…postpartum period. Maternal and obstetric complications Immediate maternal complications include placental abruption, stroke, multiple organ failure, disseminated intravascular coagulation, pulmonary oedema, hepatic complications, renal impairment…

…reduction of LDL cholesterol (LDL C), through a mechanism complementary to that of statins. Statins reduce hepatic cholesterol synthesis, whereas ezetimibe limits intestinal cholesterol uptake…

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

…patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2…

…coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a…

…or extracellular fluid depletion; congestive heart failure or other cardiac dysfunction; haemodynamic instability; anaemia; multiple myeloma or other renal disease; hepatic disease; concurrent nephrotoxic drugs…

…Definition and Pathophysiology Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a hepatic protein that regulates the availability of the low density lipoprotein receptor (LDL…

…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)…

…and formulary availability; check what applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual…

Arrhythmias and arrhythmology Pharmacology & dosing Pharmacokinetic Considerations Relevant to Dosing Amiodarone exhibits highly variable and complex pharmacokinetics that profoundly influence its dosing strategies. The drug…

…dysfunction or microvascular abnormalities without obstructive epicardial disease. The non acute phase after ACS or coronary revascularization. Non acute heart failure in which an ischaemic…

…fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical signs, and an LVEF below…

…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…

…Conversely, an angiographically identified CTO without demonstrable ischaemia or viable myocardium provides a less compelling basis for intervention. The source material does not provide a…

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…

…manifestations commonly emerge much later. Despite this prolonged course, its major complications—including myocardial infarction, unstable angina and stroke—may occur abruptly and without preceding…

Cardiology Endocrinology & metabolism Definition and pathophysiology Obesity is a chronic, relapsing and biologically complex disease characterized by excessive accumulation of adipose tissue. It is an…

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…

…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…

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…

…ischemia and infarction Pharmacology & dosing Definition and therapeutic objectives Antianginal therapy in chronic coronary syndrome (CCS) is directed primarily at reducing myocardial ischaemia and relieving…

…but symptom characteristics and clinical judgement must be incorporated. In symptomatic individuals without known CAD, newer clinical prediction algorithms are preferred over older approaches based…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Refractory angina is a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options…

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…

…constitute a cornerstone in the management of cardiovascular disease, heart failure, and chronic kidney disease (CKD). These agents interfere with the renin angiotensin aldosterone system…

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

…concentration without evidence of ischaemia should instead be classified as acute myocardial injury. Mechanisms of troponin release Troponin I and troponin T are components of…

…clinical classification comprises five groups: Group 1: Pulmonary arterial hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung…

…It is uncommon for chronic pericardial effusions to cause sudden cardiac arrest since these cases tend to be recognized and managed before circulatory collapse occurs…

…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…

…the IPAP against hypercapnia SpO₂ 88–92% Hypoxaemic failure without hypercapnia CPAP or high flow nasal oxygen 5–10 cmH₂O According to oxygenation requirement SpO₂…

…Circulation Parameter Target Comment : : : MAP ≥ 65 mmHg 80–85 mmHg in chronic hypertension or when there are signs of inadequate perfusion Urine output 0.5…

…0.5 or toe pressure < 30 mmHg. Decompensated heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute…

…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…

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

…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…

…1.73 m². Advantages of MDRD eGFR Clinical utility: The MDRD equation has been instrumental in identifying and staging chronic kidney disease (CKD), facilitating early…

…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…

…personalized treatment decisions. The SYNTAX Score was created to address the need for a standardized method to evaluate the anatomical complexity of CAD, particularly in…

…Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with higher perioperative risk…

…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…

…including those with or without previous MI. It is generally continued indefinitely unless contraindications, intolerance, clinically important bleeding, or a competing anticoagulation strategy alters the…

…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…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Atherosclerosis and acute coronary syndromes have important inflammatory components. Inflammation contributes to atherothrombosis through activation of…

…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…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Dual antiplatelet therapy (DAPT) is the combined use of aspirin and an oral P2Y12 receptor inhibitor…

…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…

…In contemporary practice, ISR remains the most frequent cause of PCI failure, despite its substantially lower incidence with drug eluting stents (DES) than with bare…

…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)…

…circulation. PAD is associated with increased cardiovascular morbidity and mortality, as well as limb complications. Atherosclerotic lesions generally affect large and medium sized arteries. Pathological…

…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…

…is more frequent in people with diabetes and becomes more common with advancing age. Presentations without pain may include: Sudden breathlessness Syncope or sudden loss…

…occur without myocardial ischaemia. Non ischaemic myocardial injury may accompany numerous cardiac and systemic disorders, including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic…

…of chronic kidney disease (CKD), which itself promotes cardiovascular disease and amplifies cardiovascular and all cause mortality. The excess risk is mediated by the combined…