…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…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…

…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…

…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…

…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…

…both clinical risk and the feasibility of complete revascularisation. The clinical evaluation includes: Symptom burden and functional limitation Evidence of heart failure Haemodynamic stability Diabetes…

…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…

…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…

…higher after treatment of ST segment elevation myocardial infarction (STEMI) and following complex PCI. Stent thrombosis remains multifactorial, reflecting interactions between patient related, lesion related…

…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…

…Dr. Araz Rawshani, a leading cardiovascular researcher at the University of Gothenburg and Sahlgrenska University Hospital, Sweden, is the force behind the comprehensive online course…

…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…

…diagnostic angiography. Collateral vessels may maintain distal perfusion and permit visualization of the vessel beyond the occlusion when the patent donor artery is injected. The…

…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…

…Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must not wait for complete diagnostic certainty. Sepsis is defined as…

…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…

…a widened QRS complex and secondary ST T wave abnormalities [7]. Diagnostic Criteria The diagnostic requirements for LBBB vary by the stringency of the criteria…

…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…

…greater extent of ischemia present in STEMI. In STEMI, a complete coronary artery occlusion leads to transmural ischemia, affecting a larger portion of the myocardium…

…perfusion on the microvascular level. This is presumably explained by distal microembolization and dysfunctional microcirculation. Indeed, studies show that 15–35% of patients with STE…

…before starting treatment. Clinical assessment History that affects the level of risk Ask briefly and to the point: When did the deterioration begin, suddenly or…

…hypoglycaemia Time of onset Document the exact clock time of symptom onset or the time last known to be well NIHSS A complete score by…

…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…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…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…

…uncertain relation to symptoms Tachyarrhythmias with uncontrolled ventricular rates Acquired advanced or complete heart block Hypertrophic obstructive cardiomyopathy with severe resting gradient Recent stroke or…

…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…

…substantial number of these patients had complete coronary artery occlusions, and outcomes improved when they were treated as acute STEMI cases. Management of left bundle…

…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…

…is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to…

…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…

…in apical windows (refer to Standard Transthoracic Echocardiogram: Complete Imaging Protocol). Nevertheless, there are obvious benefits of performing emergency bedside examinations, regardless of image quality…

…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…

…ms). Increasing the number of ultrasound lines or image depth will reduce the frame rate since more time is required to complete each frame. Thus…