…complications include placental abruption, stroke, multiple organ failure, disseminated intravascular coagulation, pulmonary oedema, hepatic complications, renal impairment, and cerebrovascular accidents. HELLP syndrome is associated with…

… combination with a PCSK9 inhibitor is also described for high risk patients with atherosclerotic peripheral arterial disease. Chronic coronary syndrome Patients with chronic coronary syndrome…

…disease. Alcohol also increases the rise in myocardial oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although…

…required in severe hepatic or renal impairment, and clinically relevant interactions occur with CYP3A4 inhibitors and inducers. Clinical indications Heart failure with reduced ejection fraction…

…of other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality. Pathophysiology The precise mechanism of contrast induced…

…people with a low muscle mass — the elderly, the undernourished, amputees, patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic…

…and Mechanisms Monoclonal Antibodies Evolocumab and alirocumab are fully human monoclonal antibodies that bind circulating PCSK9 and prevent its interaction with the hepatic LDL receptor…

…and pathophysiology Lipid lowering therapy is a central component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS)…

…Urosepsis with complicating factors cefotaxime 1 g × 3 IV 10–14 days including oral step down or piperacillin–tazobactam 4 g × 3 IV Urosepsis with…

… loading doses mitigate this delay. During chronic therapy, plasma concentrations correlate well with oral doses, averaging approximately 0.5 mg/L (0.5 µg/mL…

…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…

…Pharmacology & dosing Definition and pathophysiology Heart failure is a clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s requirements…

…in individuals without comparable renal impairment. The cardiovascular burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure…

…angiography performed for another indication. When clinically significant, it may present with chronic angina, an anginal equivalent or exertional dyspnoea. Patients may continue to have…

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…

…activity may be widespread rather than confined to a single lesion. Plaque composition is heterogeneous. Lipid rich, macrophage rich plaques are commonly associated with ru

…adipose tissue materially influence prognosis. Obesity and heart failure Obesity increases the risk of HF and is common among patients with established HF, particularly HFpEF…

…likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the European guidelines…

…metalloproteinases (MMPs) degrade the interstitial collagen of the cap, leading to structural failure. Rupture exposes highly thrombogenic subendothelial matrix components, notably tissue factor and collagen…

…likely that the coming guidelines by the American Heart Association (AHA) and American College of Cardiology (ACC) will be in line with the European guidelines…

…in selected patients. Treatment choices should be integrated with management of precipitating factors such as anaemia, uncontrolled hypertension, thyrotoxicosis, tachyarrhythmia, uncontrolled heart failure, and concomitant…

…an ischaemic mechanism. Clinical assessment and estimation of pre test probability Symptoms and clinical context The assessment begins with the clinical presentation, including the character…

…intervention (PCI), including attempted recanalization of a chronic total coronary occlusion. Angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), after appropriate investigation has…

Echocardiography Constrictive pericarditis: the end stage of pericardial inflammation Constrictive pericarditis is the result of chronic inflammation of the pericardium. In principle, all causes of…

…commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being the most common…

…level of consciousness Coma Marked drowsiness, for example a Glasgow Coma Scale below 8 Vomiting together with clear neurological impairment Respiratory failure or respiratory arrest…

…medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care…

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

…dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left ventricular (LV) remodeling Ischemic cardiomyopathy is the leading cause of heart failure with reduced…

…one of the following provides the required evidence of ischaemia: Symptoms compatible with myocardial ischaemia New ischaemic ECG changes Development of pathological Q waves Imaging…

…chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical…

…with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops acutely or subacutely. It is uncommon for chronic…

…Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, acute or chronic…

…oxygen. Acute on chronic hypercapnic failure in obesity hypoventilation and neuromuscular disease. Hypercapnic failure in cardiogenic pulmonary oedema that does not improve with CPAP alone…

…45° Stress ulcer prophylaxis During mechanical ventilation, in coagulopathy, or with a history of gastrointestinal bleeding Refeeding syndrome There is a risk in starvation, alcoholism…

…heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic…

…or neuropathic pain, in chronic non cancer pain, or in headache. A failure to improve function is a reason to taper off, not to increase…

…chronic cough, dyspnoea, wheeze or reduced exercise capacity. Suspected asthma or COPD — diagnosis and follow up. Risk groups: current or former smokers over 40 with…

…Indications Acute urinary retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a…

…heart failure, kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive…

…to healthy populations or those with acute kidney injury. Influence of Muscle Mass and Diet: Serum creatinine levels, a key component of the MDRD equation…

…Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium dose : 3.0 10…

…the need for a standardized method to evaluate the anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease …

…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…

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

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

…chronic coronary syndromes, coronary revascularization, stroke, transient ischaemic attack, and peripheral arterial disease. Heart failure is also considered established clinical CVD in the risk based…

…recently recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary…

…complications, and ischaemia related ventricular failure as potential causes of shock. Patients with moderate to severe chronic kidney disease have a higher burden of comorbidity…

…therefore provides complementary platelet inhibition. The clinical rationale for DAPT is particularly strong after ACS and coronary stent implantation. ACS is associated with a high…

…significant dynamic change is consistent with chronic myocardial injury. Non ischaemic conditions, including myocarditis, rapid ventricular rate atrial fibrillation, marked anaemia, hypertensive emergency, heart failure…

…through intimal thickening. DES release antiproliferative and anti inflammatory agents from the stent surface and have substantially reduced this process compared with BMS. Neoatherosclerosis Neoatherosclerosis…

…offering profound benefits in major adverse cardiovascular events (MACE), heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and peripheral artery disease (PAD)…

…therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality, as well as limb complications. Atherosclerotic lesions generally affect large…

…Acute pulmonary oedema. Hypotension. Progressive heart failure. Cardiogenic shock. Complete transection of a papillary muscle may cause immediately overwhelming MR. Partial rupture, often involving the…

…approximately 35–45%. In chronic coronary syndrome, cessation has been associated with a 36% reduction in premature mortality compared with continued smoking. Cessation also improves…

…Unstable myocardial ischaemia. Ventricular arrhythmia or sudden cardiac arrest. Chronic coronary dissection presenting as heart failure, although this is described as uncommon. In pregnancy associated…

…presentations Pain is not universal. Painless STEMI is more frequent in people with diabetes and becomes more common with advancing age. Presentations without pain may…

…including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic kidney disease Cardiomyopathy Stroke or subarachnoid haemorrhage Takotsubo syndrome Pulmonary embolism Recent coronary revascularization Infiltrative…

…ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular complications Symptoms are determined by the cardiovascular manifestation rather than by…