…disruption of an atherosclerotic plaque through rupture or erosion. The relative contributions of plaque disease and thrombus vary considerably. Thrombotic material may embolize distally and…

…over 40 years of age, atherosclerosis is the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma…

…smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection with or without intramural haematoma. Spontaneous coronary artery dissection…

…plaque morphology and location, comorbidities, environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial…

…stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the most likely diagnosis 3…

…a chronic and serious condition. Mortality in pulmonary embolism is up to 20%, and roughly 30% of patients with pulmonary embolism or deep vein thrombosis…

…specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic…

…SOURCES OF CARDIAC EMBOLI AND EMBOLIC POTENTIAL HIGH EMBOLIC POTENTIAL Atrial arrhythmias — especially atrial fibrillation and atrial flutter. Ischemic heart disease Both acute and chronic…

…Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac amyloidosis, BNP…

…holds true for cardiac arrests caused by chronic or acute ischemic heart disease, it is often not true in other circumstances (e.g. pulmonary embolism…

…pericarditis/myocarditis or pulmonary embolism is often a reversible arrhythmia with low risk of recurrence. Atrial fibrillation in other circumstances (particularly those listed above) is…

…time, coach actively, and do not accept a trace you would not be prepared to show a colleague. Indications Investigation of chronic cough, dyspnoea, wheeze…

…the result of a perfect storm scenario , where ischemia, hemodynamics, the autonomous nervous system, electrolyte concentrations, and other factors (potentially also genetic predisposition) interact to…

…set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for…

…RAD) and left axis deviation (LAD) Causes of right axis deviation Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale…

…RAD) and left axis deviation (LAD) Causes of right axis deviation Normal in newborns. Right ventricular hypertrophy. Acute cor pulmonale (pulmonary embolism). Chronic cor pulmonale…

…with symptoms having all of the traditional aggravating and relieving characteristics of angina; many patients report less characteristic symptoms, while others present primarily with exertional…

…and improve symptoms, functional capacity and quality of life. The underlying aetiology is heterogeneous. Chronic heart failure evaluation should therefore seek reversible or treatable causes…

…The cardiovascular burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or…

…examination pattern or biomarker signature specific to CTOs. Evaluation and physical examination Evaluation should establish: The severity and functional impact of angina or anginal equivalent…

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…

…is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction, immune cell recruitment, extracellular matrix remodelling, and thrombosis interact…

…Chronic, low grade systemic inflammation Insulin resistance Abnormal adipokine signalling Endothelial dysfunction Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate Development of…

Cardiology Evaluation and management of stable coronary artery disease Chronic coronary syndromes (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

…atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by the subendothelial accumulation of apolipoprotein B containing…

ECG Evaluation and management of stable coronary artery disease Chronic coronary syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

…uncomplicated acute coronary syndrome when LVEF is 40% is not definitive. Observational studies have yielded conflicting results, and the appropriate duration of therapy in p

…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 thrombocytopenia—is generally regarded as a severe preeclamptic phenotype or variant. Pathophysiology The precise mechanism of preeclampsia remains incompletely established. Proposed contributors include chronic…

…of a chronic total coronary occlusion. Angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), after appropriate investigation has identified the relevant endotype and…

…parietal and visceral leaves of the pericardium are most often fused. The process most often affects the entire pericardium. Constrictive pericarditis is most often chronic…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced…

…dosing Definition and Pathophysiology Angiotensin converting enzyme (ACE) inhibitors are foundational therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart…

…and chronic kidney disease (CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin…

…dominant manifestation of CAD. As LV dysfunction and HF become more prominent, angina may diminish or disappear. Others have no recognized history of angina or…

…chronic coronary syndrome (CCS), peripheral artery disease (PAD), and acute coronary syndromes (ACS). Its principal therapeutic objective is reduction of low density lipoprotein cholesterol (LDL…

…in the absence of CTEPH, lung disease, or another explanatory cause. PAH reflects marked pulmonary arterial remodelling, with fibroproliferative, plexogenic, and sometimes thrombotic changes that…

…chronic pericardial effusions to cause sudden cardiac arrest since these cases tend to be recognized and managed before circulatory collapse occurs. The leading causes of…

…and thus the selection between them may be guided by individual patient needs rather than by a distinct advantage of one drug over the other…

…7.35 Bilevel NIV IPAP 12–15 and EPAP 4–5 cmH₂O Increase the IPAP in steps of 2–3 cmH₂O every 5–10 min…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…kPa) and avoidance of hypoxia, since hypercapnia raises the intracranial pressure. Circulation Parameter Target Comment : : : MAP ≥ 65 mmHg 80–85 mmHg in chronic hypertension or…

…of all leg ulcers. Chronic venous oedema, lipodermatosclerosis, stasis dermatitis. Prevention of recurrence after a healed venous ulcer. After deep vein thrombosis with post thrombotic…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…catheter is not easier to pass. With a difficult passage it is the shape of the tip and the technique that matter, not the calibre…

…Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the effect of anticoagulants, increasing bleeding risk. Monitor coagulation…

…surface area of 1.73 m². Advantages of MDRD eGFR Clinical utility: The MDRD equation has been instrumental in identifying and staging chronic kidney disease…

…electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors…

…number of lesions, their location, and specific characteristics such as bifurcations, chronic total occlusions (CTOs), calcification, and thrombus presence. These factors are weighted and summed…

…trial. Limitations Requires detailed clinical and angiographic data. Calculation can be complex without dedicated software. May not account for all patient specific factors (e.g.…

…definition of MI. Type 1 MI is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and…

…reduce ischaemic stroke and cardiovascular mortality; prevent stent thrombosis after PCI; reduce recurrent atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention…

…adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast…

…the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine appears to exert several…

…anatomic complexity and comorbidity, which themselves may contribute to progression of native coronary artery disease. The chronic total occlusion is an important predictor of incomplete…

…with chronic kidney disease, particularly diabetic kidney disease and advanced CKD. The clinical course is often more rapidly reversible than that of other forms of…

…whether ACS or chronic coronary syndrome (CCS). Whether and how PCI was performed. The need for non cardiac surgery. The presence of an indication for…

…remains the foundation of lipid lowering treatment for patients with chronic coronary syndrome, acute coronary syndrome (ACS), atherosclerotic peripheral arterial disease, and other very high…

…accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific…