…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…

…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…

…in arterial insufficiency can cause necrosis. Screening in diabetes of 10 years' duration, or in diabetes with age 50 years. Risk assessment in known coronary…

…nearby arteries to grow new vessels into the ischemic zone. Newly formed vessels, which may originate from other branches of the same coronary artery or…

…sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain…

…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…

…Call the PCI service in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI…

…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…

…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…

…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…

…with lesion anatomy, clinical presentation, bleeding risk, the anticipated need for non cardiac surgery, procedural complexity, and the relative merits of PCI and coronary artery…

…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…

…safe in patients with coronary artery disease since it does not increase heart rate, and reduces myocardial oxygen consumption. Time to onset of action: 5…

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

…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…

…establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These findings determine the urgency and type of intervention…

…patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of those who continue. After acute coronary syndrome…

…of patients who develop shock present with it at hospital admission; approximately 90% deteriorate during hospitalization. Patients who develop shock often have severe multivessel coronary…

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

…with a worse prognosis. VA may occur in the presence of obstructive coronary artery disease (CAD), in non obstructive coronary arteries, or in patients with…

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

…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…

…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…

…independent of ischaemia. Maximal exercise capacity, expressed by exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular…

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

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

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

…a precaution. Dosage of vernakalant Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg. Normal dilution: 4 mg/ml. Recommended…

…a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child…

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

…A duration of 6 months after ACS is generally considered too short for routine use, but it may be considered in selected patients with a…

…in arterial blood flowing through the pulmonary, coronary and cerebral circulation, as well as allowing for gas exchange in the lungs. A large number of…

…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…

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

…angina, angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), post ACS or post revascularization states, and heart failure of ischaemic or cardiometabolic origin…

…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…

…ROSC) : Return of mechanical cardiac function resulting in circulation with pulse. Coronary perfusion pressure (CPP) : The pressure that drives blood flow through the coronary arteries…

…Other mechanisms capable of obstructing coronary arteries include embolism, dissection, coronary arteritis associated with systemic vasculitis, extrinsic compression, myocardial bridging and radiation induced coronary disease…

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

…Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS)…

…particularly when the clinical presentation is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads…

…The reader should already be familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and…

…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…

…of all cause death and cardiovascular death, compared to patients without such disturbances, including those with RBBB and LBBB. This was reported in the Coronary…

…in coronary and renal perfusion. • Dose dependent elevation of intracranial pressure (ICP) and reduction in cerebral blood flow. Caution • Used cautiously in patients with high…

…associated with lower cardiovascular and all cause mortality and with reduced incidence or burden of hypertension, type 2 diabetes, coronary disease, stroke, peripheral arterial disease…

…select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5…

…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…

…that the test failed to identify 27.8% of individuals with poor neurological recovery. The specificity of absent pupillary reflex for predicting a poor neurological…

…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): [ …

…with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy , can be caused by any tachyarrhythmia leading to prolonged periods of…

…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…

…Elderly age ( 65), and Drugs/alcohol. A crucial clinical pitfall is the misapplication of this score. A high HAS BLED score (≥3) indicates a need…

…heart disease. Endocarditis (common in intravenous drug addicts). Myxomatous degeneration. Rheumatic heart disease. Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension…

…because cardiac output diminishes in parallel with increasing myocardial load (and hence oxygen demand). The most common causes of acute aortic regurgitation are aortic dissection…

…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…

…the reason for which remains elusive. Gene mutations can be confirmed in roughly 60% of individuals with ARVC. Mutations in the desmosomal gene PKP2 is…

…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…

…Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The reference drug, with the greatest experience eGFR 30–60…