ECG Exercise stress test Evaluation of the exercise stress test (exercise ECG) The ECG reaction has always been a central component of the exercise stress…

ECG Evaluation and management of stable coronary artery disease Chronic coronary syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

…may not be predictably exertional or relieved by rest or nitroglycerine. Symptoms should therefore be described in detail, followed by objective evaluation for obstructive disease,

…for the evaluation of diastolic function: The ratio between E wave and A wave ( E/A ratio ). The E/A ratio is derived by measuring…

…ejection fraction. Since ejection fraction is affected by preload and afterload, it is necessary to consider loading conditions when evaluating the measured ejection fraction. Ideally…

…blood (typically <5 ng/L). This is explained by the low turnover of cardiac muscle cells ( Parmacek et al ). Cardiac troponin levels rise within a…

…initial warm up period (at a low workload), followed by a successive (graded) increase in workload. The increase in workload occurs with predefined time intervals…

Cardiology Evaluation and management of stable coronary artery disease Chronic coronary syndromes (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

Echocardiography Cardiomyopathy caused by tachycardia A prolonged tachycardia can cause cardiomyopathy with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy…

CPR Basic life support (BLS) can be provided by anyone, including laypeople. As shown in Table 1, BLS is an exceptionally effective treatment, with a…

Emergency medicine Lathundar Differential Diagnosis of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome…

Cardiology Pharmacology & dosing Definition and Pathophysiology Digoxin, a cardiac glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart…

Cardiology Endocrinology & metabolism Definition and pathophysiology Hypertriglyceridaemia (HTG) is defined by an increased concentration of circulating triglycerides. Both fasting and non fasting measurements provide prognostic…

…evaluation for coronary artery disease, etc .) are warranted. Management of AV blocks aims to restore atrioventricular conduction either pharmacologically or by means of artificial pacemakers…

…of cardiac arrest, focused echocardiography entails a swift evaluation of ventricular contractions and the status of the pericardium by an experienced clinician. The examination is…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

…chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms in the emergency department, as well as in primary…

…also allow for the evaluation of microvascular function. For a radiotracer to be suitable for quantifying myocardial blood flow, its uptake by the myocardium must…

…of systemic arterial pressure. This renoprotective effect involves a reduction in intraglomerular hyperfiltration and hypertension by disproportionately reducing glomerular efferent arteriolar vasoconstriction. Clinical Presentation and…

…imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT interval on the surface electrocardiogram (ECG…

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…

…conditions Definition and pathophysiology Familial hypercholesterolaemia (FH) is an inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life…

…rather than pacing or defibrillation systems, but their stored data may also be affected by perioperative electromagnetic interference (EMI). The principal perioperative concern is interaction…

…Refractory angina should be distinguished from symptoms caused or amplified by potentially reversible precipitating conditions. Evaluation should seek factors that increase myocardial oxygen demand or…

…ischemia and infarction Definition and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion…

…than VA accompanied by severe fixed lesions. Nevertheless, patients who develop serious arrhythmias during spontaneous episodes represent a higher risk subgroup. Evaluation and physical examination…

…Image acquisition and evaluation Stress Imaging : Initially performed using exercise or pharmacologic agents to elevate myocardial oxygen demand (or simulate increased demand using vasodilatory agents…

…examination The use of echocardiography has increased dramatically during the past few decades. Advances in echocardiography have been propelled by breakthroughs in engineering, software development…

…VA score for stroke risk assessment in atrial fibrillation patients. By excluding the sex parameter, the CHA₂DS₂ VA score addresses concerns about overestimating stroke risk…

…Despite their proven morbidity and mortality benefits, their use is limited by specific adverse effects. Most of these adverse events are related to the suppression…

…5]. Unexplained LV hypertrophy (LVH) or heart failure with preserved ejection fraction (HFpEF) at hospitalization warrants evaluation [5]. Heightened awareness is essential in patients with…

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

…be required. Evaluation and physical examination Assessment begins by establishing that the patient has a clinical heart failure syndrome and by determining the LVEF. Physical…

…compartments. Heart failure is defined physiologically by the inability of the heart to provide blood flow appropriate to tissue requirements unless filling pressures are elevated…

…and other individuals who may carry an inherited predisposition to cardiovascular disease. It combines a structured family history, clinical evaluation, cardiac investigations, genetic counselling and…

…myocardial injury, demonstrated by a rising and/or falling troponin pattern with at least one value above the assay specific 99th percentile upper reference limit;…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…or chest pain equivalent symptoms. The ECG assessment remains necessary even when symptoms have improved by the time of medical evaluation, because transient or evolving…

…increased, relatively autonomous from angiotensin II and plasma potassium, and resistant to suppression by sodium loading. It is the most common form of secondary hypertension…

…Bundle Branch Block, defined by an rSR' pattern in lead V1 and a qRS pattern in lead V6 with QRS duration <120 ms, is listed…

…Renal function biomarkers are essential in the evaluation and ongoing management of patients on sotalol. Because the drug is excreted unchanged primarily by the kidneys…

…persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes. The central therapeutic objective is…

…attaining an upright posture or following painful stimuli and emotional stress. By the age of 60, vasovagal syncope is reported to occur in over 40%…

…refer to Evaluation of coronary artery disease and angina pectoris). Yet, exercise stress testing provides a fundamental parameter that cannot be obtained by other imaging…

…is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and…

…Acute Coronary Syndromes Treatment with Ticagrelor should start with a loading dose of 180 mg (two 90 mg tablets) followed by 90 mg twice daily…

…AAA growth is variable. Aneurysms smaller than 4 cm may enlarge by approximately 1.5–2 mm per year, whereas larger aneurysms generally expand more…

…Evaluation and physical examination ALI requires immediate clinical assessment by a vascular specialist or urgent transfer to a facility with vascular expertise. The initial evaluation…

…detailed prognostic evaluation using two complementary domains: Indicators of acute PE severity , including clinical findings, RV dysfunction on imaging, and myocardial injury shown by laboratory…

…Long term prognosis is influenced particularly by: Resting left ventricular function The amount of residual viable myocardium exposed to ischaemic risk Susceptibility to serious ventricular…

…particularly after complex coronary intervention. The clinical importance of residual disease is also influenced by anatomic complexity and comorbidity, which themselves may contribute to progression…

…Within the ARC HBR framework, HBR is defined by the presence of at least one major criterion or two minor criteria. The source material does…

…ultimately prevailed. The need for a standardized global definition led to early efforts by the World Health Organization in the mid 20th century, relying primarily…

…perforation, and abrupt closure. The clinical consequences depend heavily on the amount of viable myocardium supplied by the affected artery. Large areas of jeopardized myocardium…

…effects on alpha receptors. Stimulation of beta receptors increases inotropy and chronotropy by elevating intracellular cyclic adenosine monophosphate (cAMP) and calcium, as well as through…

…including subacute rupture. Evaluation and physical examination The diagnosis of pericarditis is clinical and is supported by additional findings. A definite diagnosis requires a compatible…

…is accompanied by disproportionate systemic venous congestion, hypotension, or evidence of low output despite relatively limited elevation of left sided filling pressure. Evaluation and physical…

…myocardial territory and limitation of infarct size. The extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from…

… consequently, inducible regional systolic wall thickening abnormalities may develop in the myocardial territory supplied by the narrowed artery. The principal diagnostic endpoint is a new…