…obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries (Felker et al). Left ventricular dilation entails a markedly elevated risk of…

…muscle rupture. The risk of rupture is greater for the posteromedial papillary muscle, which only receives blood supply from one coronary artery (Coronary arteries). Chronic…

…associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have…

…the progressive loss of myocytes following the occlusion of a coronary artery. The size, location, and duration of the occlusion are of prime importance but…

…formerly termed Prinzmetal or variant angina, is myocardial ischaemia caused by transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible…

…is prevention of thromboembolic complications, particularly stroke. In untreated AF, stroke risk is increased approximately five fold, and AF is associated with roughly one in…

…after uncomplicated acute coronary syndrome when LVEF is 40% is not definitive. Observational studies have yielded conflicting results, and the appropriate duration of therapy in…

…and symmetric. Their duration is short; they typically disappear within minutes after a total occlusion in a coronary artery occurs (then of course, the ST…

…than does ventricular rhythm; idioventricular rhythm is primarily seen after reperfusion in an occluded coronary artery. It also occurs as side effect of drugs, hypoxia…

…LCX or the right coronary artery (RCA). For details, refer to chapter The Coronary Arteries. Mitral valve disease A wide range of conditions may cause…

…and prognosis of most cardiac diseases, including coronary artery disease, heart failure, arrhythmias, structural heart disease, etc. Over the years, a large number of parameters…

…and the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty was initially…

…cannot be performed within 120 minutes Fibrinolysis within 10 minutes of the diagnosis, if symptom duration is under 12 hours and there is no contraindication…

…with rapid onset of action. Labetalol has less antihypertensive efficacy as compared with nicardipine. Labetalol is safe in patients with coronary artery disease since it…

…ischaemia in either of two settings: Obstructive coronary artery disease (CAD) that cannot be controlled despite escalation of antianginal medical therapy, coronary artery bypass grafting…

…to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with…

…cause necrosis. Screening in diabetes of 10 years' duration, or in diabetes with age 50 years. Risk assessment in known coronary or cerebrovascular disease. Follow…

…ischaemic electrocardiographic changes during rapid AF. ST segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material…

…smoking After acute coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to…

…zone. Coronary Occlusion and Myocardial Injury STEMI generally results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery…

…satisfactory quality of life if the circulation is temporarily supported by ECMO. Furthermore, ECMO might be required to facilitate procedures such as percutaneous coronary intervention…

…occlusion reflow cycle repeatedly to the circumflex artery before a 60 minute occlusion of the left anterior descending coronary artery (LAD) would reduce the infarct…

…delivered bolus to achieve sufficiently high concentrations at its clinical site of action—the coronary artery perfusing the AV node—before the drug is eliminated…

…has become less prominent as a primary diagnostic test for obstructive coronary artery disease (CAD), because coronary computed tomography angiography (CCTA) and functional imaging have…

…in persons who are otherwise healthy. The majority of those with LAFB, however, have significant heart disease. Myocardial infarction, coronary artery disease, left ventricular hypertrophy…

…contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary and…

…contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary and…

…contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary and…

…days duration. Vernakalant does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting appropriate for cardioversion. Administration of…

…based tool if one is available. This page is a rapid guide, not a treatment review. For a fuller account of two of the commonest…

…reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect, the dosing…

…is also indicated. Possible shortening of DAPT A duration of 6 months after ACS is generally considered too short for routine use, but it may…

…VT]). The VF waveform is initially coarse ( i.e fibrillatory waves have large amplitudes) but as the duration of VF is prolonged, the amplitude gradually…

…the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction). 1 Initial diagnosis of STEMI…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

…or another form of physiological stress, but it may also occur at rest or remain clinically silent. The underlying coronary disease may be obstructive or…

…a few hours after the onset of myocardial infarction. This is utilized in clinical practice by detecting troponins in patients with suspected acute coronary syndromes…

…High aortic pressure and low right atrial pressure favor coronary blood flow. A CPP of approximately ≥ 15 mmHg is required to induce spontaneous electrical activity…

…Angina occurring after a recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms…

…combination with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS), including: Unstable angina (UA…

…For chronic coronary syndromes treated with elective PCI, the standard DAPT duration is six months, usually with aspirin and clopidogrel. Shortening therapy to one to…

…can shorten the time to diagnosis and facilitate triage of patients with suspected ST segment elevation myocardial infarction to a percutaneous coronary intervention capable hospital…

…discussion of the electrophysiological principles, ECG changes and clinical implications is provided. The reader should already be familiar with the classification of acute coronary syndromes…

…autosomal dominant mechanisms. Complex or multifactorial genetic architecture. The inheritance pattern affects the appropriate scope and duration of family surveillance. For example, heterozygous carriers in…

…delay is defined as “a QRS duration greater than 110 ms in adults, greater than 90 ms in children 8 to 16 years of age…

…avoid cyanide toxicity. • Dose dependent reduction in coronary and renal perfusion. • Dose dependent elevation of intracranial pressure (ICP) and reduction in cerebral blood flow. Caution …

…treatment. It is associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of hypertension, type 2 diabetes, coronary disease, stroke…

…anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other…

…displacement, annular dilatation, or both; progressive ventricular remodeling may also occur in primary valvular disease. Increasing severity of mitral regurgitation is associated with worse outcomes…

…seconds of cardiac arrest and light reactivity is lost when cerebral blood flow ceases. In other words, during prolonged cardiac arrest without effective perfusion, one…

…help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key Formulas BSA Calculation (Mosteller formula): [ …

…ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia) can also cause this cardiomyopathy. The duration of the tachyarrhythmia appears to be a stronger risk factor…

…Tetralogy of Fallot Marfan syndrome Takayasu's arteritis Iatrogenic (e.g complication of catheterization) Congenital dysplasia/aplasia of the pulmonary valve Idiopathic pulmonary artery dilation…

…and the arrhythmia itself. This remodeling manifests as interstitial fibrosis, atrial dilation, and endocardial denudation, which collectively promote local inflammation and create a highly prothrombotic…

…back to the right atrium and venous system, resulting in dilation of vena cava inferior ( 2.1 cm). Severe tricuspid regurgitation may lead to systolic…

…Table 1. Causes of aortic regurgitation Bicuspid aortic valve Rheumatic heart disease Calcified aortic valves Idiopathic aortic dilatation (aneurysm) Hypertension Aortic dissection, proximal Marfan syndrome…

…ventricle, which is counteracted by dilatation of the ventricle. Dilatation of the right ventricle results in reduced intraventricular pressure and thereby reduced myoardial load. Pulmonary…

…arrest; the disease is one of the most common causes of sudden cardiac arrest among adolescents and athletes (hypertrophic cardiomyopathy is the most common cause)…

…pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily. Principles of management Medical therapies do not alter disease progression. Diuretics…

…and assess the effect before the next one is given. The serious incidents almost always arise when the principle of titration is abandoned — when a…