…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…

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

…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…

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…

…dyslipidaemia and systemic inflammation. It is also associated with respiratory disorders, notably obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome, which further increase cardiovascular burden…

…stable coronary artery disease is part of the broader syndrome of chronic coronary syndromes (CCS) . This syndrome includes six clinical manifestations of coronary artery disease…

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…

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

…be selected according to clinical judgement. Low to moderate probability: greater than 5% to 50% in the chronic coronary syndrome pathway. Coronary CT angiography (CCTA…

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

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…

…The ECG can show low voltage and nonspecific ST T changes. Conventional thoracic X ray sometimes reveals calcification of the pericardium. With MRI or CT…

…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…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…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…

…endings and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough…

…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…

…of repeated ischemic episodes or chronic reductions in perfusion. The amount and distribution of both viable and nonviable myocardium, together with coronary anatomy and the…

…therapy is a central component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS), peripheral artery disease (PAD)…

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

…cause. PAH reflects marked pulmonary arterial remodelling, with fibroproliferative, plexogenic, and sometimes thrombotic changes that may result in near total obliteration of affected vessels. Genetic…

…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…

…workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A…

…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…

…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…

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

…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…

…for pain). An opioid is rarely the right choice in nociplastic or neuropathic pain, in chronic non cancer pain, or in headache. A failure to…

…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…

…with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity reactions, such as asthma attacks, angioedema, or urticaria with…

…critical, especially in individuals with near normal kidney function, alternative equations like the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation may offer improved accuracy…

…ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is…

…standardized method to evaluate the anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables…

…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…

…pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms…

…treatment with one antiplatelet drug constitutes single antiplatelet therapy (SAPT). The benefit of antiplatelet therapy must always be balanced against bleeding. This balance changes according…

…abnormal single risk factors or genetic, rare lipid, or BP disorders Pregnancy Established ASCVD includes previous acute coronary syndrome, chronic coronary syndromes, coronary revascularization, stroke…

…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…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease…

…major or life threatening bleeding. The clinical presentation, whether ACS or chronic coronary syndrome (CCS). Whether and how PCI was performed. The need for non…

…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…

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

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

…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)…

…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…

…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…

…tear commonly develops at the interface between infarcted and viable myocardium. The incidence has fallen substantially with contemporary reperfusion, particularly primary percutaneous coronary intervention (PCI)…

…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…

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

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

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

…chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with…

…Chronic aortic regurgitation leads to dilatation and hypertrophy of the left ventricle. Cardiac remodeling Ventricular dilatation and hypertrophy lead to myocardial remodeling and neurohormonal changes…

…apnea and chronic obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and AVRT (pre excitation, WPW syndrome)…

…paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter is not capable of…