…right ventricle. Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism…

…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…

…chronic The severity of ischaemia and whether infarction has occurred The extent and degree of myocardial involvement The anatomical territory, including anterior, inferoposterolateral or right…

…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…

…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…

…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…

…supply and demand. The universal classification distinguishes infarction according to its mechanism: Type 1 myocardial infarction: acute atherosclerotic plaque disruption or erosion with coronary thrombosis…

…blood flow from the right to the left atrium. Echocardiography is of importance for cardioembolic stroke, cryptogenic stroke, and for emboli arising in the proximal…

…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…

…or pulseless VT (i.e. shockable), and the probability of survival is higher (since these arrhythmias can be defibrillated). Likewise, the later the ECG is…

…ECG diagnosis and management Atrial fibrillation is the most common abnormal tachyarrhythmia (only sinus tachycardia is more common). The prevalence of atrial fibrillation correlates strongly…

…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 discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…No risk of hypercapnia and a normal blood gas Usually 94 to 98 percent An individually documented target prescription, for example in chronic hypercapnia Follow…

…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…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the…

…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…

…in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to the renal veins and can reduce GFR…

Myocardial ischemia and infarction Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for…

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…

…Hemodynamic effects of constrictive pericarditis Diastolic heart failure and right heart failure The rigid pericardium prevents all four heart chambers from dilating adequately during diastole…

…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…

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

…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…

…concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic heart…

…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…

…10 days Clostridioides difficile, high risk of recurrence fidaxomicin 200 mg × 2 PO 10 days In appendicitis, cholecystitis, diverticulitis and pancreatitis, antibiotics are given only…

…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…

…Instillation therapy and contrast studies of the urinary tract. Wound healing with a sacral pressure sore or extensive perineal wounds where urinary leakage prevents healing…

…risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity…

…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…

…designed to improve the prediction of long term outcomes after revascularization. It incorporates both anatomical (from the original SYNTAX Score) and clinical variables (e.g…

…or chronic, when troponin elevation persists without such a change. Myocarditis, sepsis, takotsubo cardiomyopathy, valvular disease, arrhythmias, and heart failure are among the conditions associated…

…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…

…the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease, particularly diabetic kidney disease and advanced CKD…

…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…

…analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury…