…or cold exposure. The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes…

…to fluid retention and worsening congestion The clinical course may be chronic and relatively stable or punctuated by episodes of worsening heart failure requiring hospitalization…

Cardiology Nephrology Definition and pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months…

…chronic angina, an anginal equivalent or exertional dyspnoea. Patients may continue to have lifestyle limiting symptoms despite guideline directed medical therapy (GDMT), prompting consideration of…

…vascular cell adhesion molecule 1 (VCAM 1) and intercellular adhesion molecule 1 (ICAM 1), and increasing the permeability of the endothelium to circulating apolipoprotein B…

…and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction, immune cell recruitment…

…Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate Development of type 2 diabetes mellitus Atherosclerotic cardiovascular events HF and atrial fibrillation Obesity…

…guidelines. Hence, this chapter will present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease…

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

…guidelines. Hence, this chapter will present the most recent evidence and recommendations for the evaluation and treatment of chronic coronary syndromes (CCS). Ischemic heart disease…

…antianginal drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients, initial therapy consists of a beta…

…the result meaningfully increases the likelihood of disease and can justify further investigation or treatment. Testing is therefore not an automatic response to chest pain…

…severe preeclamptic phenotype or variant. Pathophysiology The precise mechanism of preeclampsia remains incompletely established. Proposed contributors include chronic uteroplacental ischaemia, an exaggerated maternal inflammatory response…

…because quality of life is often poor, hospitalizations are frequent, and healthcare resource utilization is high. Clinical Presentation and Symptoms The dominant manifestation is chronic…

…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…

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

…The biochemical grade alone does not indicate how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be…

…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…

…tract. This process is not dose dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated…

…up to 30% is considered acceptable. In the setting of acute heart failure, N terminal pro B type natriuretic peptide (NT proBNP) values, potassium concentrations…

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

…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…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…precapillary PH, partly because this value has been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk…

…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…

…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…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…points, not aims in themselves. Almost all of them have proved to work better as ranges to stay within than as figures to strive for…

…4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only…

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

…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…

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

…prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a history of asthma…

…identifying and staging chronic kidney disease (CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of eGFR in clinical…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…disease . It integrates multiple variables, including the number of lesions, their location, and specific characteristics such as bifurcations, chronic total occlusions (CTOs), calcification, and thrombus…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…release that does not fulfil the criteria for ischaemic myocardial infarction. It may be acute, when serial troponin values show a dynamic change, or chronic…

…after PCI; reduce recurrent atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term…

Cardiology Definition and purpose Cardiovascular risk assessment estimates an individual’s probability of experiencing cardiovascular disease (CVD) over a defined period. SCORE2 and SCORE2 Older…

…with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine…

…predictor of incomplete anatomical revascularization with PCI. PCI of chronic total occlusion lesions may improve angina and quality of life, but randomized trials have not…

…outcomes. The risk of death at 1 year is increased in comparison with patients with preserved renal function, although the association may not be causal…

…strategy The standard treatment after ACS is DAPT for 12 months , irrespective of stent type. The preferred regimen is aspirin plus a potent P2Y12 inhibitor…

…that it be of the same type as the initial event. Ezetimibe is recommended when the LDL C target is not achieved with the maximum…

…Initial hs cTn measurement Continuous cardiac monitoring The source material does not provide a detailed list of physical examination findings or a specific examination sequence…

…although its resolution does not consistently permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may…

…shift. For decades, the management of type 2 diabetes mellitus (T2DM) and obesity was siloed, with clinicians focusing primarily on hemoglobin A1c (HbA1c) reduction, blood…

…Addition of ezetimibe if the LDL C target is not achieved. Addition of a PCSK9 inhibitor when the target remains unmet despite maximally tolerated statin…

…or progress to chronic limb threatening ischaemia (CLTI). Clinical presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical…

…Hypertension. Absence of an adequate collateral circulation. A first or anterior infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to…

…coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to chronic limb threat

…cause of ACS during pregnancy and the postpartum period in the cited data. Angiographic classification SCAD is conventionally divided into three angiographic patterns: Type Angiographic…

…any time, although clustering in the morning within several hours of awakening has been described. Atypical and painless presentations Pain is not universal. Painless STEMI…

…and type 3 MI. A diagnosis of MI should not be made solely from an abnormal cTn concentration in the absence of evidence of ischaemia…

…and peripheral artery disease (PAD). Diabetes also substantially increases the risk of chronic kidney disease (CKD), which itself promotes cardiovascular disease and amplifies cardiovascular and…

…in the left ventricle and left atrium. Chronic aortic regurgitation leads to dilatation and hypertrophy of the left ventricle. Cardiac remodeling Ventricular dilatation and hypertrophy…

…attempts to restore sinus rhythm by use of antiarrhythmic drugs. Randomized controlled trials have not demonstrated any clear difference in mortality when comparing rate and…

…practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter is not capable of persisting for longer periods of time…