…focal arterial lesions. Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple arterial territories. The arterial wall…

…been identified as important risk factors. Severe atherosclerosis of the axillary or subclavian arteries may increase the risk of embolization. Risk assessment should be individualized…

…Left ventricular aneurysm with thrombus Cardiomyopathies Valve prosthesis Devices (pacemaker, ICD CRT) Endocarditis Cardiac tumors Atherosclerosis of the aorta LOW EMBOLIC POTENTIAL SEP (Spontaneous Echocardiographic…

…of inert cholesterol debris, modern vascular biology has redefined atherosclerosis as a dynamic, immune mediated fibroproliferative response to endothelial injury [2] . The process initiates with…

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

…pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing…

…pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing…

…two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal…

…Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose…

…the anticipated benefit–risk balance of revascularization. Coronary angiography remains primarily an anatomical examination, whereas contemporary decision making increasingly combines anatomical imaging with functional assessment…

…and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products…

…related to insulin resistance and the risk of diabetes and cardiovascular disease than total adiposity alone. The waist circumference associated with risk varies among populations…

Cardiology Pharmacology & dosing Definition and pathophysiology Lipid lowering therapy is a central component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD)…

…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…

…with worse outcomes. Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with…

…from the causal role of low density lipoprotein cholesterol (LDL C) and other apoB containing lipoproteins in atherosclerotic cardiovascular disease (ASCVD). Atherosclerosis develops through the…

…of cardiovascular disease (CVD), cardiovascular risk factor clustering, disability and premature mortality. Cardiovascular conditions associated with obesity include hypertension, dyslipidaemia, coronary artery disease (CAD), atherosclerosis…

…coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI), including attempted recanalization of a chronic total coronary occlusion. Angina or ischaemia with non obstructive…

…ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures. Both…

…health status but does not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical therapy and secondary…

…dissection of the coronary artery wall with accumulation of blood within the false lumen, which compresses the true lumen to varying degrees; this non atherosclerotic…

…reaction in various settings with ischemia or increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery (no atherosclerosis) At rest Oxygen…

…successful primary preventive strategies, such as reduced smoking rates, aggressive lowering of blood lipids with statins and sophisticated treatments for hypertension. However, coronary artery disease…

…Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia may therefore remain undetected unless CT based coronary calcium assessment or another anatomical technique is added…

…objective is prevention of thromboembolic complications, particularly stroke. In untreated AF, stroke risk is increased approximately five fold, and AF is associated with roughly one…

…obstruction of epicardial coronary arteries. Endothelial dysfunction, coronary microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other…

…elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within this spectrum, Heart Failure with Reduced Ejection Fraction (HFrEF) is…

…dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for approximately 80%–90% of acute aortic syndromes, IMH for approximately 10%–20%…

…accelerates atherosclerosis, increases myocardial oxygen demand, and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of heart…

…be the first clinically important manifestation of an otherwise unrecognized inflammatory disease. Epidemiology and disease specific patterns Patients with inflammatory rheumatic disease have a higher…

…to 30 years of age. People with familial hypercholesterolemia have no other metabolic aberration, besides high LDL cholesterol. Treating these individuals with LDL lowering drugs…

… concealed diffuse atherosclerosis; myocardial bridging; myocardial metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not…

…patterns: Type Angiographic appearance Diagnostic considerations Type 1 Contrast staining of the arterial wall with multiple lumens or radiolucent channels The classic appearance and usually…

…coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular complications Symptoms are…

…Risk factors for calcification overlap with risk factors for coronary heart disease (atherosclerosis). The average age at diagnosis of aortic stenosis is 75 years in…

…and results of the exercise test may be affected by patient characteristics. For example, exercising patients with ongoing myocardial ischemia may provoke life threatening ventricular…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…caused by partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions and…

…myocardial necrosis. It most commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of an intraluminal thrombus. The…

…risk of atherosclerotic plaque rupture is increased during infections). As noted by Bonow et al, it is also reasonable to believe that patients with heart…

…refractory to guideline directed medical therapy, occur at a low level of exertion, or are associated with high event risk. The apparent differences between thresholds…

…haemorrhage into the plaque. The diagnosis is supported by the general criteria for acute MI together with evidence of acute coronary atherothrombosis. Post mortem demonstr

…Represents a periprocedural myocardial infarction associated with coronary artery bypass grafting (CABG). Clinical Presentation and Symptoms The diagnosis of an acute MI remains a comprehensive…

…acute coronary syndrome is the result of a perfect storm scenario, where disruption of an atherosclerotic plaque coincides with a pro thrombogenic moment in thrombocytes…

…patients with ischemic heart disease, the majority of all ischemic episodes are asymptomatic (refer to The Ischemic Cascade). Acute coronary syndromes occur when atherosclerotic plaques…

…the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip of the…

Cardiology Definition and purpose Cardiovascular risk assessment estimates an individual’s probability of experiencing cardiovascular disease (CVD) over a defined period. SCORE2 and SCORE2 Older…

…or ECG changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction…

…al ). Among patients with coronary heart disease, left ventricular function is actually a stronger predictor of death than the atherosclerotic burden. Assessment of the size…

…be initiated concurrently. In patients with a confirmed indication for treatment but blood pressure in the range of 120–139/70–89 mmHg, concomitant indications…

…dL ( 5.6 mmol/L) Triglyceride rich lipoproteins, remnant lipoproteins and insulin resistance are associated with atherosclerotic cardiovascular disease (ASCVD), particularly in peripheral arterial disease…

…for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…patients with a lower suspicion of obstructive disease. Patients with no plaque or stenosis on CCTA should be reassured, and non atherosclerotic causes of symptoms…

…characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and a consequent excess risk of premature atherosclerotic cardiovascular disease (ASCVD)…

…are related to atherosclerotic disease. At least 90% of AAAs larger than 4 cm are associated with atherosclerotic pathology. AAA prevalence increases with age and…

…heart failure of ischaemic or cardiometabolic origin. Major clinical presentations The principal outpatient presentations include: Reproducible stress induced angina or ischaemia associated with obstructive epicardial…

…with or without other LDL C lowering drugs, when additional LDL C reduction is required, including in patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous…

…therapy, generally with ezetimibe where appropriate. Established clinical atherosclerotic cardiovascular disease (ASCVD) and FH are principal settings in which these drugs have received approval. In…

…risk of atherosclerotic cardiovascular disease, myocardial infarction, stroke, heart failure, atrial fibrillation and peripheral artery disease. Prognosis is generally worse when diabetes coexists with these…