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…

…3 IV Pneumonia, in chronic lung disease amoxicillin 750 mg × 3 PO 5–7 days or benzylpenicillin 3 g × 4 IV Pneumonia, suspected atypical pathogen…

…Thus, the presence of non obstructive epicardial arteries does not exclude a coronary cause of symptoms. CCS is a clinical syndrome rather than a permanently…

…not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without…

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…

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

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

…and population level risk estimation, but it does not characterize body composition, fat distribution, skeletal muscle mass, physical fitness or individual health status. In particular…

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…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

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…

…probability is central because the clinical value of any diagnostic test depends not only on its sensitivity and specificity but also on disease prevalence in…

…hypertension without apparent organ injury to severe multisystem disease. Severe features include: Severe hypertension, defined as blood pressure ≥160/110 mmHg Headache that does not…

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…

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…

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

…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…

…picture may include: Symptoms attributable to chronic LV systolic dysfunction and HF Angina, although its absence does not exclude ischemic cardiomyopathy Symptoms related to recurrent…

…component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS), peripheral artery disease (PAD), and acute coronary syndromes…

…a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction. Cardiac troponin identifies injury to…

…used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction…

…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…

…and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use of beta blockers…

…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…

…symptoms (pericarditis, encephalopathy) and certain poisonings. Early initiation without an absolute indication has not been shown to improve survival. Parameter Guide value : : Effluent dose, continuous…

…all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics. 5. Biopsy any ulcer that has not healed…

…between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture…

…and must not lean forward during expiration. 2. Apply the nose clip and have the patient seal the lips tightly around the mouthpiece without the…

…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…

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

…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…

…HF), acute Heart failure (HF), chronic Bradycardia (second line alternative) Medium dose : 3.0 10.0 μg/kg/min. + ++++ + +++++ Medium dose dopamine activates β1…

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

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

…infarction. It may be acute, when serial troponin values show a dynamic change, or chronic, when troponin elevation persists without such a change. Myocarditis, sepsis…

… prevent stent thrombosis after PCI; reduce recurrent atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant…

…In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification for that treatment decision. Population to which SCORE2 and SCORE2…

…lowering and other guideline directed therapies. Anti inflammatory treatment seeks to reduce this residual risk without necessarily altering lipid concentrations, blood pressure or other conventional…

…PCI of chronic total occlusion lesions may improve angina and quality of life, but randomized trials have not demonstrated reductions in mortality or myocardial infarction…

…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…

…be considered in patients who: Have tolerated DAPT without significant bleeding. Have high ischaemic risk. Do not have a high risk of major or life…

…target is not achieved with the maximum tolerated statin dose. This recommendation carries Class I status with Level B evidence in the chronic coronary syndrome…

…troponin elevation without evidence of ischaemia represents acute myocardial injury rather than MI. Persistent elevation without a significant dynamic change is consistent with chronic myocardial…

…angina caused by disease in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS)…

…major adverse cardiovascular events (MACE), heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and peripheral artery disease (PAD). Figure 1 (below) shows…

…FH are principal settings in which these drugs have received approval. In chronic coronary syndrome, the recommended LDL C objective is: LDL C <1.4…

…Clinical assessment should include functional status and walking capacity, because these may reveal “masked” PAD in patients who do not exert themselves sufficiently to provoke…

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

…In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately from nicotine. Smoking is…

…when marked hormonal changes occur. Hypertension and oestrogen exposure. Emotional or chronic mental stress. Fibromuscular dysplasia (FMD), which may produce arterial wall abnormalities and intramural…

…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…

…or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia. Non ischaemic myocardial injury…

…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…

…regurgitation are aortic dissection , endocarditis and trauma . Chronic aortic regurgitation If aortic regurgitation develops gradually, then the ventricle will adapt to the volume overload. Unfortunately…

…2), obesity, smoking, obstructive sleep apnea and chronic obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT 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…