…lesions causing ischaemia have been treated. Conversely, angiographically satisfactory stenting may leave clinically relevant residual ischaemia, particularly after complex coronary intervention. The clinical importance of…

…completely between cycles — it is the freeze–thaw–freeze cycle that causes cell death, not the cold alone. The temperature at the outer edge of…

…at risk has been described as approximately 75–100%, depending on coronary dominance. Significant left main stenosis is generally defined as a diameter reduction of…

…weeks after infarction. Predisposing features Risk features vary by lesion but include: Older age. Female sex. Hypertension. Absence of an adequate collateral circulation. A first…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…crush technique, stent fracture or collapse Lesion specific angiographic features Residual dissection at a stent margin, impaired flow into or out of the stent, stent…

…stenosis with the pressure that would be available in the absence of that stenosis. The complete physiological formulation considers coronary venous pressure: Distal coronary driving…

…ability is less robust in CABG treated patients, as surgery can bypass complex lesions irrespective of their angiographic complexity. Evolution: SYNTAX Score II To address…

…lesion of atherosclerosis: the fatty streak [5] . Ruptured atherosclerotic lesion with atherotrombosis. Over decades, the lesion progresses from a simple fatty streak to a complex…

…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…

Echocardiography The standard transthoracic echocardiographic examination This chapter presents a sequential series of images that comprise a complete standard echocardiographic examination. The image views are…

…fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such books will realize their shortcomings at their first encounter…

…The ECG shows AV block III (complete heart block). P waves are not related to QRS. PP interval is constant, but independent of RR interval…

…narrow QRS complexes indicate that the block and the ectopic focus (which generates the escape rhythm) are located proximal to the bifurcation of the His…

Cardiology Clinical medicine Definition and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible…

…an occlusion length of at least 20 mm. These characteristics are incorporated into the J CTO score, which estimates the likelihood of successful antegrade guidewire…

…Regardless of which waves are visible, the wave(s) that reflect ventricular depolarization is always referred to as the QRS complex . Naming of the waves…

…where hypovolaemia is likely, but avoid repeated blind boluses in cardiogenic toxic shock D Plasma glucose immediately. Assess the level of consciousness, the pupils, tone…

…disorientation, agitation, drowsiness or a reduced GCS Respiration A respiratory rate of at least 22/min, increased work of breathing, a new oxygen requirement, a…

…necessary ECG skills required for clinical work. You must complete the ECG course in order to obtain your certificate. New ECG test will be added…

…elevations on ECG. NSTE ACS is caused by partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically…

…Elevation Myocardial Infarction) in terms of treatment and interventions. As discussed previously, STEMI is the result of a complete and proximal occlusion in a coronary…

…for a complete diagnosis or for grading. Antihistamines, corticosteroids, inhaled bronchodilators and nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is…

…both are predictable. Indications Inability to protect the airway: reduced level of consciousness, loss of pharyngeal reflexes, vomiting with a risk of aspiration. Inadequate oxygenation…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

…complete in a minority Tachycardia, tachypnoea, cold periphery Almost always Pulsus paradoxus above 10 mmHg A fall in systolic blood pressure during inspiration; one of…

…discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of…

…130 msec in females , along with slurring or notching of the mid QRS in at least two left facing leads [7]. These stricter parameters correlate…

…reducing the dose or stopping therapy. It is divided clinically into: Complete intolerance: inability to tolerate any dose of any statin. Partial intolerance: inability to…

…A complete airway obstruction results in PEA and cardiac arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia is managed according…

…remains uncertain, the cesarean section should be pursued if the fundal height of the uterus reaches or surpasses the level of the umbilicus. The fetus…

…intentionally slow (due to the low concentration of gap junctions in AV nodal cells), which allows for ventricular filling to complete prior to ventricular contraction…

…over half of the cases identified as STEMI by EMS are true positives. Negative Predictive Value (NPV) : The NPV is exceptionally high at 99.7…

…infarction process is more or less completed. Post ischemic T wave inversions emerge at the earliest 4–6 hours after an episode of ischemia/infarction…

…air entry, speech, work of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema…

…time of onset, a late time window, or when thrombectomy can start at the earliest after 6 hours, according to the local protocol MRI of…

…lavage An unprotected or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or suspected oesophageal perforation Gastric lavage…

…mL of lidocaine gel into the urethra. Pinch the meatus closed and wait at least 3–5 minutes — the anaesthetic and lubricating effect of the…

…before starting. A complete medication list including over the counter drugs, herbal remedies and supplements. An assessment of bleeding risk and the risk of falls;…

…Radiation exposure of approximately 1–1.5 mSv with contemporary techniques The total CAC burden should be reported using the Agatston score. A complete report…

…particularly in complex multivessel or left main disease. Clinical presentation and symptoms The clinical presentation of multivessel CAD varies from stable angina or exertional limitation…

…separate chapter discusses Long QT syndrome (LQTS). A complete list of drugs causing QT prolongation can be found here. Corrected QT intervals (QTc) can be…

…This evaluation should include a detailed history, thorough questioning of eyewitnesses, and a complete physical and neurologic examination. Blood pressure and heart rate should be…

…is because it does not ensure complete drainage of the pericardium, and needles or catheters are at risk of bending or damage during chest compressions…

…or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice versa …

…be partially or completely obstructed. Consequently, the myocardium supplied by the occluded artery becomes ischemic. Ultimately this results in myocardial necrosis (death of myocytes) which…

…the T wave in lead aVL will be inverted and in some cases lead I will display a monophasic R wave instead of qR complex…

…Importantly, all P waves are followed by QRS complexes. First degree AV block is rarely of clinical significance and typically does not require intervention. In…

…other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated in patients with severe hypertension, unstable angina…

…consider a complete block located in the atrioventricular node. In such scenarios, cells in the bundle of His (which possess automaticity) will not be reached…

…which at the time was primarily fibrinolysis (Wilner et al.). Their findings revealed that a substantial number of these patients had complete coronary artery occlusions…

…hallmark of LBBB is the prolonged QRS duration. A QRS duration of 120 ms (0.12 s) or more is required to diagnose a complete…

…in patients with STEMI, those with NSTEMI and unstable angina are at considerable risk of developing life threatening ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) and…

…amplitude of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex…

…Echocardiogram: Complete Imaging Protocol). Nevertheless, there are obvious benefits of performing emergency bedside examinations, regardless of image quality. The ultrasound transducer is held at the…

…the ventricles it will spread partly or entirely outside of the conduction system and thus produce a wide QRS complex (QRS duration ≥0.12 s)…

…each time until it is completely refractory and blocks the atrial impulse. This manifests on the ECG with gradual prolongation of the PR interval until…

…or other situations with increased myocardial load. Symptoms are exacerbated by increasing the level of exertion ( i.e increasing the myocardial load), and vice versa …

…The mitochondrial density allows for complete replenishment of ATP within 10 seconds (Fell et al, Houtkooper et al). The majority of ATP produced is utilized…

…The speed at which the images are updated is crucial for producing a high resolution movie. The rate of update is described by the technical…