are placed proximally on the thighs and arm electrodes are placed proximally on the upper arm…

…above the 99th percentile upper reference limit, it must be stable or falling before a subsequent rise can reliably be attributed to acute procedural injury…

…any deflection/wave is measured by using the PR segment as the baseline. Several conditions can reduce the ability of the atrioventricular (AV) node to…

…device. Home blood pressure monitoring (HBPM): self measurement at home, generally with a validated upper arm oscillometric device. Ambulatory blood pressure monitoring (ABPM): automated measurement…

…injury. Myocardial injury Myocardial injury is defined by at least one cardiac troponin (cTn) concentration above the assay specific 99th percentile upper reference limit (URL)…

…exercise capacity (and VO2 max , see below). In addition to exercise capacity, stress testing also provides information on electrocardiographic (ECG) reaction, the occurrence of arrhythmias…

…gel is recommended. In addition to the gel, it is important to apply some pressure when holding the transducer against the skin. Patients with extensive…

…atherosclerotic vascular disease or familial hypercholesterolaemia, addition of bempedoic acid to statin therapy reduced LDL C by approximately 16.5%; the reduction in a subgroup…

…contractility. Analogous electrophysiological changes occur within the sinus and atrioventricular (AV) nodes. In addition to these direct effects, adenosine antagonizes catecholamine stimulated adenylate cyclase. This…

…ventricular function is therefore an important therapeutic objective. Exercise intolerance Exercise limitation is multifactorial. In addition to elevated exercise induced filling pressures, patients may have:

…drug users (intravenous addiction), elderly patients with altered valves, patients with valve prostheses or other cardiac devices (pacemaker, CRT, ICD). In addition to staphylococcus aureus …

…pacing. 25 mm/s. In addition to stimulation artifacts, ventricular pacing yields wide QRS complexes with LBBB morphology (i.e left bundle branch block appearance)…

…the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood tests and…

…increasingly common to dispatch first responders to OHCA, in addition to ambulances. Chest compressions are prioritized above ventilations. DEFIBRILLATION Public defibrillators (AED, Automatic External Defibrillator…

…or the external jugular vein are the vessels that can most often still be punctured — and ultrasound makes the deep forearm veins accessible to those…

…valvular regurgitation and defects in the atria or ventricles (Figure 2). In addition, color Doppler can be used to align the continuous Doppler. Figure 2…

…myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock…

…high value As required, in addition to the mealtime dose Never stop basal insulin in a person with type 1 diabetes , not even before fasting…

…receiving background statin therapy and in those unable to tolerate statins, provided that hepatic LDL receptor expression is present. Additional lipid effects include: Approximately 25%…

…Additional pharmacological options include quinidine, ranolazine, and procainamide [4]. Catheter Ablation : Catheter ablation may be employed as an interventional alternative to suppress the arrhythmia [4…

…duration of 120 ms (0.12 s) or more is required to diagnose a complete left bundle branch block . In addition to prolonged QRS duration…

…Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint. Known hypersensitivity to the preparations. Relative: Poorly controlled diabetes — expect a…

…combined dyslipidaemia, non HDL C is particularly relevant because it captures triglyceride rich lipoproteins in addition to LDL and other apoB containing particles. Cardiovascular risk…

…heart disease and GUCH Complex malformations often require intervention (surgical or catheter based intervention). In addition to the malformation, these subjects frequently develop associated complications…

…L). Reasonable addition of a non statin agent when LDL C is 55–69 mg/dL (≥1.4 to <1.8 mmol/L). Non statin…

…after hospitalization for heart failure is 60%, which is comparable to common cancers ( Stewart et al ). In addition, heart failure is a disabling condition with…

…after hospitalization for heart failure is 60%, which is comparable to common cancers ( Stewart et al ). In addition, heart failure is a disabling condition with…

…inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the 1930s, to a routine, safe, and sophisticated treatment used worldwide…

…you unlimited access without any recurring costs. Purchasing this membership grants you permanent access to the website and there are no additional costs and no…

…Addison's disease, renal failure, tamoxifen, lithium, thiazide diuretics, D vitamin and calcium overdose. ECG changes due to hypercalcemia Common ECG changes Shortened QT interval…

…earlier identification and treatment of high risk ACS patients. Future randomized trials are needed to validate this paradigm and support its broader adoption. Figure 1…

…of cases, hypercalcemia is attributed to primary hyperparathyroidism or neoplastic etiologies. Other causes include immobilization, sarcoidosis, thyrotoxicosis, familial hypocalciuric hypercalcemia, Addison's disease, renal insufficiency…

…be universal adoption of the Cabrera format. This recommendation, 1 was issued 16 years ago and fortunately all modern ECG machines can switch to the…

…Addisonian crisis, hydrocortisone must be given immediately — the test must never delay treatment. Indications Suspected primary adrenal insufficiency (Addison's disease): fatigue, weight loss, hyperpigmentation…

…weight, smoking, diet, physical inactivity, and alcohol consumption. Additional considerations include psychosocial stress, obstructive sleep apnoea, social determinants of health, air pollution, family history, ethnicity…

ECG Myocardial ischemia and infarction Using the ECG to localize myocardial infarction and the coronary occlusion Determining the localization of myocardial infarction and ischemia, as…

…exclusively at the infarct related artery (IRA), or it may extend to additional non infarct related lesions. Culprit only revascularization treats the artery responsible for…

…used as an adjunct to dietary measures and maximally tolerated statin therapy, with or without other LDL C lowering drugs, when additional LDL C reduction…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…additional mechanisms include vascular stiffness and accelerated medial calcification related to disturbed calcium–phosphate metabolism. Patients with advanced CKD are particularly vulnerable to structural cardiac…

…more patients survive with severe, diffuse CAD that is no longer amenable to additional mechanical revascularization. Despite treatment with antianginal drugs and PCI or CABG…

…becomes even modestly active, while additional activity continues to confer benefit with progressively smaller incremental effects. Some activity is preferable to none, and benefit is…

…RVD 2), cm 2.7–3.3 3.4–3.7 3.8–4.1 4.2 Base to apex length (RVD 3), cm 7…

…for an additional 15 minutes after the completion of the infusion. The initiated infusion should always be completed (regardless of whether conversion to sinus rhythm…

…confirmed hypertension generally require BP lowering treatment without additional risk stratification for that treatment decision. Population to which SCORE2 and SCORE2 OP apply SCORE2 and…

…lowering and other guideline directed therapies. Anti inflammatory treatment seeks to reduce this residual risk without necessarily altering lipid concentrations, blood pressure or other conventional…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

…initial combination drug. It is also an appropriate first line pharmacological option when a patient is unable to tolerate any statin regimen. The treatment sequence…

…CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18% to 52%. They frequently occur in patients with severe coronary artery…

…and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of…

…and an additional trigger is required. Potential triggers include thrombus formation and sympathetic activation. Rho kinase may increase vascular smooth muscle sensitivity to calcium by…

…sudden cardiac arrest is common. The following cardiomyopathies lead to dilation of the ventricle: Dilated cardiomyopathy (DCM) Idiopathic or genetic . Ischemic cardiomyopathy Alcoholic cardiomyopathy Diabetic…

…possess an additional pathway between the atria and the ventricles. Such pathways may be conductive, such that they can transmit the atrial impulse to the…

…CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical laboratories, enhancing consistency in patient care…

…doses according to the local protocol. Tapering after pharmacological treatment Duration and dose Risk of HPA suppression Tapering : : : < 3 weeks, at any dose Low…