Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…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…

Cardiology Coronary Atherosclerosis Coronary atherosclerosis is a chronic, progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental…

…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…

…terms refer to symptomatic coronary atherosclerosis. Traditional classification of coronary artery disease Traditionally, coronary artery disease has been classified into the following three syndromes: Stable…

…terms refer to symptomatic coronary atherosclerosis. Traditional classification of coronary artery disease Traditionally, coronary artery disease has been classified into the following three syndromes: Stable…

…components of assessment. The history should include: previous TIA or stroke; symptoms suggesting current or recent cerebral ischaemia; known CAD, PAD, or other atherosclerotic disease…

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

…exercise. Anomalous origin of the left coronary artery is less frequent but is considered more malignant than anomalous origin of the right coronary artery. High…

…modifiable driver of atherosclerosis and cardiovascular disease. Its relationship with cardiovascular risk is nonlinear: even light smoking carries a substantial proportion of the excess ischaemic…

…hypertension together promote left ventricular hypertrophy and kidney injury. The syndrome is therefore both a clinical risk factor cluster and a marker of broader metabolic…

… doubling the dose produces an additional reduction of approximately 6%. Clinical indications and treatment goals Established atherosclerotic cardiovascular disease Patients with established ASCVD are at…

…altered shear stress and intimal injury promote atherosclerosis. The principal anatomical distributions are: Abdominal aorta and iliac arteries, involved in approximately 30% of symptomatic patients…

…of long term outcomes after revascularization. It incorporates both anatomical (from the original SYNTAX Score) and clinical variables (e.g., age, sex, renal function, left…

…formation and progression. As the burden of retained atherogenic particles accumulates over time, the probability of an acute atherosclerotic cardiovascular event increases. Non HDL Cholesterol…

…individual’s cardiovascular risk. Cardiorespiratory fitness, skeletal muscle mass and the distribution of adipose tissue materially influence prognosis. Obesity and heart failure Obesity increases the…

…or CABG, daily or weekly angina remains present in approximately 2%–24% of patients with CAD. The pathophysiology of refractory angina is heterogeneous. In obstructive…

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

…Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies the left anterior descending and left…

…and the extent of underlying coronary artery disease (CAD) and structural cardiac abnormalities. Mechanisms involving reduced myocardial perfusion include fixed coronary atherosclerosis without plaque rupture…

…atherosclerotic arteries. This engenders the typical ECG changes as well. In acute coronary syndromes, however, symptoms and ECG changes are manifest at rest because of…

…of destabilization of the plaque. Atherosclerotic plaques are vulnerable and may disrupt, which may ultimately lead to death ( Stone, Libby et al. ). As the atherosclerotic…

…induced myocardial ischaemia. Detect and characterize myocardial scar. Estimate the risk of major adverse cardiovascular events. Assess left ventricular volumes, regional wall motion, and ejection…

…Thrombus formation is most commonly related to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also…

…microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism…

…is specifically classified by the 2022 AHA/ACC/HFSA and 2021/2023 ESC guidelines as HF with a left ventricular ejection fraction (LVEF) of ≤40%…

…involves the descending aorta distal to the left subclavian artery. Penetrating atherosclerotic ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the…

…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…

…to three fold greater prevalence of asymptomatic atherosclerotic cardiovascular disease (ASCVD) than the general population. The evidence for premature atherosclerosis is particularly strong in RA…

…be beneficial, whereas triglyceride levels seem to be of little or no importance for atherosclerosis. When discussing atherosclerosis, the focus is on LDL cholesterol. Virtually…

… 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…

…should therefore prompt consideration of systemic arteriopathy rather than being regarded solely as an isolated coronary event. SCAD predominantly affects the left sided coronary circulation…

…consequences of diabetes may present through any major cardiovascular phenotype: CAD, including chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left…

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

…have more atherosclerosis (both in frequency and severity) which may compensate for the inability to reach their maximal heart rate. Ultimately, the specificity of exercise…

…stabbing. Its location and radiation may reflect the segment of aorta involved, although the source material does not provide a detailed symptom to anatomy correlation…

…definitions of acute coronary syndromes (ACS) and acute myocardial infarction (AMI) Acute coronary syndromes occur when atherosclerotic plaques disrupt, resulting in the activation of thrombocytes…

…commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of an intraluminal thrombus. The clinical spectrum includes unstable…

…during the infection. Systemic inflammation results in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic…

…dedicated testing, or a qualitative assessment of CAC on a non gated chest CT, can modify the estimated likelihood of atherosclerotic obstructive CAD. CAC is…

…atherothrombosis. It is usually precipitated by disruption of an atherosclerotic plaque through rupture or erosion. The relative contributions of plaque disease and thrombus vary considerably…

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

…models. Targeting risk factors has been very successful in the primary and secondary prevention of atherosclerotic cardiovascular disease, both at the population and individual levels…

…but an atherosclerotic plaque may prevent oxygen supply from increasing in parallel with oxygen demands. Depending on several factors– including the severity of the stenosis…

…ulcers and before deciding the level of amputation. Contraindications There are no absolute contraindications. Refrain or modify in: Deep vein thrombosis in the leg — cuff…

…They supersede risk models that estimate cardiovascular mortality alone because non fatal events constitute an important component of the overall burden of atherosclerotic cardiovascular disease…

…the plaque exposes highly thrombogenic materials which activate circulating platelets and coagulation factors, which results in thrombus formation (Figure 1). Disruption of an atherosclerotic plaque…

…stronger predictor of death than the atherosclerotic burden. Assessment of the size, mass, geometry, and function of the left ventricle is fundamental for the diagnosis…

…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…

…is generally considered appropriate when triglycerides exceed 500 mg/dL to reduce this risk. The ASCVD implications of chylomicronaemia itself remain uncertain, whereas moderate HTG…

…In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases…

…atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI…

…tomographic angiography (CCTA) is a non invasive anatomical examination that depicts the coronary arterial lumen, atherosclerotic plaque, and the severity and distribution of coronary stenosis…

…consequent excess risk of premature atherosclerotic cardiovascular disease (ASCVD), particularly coronary artery disease (CAD). FH results from pathogenic variants affecting proteins in the hepatic LDL…

…the abdominal aortic diameter exceeds 3 cm. Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of…

…of physiological stress, but it may also occur at rest or remain clinically silent. The underlying coronary disease may be obstructive or non obstructive. Atherosclerotic…

…is required. Combination therapy should be selected according to the magnitude of additional LDL C lowering needed and the patient’s prior treatment. Inclisiran is…

…populations. In symptomatic atherosclerotic disease, the international guideline identifies benefit from adding PCSK9 inhibition to statin therapy when LDL C is ≥1.8 mmol/L…

…cellular mechanisms remain proposed explanations for observed clinical effects. Cardiovascular and renal disease associations Diabetes substantially increases the risk of atherosclerotic cardiovascular disease, myocardial infarction…