…remain stable for prolonged periods, but chronic coronary disease can progress or destabilize abruptly, leading to an acute coronary syndrome (ACS). Clinical manifestations may therefore…

…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…

…between the cardiac and renal axes may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is particularly associated with elevated central…

…presentation and symptoms A CTO may be asymptomatic and identified during angiography performed for another indication. When clinically significant, it may present with chronic angina…

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…

…and thrombosis interact to produce focal arterial lesions. Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple…

…tissue promotes: Chronic, low grade systemic inflammation Insulin resistance Abnormal adipokine signalling Endothelial dysfunction Dyslipidaemia A prothrombotic state Albuminuria and declining estimated glomerular filtration rate…

…syndrome of chronic coronary syndromes (CCS) . This syndrome includes six clinical manifestations of coronary artery disease (discussed below). Moreover, prognostication, selection of diagnostic tests, and…

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

…artery disease Chronic coronary syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as…

…with CAD without previous MI and with normal LVEF is uncertain. Similarly, evidence for routine long term beta blocker therapy after uncomplicated acute coronary syndrome…

…is optional and may be selected according to clinical judgement. Low to moderate probability: greater than 5% to 50% in the chronic coronary syndrome pathway…

…hepatic complications, renal impairment, and cerebrovascular accidents. HELLP syndrome is associated with substantial morbidity and mortality. Pregnancy related hypertension also influences obstetric management. In late…

…a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options. It is defined by symptoms lasting more than 3 months and…

…reveals calcification of the pericardium. With MRI or CT, the thickness of the pericardium can be measured and in most cases, a thickening is noted…

…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…

…Chronic At least 48 hours Unknown Treated as chronic with respect to the correction limits The brain adapts to prolonged hypotonicity by extruding electrolytes and…

…Cystatin C based eGFR With an atypical muscle mass, or to confirm a creatinine based value The mean of creatinine and cystatin C The most…

…akin to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough and a tickle or sensitivity in the throat, and is…

…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…

…processes: Recurrent or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse…

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

…acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction…

…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…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

…reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown…

…above 6.0 kPa despite optimal medical treatment with bronchodilators, steroids and controlled oxygen. Acute on chronic hypercapnic failure in obesity hypoventilation and neuromuscular disease…

…single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period…

…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…

…leg ulcers. Chronic venous oedema, lipodermatosclerosis, stasis dermatitis. Prevention of recurrence after a healed venous ulcer. After deep vein thrombosis with post thrombotic syndrome. Differential…

…up to 10 mL with sodium chloride) before intravenous titration. Half of all opioid dosing errors arise at the dilution step, and an undiluted syringe…

…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…

…resistance, and never catheterising urethrally when urethral injury is suspected. Indications Acute urinary retention. Chronic urinary retention with renal impairment or a large residual volume…

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

…like the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation may offer improved accuracy. Additionally, considering factors such as patient demographics, muscle mass, and clinical…

…chronic Bradycardia (second line alternative) Medium dose : 3.0 10.0 μg/kg/min. + ++++ + +++++ Medium dose dopamine activates β1, releases norepinephrine and thus increases…

…in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables, including the number of lesions, their location, and specific characteristics…

…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…

…and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with…

…chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI is associated with…

…lipid, or BP disorders Pregnancy Established ASCVD includes previous acute coronary syndrome, chronic coronary syndromes, coronary revascularization, stroke, transient ischaemic attack, and peripheral arterial disease…

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

…The chronic total occlusion is an important predictor of incomplete anatomical revascularization with PCI. PCI of chronic total occlusion lesions may improve angina and quality…

…AKI is negligible or very low. Risk rises substantially with chronic kidney disease, particularly diabetic kidney disease and advanced CKD. The clinical course is often…

…infarction and stent thrombosis. Bleeding risk, particularly major or life threatening bleeding. The clinical presentation, whether ACS or chronic coronary syndrome (CCS). Whether and how…

…any statin regimen. The treatment sequence for patients with chronic coronary syndrome is: Lifestyle intervention and a maximally tolerated high intensity statin. Add ezetimibe if…

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

…segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), myocardial infarction, and repeat target lesion revascularization…

…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…

…In chronic coronary syndrome, the recommended LDL C objective is: LDL C <1.4 mmol/L (<55 mg/dL) , and A reduction of at least…

…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…

…with contemporary reperfusion, particularly primary percutaneous coronary intervention (PCI). In a large epidemiological analysis, mechanical complications occurred in approximately 0.27% of STEMI cases and…

…associated with reductions in reinfarction of approximately 30–40% and in death of approximately 35–45%. In chronic coronary syndrome, cessation has been associated with…

…or chronic mental stress. Fibromuscular dysplasia (FMD), which may produce arterial wall abnormalities and intramural haematomas. Inherited connective tissue disorders, including Marfan syndrome and Ehlers…

…and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with…

…numerous cardiac and systemic disorders, including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic kidney disease Cardiomyopathy Stroke or subarachnoid haemorrhage Takotsubo syndrome Pulmonary…

…recommended in patients with CVD. The clinical consequences of diabetes may present through any major cardiovascular phenotype: CAD, including chronic coronary syndromes and acute coronary…

…parallel with increasing myocardial load (and hence oxygen demand). The most common causes of acute aortic regurgitation are aortic dissection , endocarditis and trauma . Chronic aortic…

…developing atrial fibrillation: atrial flutter, AVNRT and AVRT (pre excitation, WPW syndrome) being the most common. Atrial fibrillation with onset during hyperthyroidism (thyrotoxicosis), alcohol overdose…

…atrial fibrillation. Acute and paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter…