…apnea primarily reflect the extent of weight loss, the reductions in hard cardiovascular outcomes (MI, stroke) and metabolic liver disease involve significant weight independent pathways…

…absolute contraindications, but be cautious and consider referral in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the…

…related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint…

…and all bites on the hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis…

…Contraindications Absolute: Infection, a wound, scar tissue, a tattoo or skin disease at the injection site. Known hypersensitivity to the preparation. Intramuscular injection in marked…

…Relevant predispositions, such as connective tissue disease. No single pain descriptor is diagnostic. The severity of pain also has limited discriminatory value. Features suggesting myocardial…

…discomfort) Chest pain during exercise is one of the strongest predictors of coronary artery disease. The severity of the pain may be graded from 0…

…to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can otherwise be hard to see, particularly when the patient…

…cutaneous vasculitis, lymphoma or granulomatous disease. A treatment resistant rash without a definite diagnosis. Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma…

…189 mg/dL, 10 year risk of a first hard ASCVD event—fatal or nonfatal myocardial infarction or stroke—should be estimated. The risk categories…

…patients with cardiovascular disease. The highest mortality rate was observed in patients with elevated TnT levels who had underlying cardiovascular disease, of which 69.4…

…of significant LMCA disease, including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy of…

…Figure 1. Flowchart showing the natural course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG…

…excess ischaemic heart disease risk associated with heavy smoking. Consequently, reducing the number of cigarettes smoked does not produce a proportional reduction in cardiovascular harm…

…authors reported that 60–70% of all cases had no myocardial disease or acute coronary syndrome. Indeed, the majority of the victims were healthy and…

…age related reduction in cardiovascular reserve, and the increasing burden of comorbid disease. Heart failure with preserved ejection fraction becomes particularly common among the very…

…Suspected secondary adrenal insufficiency in pituitary disease, after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment…

…in Complex Coronary Artery Disease The SYNTAX Score is a semi quantitative scoring system designed to assess the complexity of coronary artery disease (CAD) and…

…with asthma/chronic obstructive pulmonary disease (COPD). Dyspnea has been reported in patients treated with ticagrelor. Patients with a history of ischemic stroke can be…

…sporadic, age related disease characterized by a normal TTR genetic sequence [9, 19]. It is currently considered the most frequent form of CA worldwide [15]…

…balancing estimating the risks of bleeding. Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or renal disease (1 point…

…mitral valve disease is a common cause ( Figure 25, P mitrale ). If the atria are depolarized by impulses generated by cells outside of the sinoatrial…

…risk of cerebrovascular complications. Seizures in a patient with preeclampsia indicate eclampsia. Postpartum disease is clinically important. Hypertension is most frequent in women who had…

…more common in individuals with structural and ischemic heart disease. Assessment of ischemia on ECG is difficult in the presence of left bundle branch block…

…to determine whether the transient loss of consciousness was due to syncope, identify the cause, and assess the risk for future episodes and serious harm…

…a non significant increase in cerebral haemorrhage. Bleeding outcomes The principal harm of aspirin in primary prevention is bleeding, which may occur relatively soon after…

…ventricular rate (beta blockers being the mainstay of this therapy). Rate control does not affect the rhythm per se . Rhythm control, on the other hand…

…variation as part of fluid management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the…

…trial participants who were described as frail generally had no more than mild frailty, limiting the applicability of trial findings to people with substantial functional…

…background therapies 17%–25% In patients with atherosclerotic vascular disease or familial hypercholesterolaemia, addition of bempedoic acid to statin therapy reduced LDL C by approximately…

…Causes Tamponade shares the causes of pericardial effusion. Important clinical associations include: Idiopathic or viral pericarditis Malignant pericardial disease Tuberculosis Purulent or bacterial pericarditis Trauma…

…prompt follow up Main risk of management Overtreatment may impair autoregulation and cause ischemia Acute rapid reduction may cause harm without prognostic benefit Clinical Presentation…

…Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be…

…diagnosed with atrial fibrillation in their 60s. The father had repeated episodes of ventricular tachycardia and ventricular fibrillation. Several relatives presented with identical ECG changes…

…old, healthy and diseased individuals. For example, roughly 90% of males aged <30 years display concave ST segment elevations in leads V2–V3. This explains…

…For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery disease (i.e CCS). The new…

…updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery disease (i.e. CCS). The…

…reduce stroke risk, and detection may lead to inappropriate anxiety and invasive procedures. Symptomatic disease Symptoms of carotid disease include: TIA; ischaemic stroke; focal neurological…

…presence of arrhythmogenic substrates. A substrate is defined as a physiological or anatomical factor that can trigger or sustain arrhythmias, such as necrotic tissue after…

…coronary blood flow at rest: 0.6 to 1.3 mL/min/g of myocardial tissue During hyperemia (maximum stress): Approximately 3.58 ± 1.14…

Cardiology Nephrology Definition and pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…a chronic, relapsing and biologically complex disease characterized by excessive accumulation of adipose tissue. It is an important cause of cardiovascular disease (CVD), cardiovascular risk…

…on lesion location, severity, length, the presence of multilevel disease and collateral circulation. Flow limitation may be clinically silent, manifest as exertional symptoms, or progress…

…flow in milliliters per minute per gram of tissue (mL/min/g). This technique excels in detecting balanced ischemia. Such ischemia, seen in multivessel disease…

…of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease…

…cardiovascular disease. It has been the number one killer in Western and high income countries for more than half a century, causing approximately 20% of…

…cardiomyopathies and channelopathies. Nevertheless, apparently sporadic disease may result from: Incomplete penetrance of a variant inherited from a parent. A de novo variant. Less commonly…

…most persuasive when the initial probability is high enough that the result meaningfully increases the likelihood of disease and can justify further investigation or treatment…

…and cardiac catheterization. Principles of management of congenital heart disease and GUCH Complex malformations often require intervention (surgical or catheter based intervention). In addition to…

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

…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…

…explain the marked differences in characteristics and outcomes across the data sources for out of hospital cardiac arrest (OHCA) and in hospital cardiac arrest (IHCA…

…mean transit time — isolates microvascular resistance. Only indices that detect microvascular disease as an independent cause of ischemia, including with non obstructive epicardial arteries (ANOCA…

…stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine as…

…atherothrombosis. It is usually precipitated by disruption of an atherosclerotic plaque through rupture or erosion. The relative contributions of plaque disease and thrombus vary considerably…

…the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material…

…cardiac disease Oxygen targets Patient Initial target saturation : : Known COPD or another clear risk of hypercapnic respiratory failure 88 to 92 percent No risk of…