…the muscle insertion. 3. Stretch the skin with the thumb and index finger, or compress the muscle in a slim patient. 4. Insert the needle…

…repolarization time is extended to a greater degree at slower heart rates. Sotalol does not significantly alter resting membrane potential, action potential amplitude, or Vmax…

…Of every 10 such victims, the heart in 6 or 7 showed no recent disease in coronary arteries or in heart muscle. In other words…

…spreads outside the conduction system, which is considerably slower, as compared with impulse transmission within the conduction system (His Purkinje network). Assessing pacemaker function Base…

…Both the parent drug and its metabolite accumulate extensively in various tissues, including the liver, lung, fat, and skin, with myocardial concentrations reaching 10 to…

…when LDL C is normal or low. Clinical Significance Non HDL C is strongly associated with cardiovascular risk for both initial and on treatment assessment…

…Measure the blood pressure in both arms when fitting the device. Use the arm with the higher pressure, or the non dominant arm if the…

Echocardiography Dilated cardiomyopathy (DCM) Dilated cardiomyopathy (DCM) is defined as dilation of one or both ventricles. Dilation of the left ventricle is virtually always accompanied…

…devices, may provide less accurate MAP readings compared to invasive arterial catheterization, particularly in patients with irregular heart rhythms or low blood pressure. Additionally, individual…

…individuals with previous virological failure if it risks loss of suppression. Clinical presentation and symptoms The source material does not describe specific symptoms or physical…

…a precisely regulated electrical shock to terminate a tachyarrhythmia, and it encompasses both synchronized cardioversion and defibrillation ; the key distinction is timing relative to the…

…Notably: Both hyperkalemia and hypokalemia can induce life threatening arrhythmias and cardiac arrest, with hyperkalemia being the most prevalent electrolyte disturbance observed in cardiac arrest…

Arrhythmias and arrhythmology ECG Definition of sinus arrhythmia (respiratory sinus arrhythmia) Sinus arrhythmia and respiratory sinus arrhythmia both refer to the same phenomenon. Sinus arrhythmia…

…and volume status, including signs of both hypovolaemia and venous congestion. 4. Take an urgent panel: creatinine, urea, sodium, potassium, bicarbonate or blood gas, calcium…

…s phenomenon, thromboangiitis obliterans. An arm with an AV fistula or with planned vascular access for dialysis. Previous vascular surgery in the area. Coagulopathy and…

…in a ventilated patient in sinus rhythm without spontaneous breathing, passive leg raising with an increase in stroke volume 10%, or inferior vena cava variability …

…benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your national or regional poison…

…agents with inotropic and vasopressor effects, and they often need to be combined in order to optimise or correct the haemodynamics. Most agents exert both…

…both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or…

…cautiously in patients with high intracranial pressure or azotemia. • Should not be given to pregnant women. • Should not be given to patients with Leber optic…

…COPD) : Associated with higher perioperative risk. Clinical Applications Personalized Decision Making : SYNTAX Score II helps determine whether a patient should undergo PCI or CABG based…

…among patients without evidence of myocardial injury (normal troponin I levels). Hence, troponin I was a strong predictor of survival in patients hospitalized with COVID…

…peripheral arterial disease. More than 70% of older adults presenting with myocardial infarction, stroke, acute aortic syndromes, or heart failure have preexisting hypertension. The relationship…

…or both. A person may also be considered at increased cardiovascular risk without a calculated SCORE2 or SCORE2 OP estimate when certain clinical conditions are…

…1.73 m², excess urinary albumin excretion—typically a spot urinary albumin to creatinine ratio (UACR) above 30 mg/g—or both. The eGFR is…

…without hypoperfusion Intravenous loop diuretic therapy Congestion with hypoperfusion Loop diuretic therapy; consider inotropic support Persistent congestion despite initial therapy Increase diuretic dose and/or…

…should receive both lifestyle and antihypertensive drug therapy. For grade 1 hypertension, pharmacological treatment has demonstrated cardiovascular benefit, although in younger individuals with low short…

…cardiovascular event risk. Quantify myocardial blood flow when PET is used. SPECT is recommended in suspected chronic coronary syndrome with moderate or high pre test

…perfusion. Dobutamine is a synthetic catecholamine that functions as an agonist of both beta1 and beta2 adrenergic receptors, with variable effects on alpha receptors. Stimulation…

