…limit for troponins Regardless of how sensitive troponin assays are, it is always possible to define an upper reference limit . Any value above the upper…

…issued by the International Society for Holter and Non Invasive Electrocardiology , where it is stated that it is extremely uncommon to have a non ischemic…

…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…

…The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary mechanisms: Plaque Rupture: Accounting for 60 70% of ACS presentations…

…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…

…in stent restenosis. Type 5 MI: MI related to CABG. Type 4b and type 4c events fulfil the criteria for type 1 MI. Procedural myocardial…

…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…

…incorrect measurement may lead to misclassification. Blood pressure should be measured with a validated and calibrated device using a consistent method for the individual patient…

…cause additional myocyte necrosis. Plaque disruption may also be accompanied by haemorrhage into the plaque. The diagnosis is supported by the general criteria for acute…

…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…

…absence for ultrasound practitioners (Harrison et al). When performing emergency echocardiography, or any examination without a proper examination table, it may be difficult to acquire…

…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)…

…obtained for visualizing the pericardium, its surroundings, the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography…

CPR Time is the most critical factor for survival in cardiac arrest. Life saving interventions must be initiated momentarily to maximize the probability of survival…

…for the bone in question): A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis…

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

…the thrombotic process is dynamic, with varying degrees of occlusion that may provide a window of opportunity for reperfusion. In addition, some patients present with…

…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…

…cholesterol (LDL C). Increased PCSK9 activity therefore contributes to higher LDL C concentrations. The genetic evidence provides the rationale for therapeutic inhibition. Gain of function…

…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…

…A joint prosthesis in the adjacent joint. Known hypersensitivity to the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days…

…it captures triglyceride rich lipoproteins in addition to LDL and other apoB containing particles. Cardiovascular risk categories Primary prevention For adults aged 40–75 years…

…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…

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

…prognosis. The 5 year survival rate after hospitalization for heart failure is 60%, which is comparable to common cancers ( Stewart et al ). In addition, heart…

…prognosis. The 5 year survival rate after hospitalization for heart failure is 60%, which is comparable to common cancers ( Stewart et al ). In addition, heart…

…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…

…reliance on ST segment elevation as the key trigger for emergent reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute…

…per hour for a total of 4 6 mEq/L in 24 hours may be targeted. Chronic Hyponatremia ( 48 hours duration): Due to cellular adaptations…

…of displaying the ECG leads is referred to as the Cabrera format and it has been the existing standard in Sweden for over 30 years…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

…factors make a particularly large contribution to cardiovascular disease. Hypertension is a major component of this burden, followed by non HDL cholesterol. For myocardial infarction…

…knowledge is valuable for most clinicians. For cardiologists – particularly interventional cardiologists – this knowledge is of critical importance as they must be able to directly pinpoint…

…or it may extend to additional non infarct related lesions. Culprit only revascularization treats the artery responsible for the acute clinical event during the index…

…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…

…and revascularisation recommendations are not restricted to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the…

…vulnerable to structural cardiac abnormalities, HF and sudden cardiac death. The relationship between glycaemia and cardiovascular disease is complex. Glycaemic control is important for prevention…

…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…

…Balance exercises Flexibility exercises Walking, yoga and gardening may provide useful activity for individuals who are reluctant to undertake formal exercise. Increasing movement during daily…

…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…

…If conversion to sinus rhythm is not successful, blood pressure and ECG should be observed for an additional 15 minutes after the completion of the…

…to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification for…

…previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine as an adjunct to, rather than a replacement for, established secondary prevention…

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…

…first line pharmacological option when a patient is unable to tolerate any statin regimen. The treatment sequence for patients with chronic coronary syndrome is: Lifestyle…

…obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18% to 52%…

…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…

…to valvular heart disease Long term prognosis varies markedly across these conditions. The prognosis in idiopathic dilated cardiomyopathy may be poorer than the prognosis for…

…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…

…to the local protocol. Usually a bolus followed by repeated doses or an infusion Suspected adrenal crisis Give the corticosteroid immediately. Do not wait for…