…without anatomical or physiological criteria supporting revascularization. In less severe coronary disease, PCI generally offers more rapid recovery and lower initial morbidity than CABG, with…

…Sedation and Intubation : Along with anxiolytics, these measures minimize sympathetic surges [4]. Surgical Interventions : Stellate ganglion block (SGB) or cardiac surgical sympathetic denervation can be…

…cardiac cells—both conduction and contractile cells—must undergo rapid repolarization to ensure they are excitable when the next action potential occurs. If any component…

ECG Hypertrophy and dilatation Principles of atrial and ventricular enlargement (hypertrophy and dilatation) Cardiac chamber enlargement refers to abnormally large atria or abnormally large ventricles…

…Patients with significant heart disease (known or unknown) may not achieve the expected maximum heart rate and it may be hazardous to push them towards…

…without the need for chest compressions. ECMO is considered in individuals who can survive with satisfactory quality of life if the circulation is temporarily supported…

…both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or…

…in STE ACS/STEMI. Note that a patient with STEMI may present during any of the phases illustrated in this figure, which is why it…

…trials, tenecteplase was non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]…

…metabolic alkalosis. A high pH with a low pCO₂ suggests respiratory alkalosis 3 Is the compensation adequate? Calculate the expected pCO₂ or HCO₃. A value…

…heart level Measure in both arms at the first visit; a difference 15 mmHg suggests vascular disease, and the arm with the higher reading is…

…not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small 5–10 mL syringe…

…direct laryngoscope with Macintosh blades 3 and 4 as back up, always with the light checked. Tubes in three sizes, a stylet or bougie taken…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…course. An AST/ALT ratio 2 with moderately raised values suggests alcohol related liver disease; a ratio < 1 suggests steatohepatitis or viral hepatitis. An…

…list (metformin, NSAIDs, RAAS blockade, gabapentin, direct oral anticoagulants) and refer to nephrology at an eGFR < 30, with rapid deterioration, or with A3 albuminuria.

…performance compared to both HEMORR₂HAGES and ATRIA. The HAS BLED score had the highest net reclassification improvement for predicting clinically relevant bleeding, with a 10…

…pressure control. Mechanism of action Nitroglycerin provides nitric oxide (NO) that induces vasodilatation (of both arterioles and veins) via generation of cyclic GMP, which then…

…10% of cases. Intermediate high risk PE occurs in haemodynamically stable patients with both RV dysfunction on imaging and elevated cardiac biomarkers. Intermediate low risk…

…Patients with AF in the setting of ACS have more comorbidities and a higher risk of complications than patients without AF; both short and long…

…AF) in clinical practice. Both arrhythmias are associated with similar clinical settings and frequently coexist in the same patient population. AF can act as a…

…Female specific or female predominant factors associated with later cardiovascular risk include: Premature menopause Premature ovarian insufficiency Hypertensive disorders of pregnancy Preeclampsia Preterm delivery Gestational…

…particularly important in determining management. The benefit of carotid revascularisation is greatest in patients with a recent TIA or stroke, particularly when the event occurred…

…characterize both calcified and non calcified plaque and can assess stenosis. A major limitation is that CAC does not measure total plaque burden or stenosis…

…must consider both cardiac and non cardiac etiologies [1]. Cardiac Causes The primary differential diagnoses include conditions that directly affect the myocardium or major vessels…

…settings: After ACS , whether managed medically or with revascularization. After elective PCI for CCS , particularly after stent implantation. In both situations, DAPT is generally a…

…annular dilatation, or both; progressive ventricular remodeling may also occur in primary valvular disease. Increasing severity of mitral regurgitation is associated with worse outcomes. Pulmonary…

…MI requires both: Acute myocardial injury, demonstrated by a rising and/or falling troponin pattern with at least one value above the assay specific 99th…

…the clinical state during treatment with an angiotensin receptor–neprilysin inhibitor. Clinical Applications Natriuretic peptides have three principal roles: Supporting or excluding the diagnosis of…

…of repeated ischemic episodes or chronic reductions in perfusion. The amount and distribution of both viable and nonviable myocardium, together with coronary anatomy and the…

…performed when angina is present without anatomical or physiological criteria supporting revascularisation. Evaluation and Physical Examination Assessment should establish both clinical risk and the feasibility…