…Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and bleeding. The source material does not specify a symptom based surveillance protocol…

…resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with an ACE inhibitor or ARNI, a beta blocker and a mineralocorticoid receptor…

…individualized within the applicable guideline framework. Combination therapy is based on the complementary mechanisms of drugs from different classes. By acting on more than one…

…an important contrast. Patients with manifest clinical disease are at high risk of progression and generally require all appropriate evidence based measures, including drug treatment…

…Provide the interpretation based on the score var interpretation = ""; if (score == 0) { interpretation = "Low risk (0%) for stroke; consider no antithrombotic therapy."…

…absent or nonspecific Treatment setting Usually hospital based, often ICU Usually outpatient Initial treatment Carefully titrated intravenous therapy when indicated Oral treatment and prompt follow…

…without acute elevations in cardiac troponin concentrations. Based on the presenting electrocardiogram (ECG) and the presence of troponin elevation, ACS are classified into unstable angina…

…for drugs that aggravate or even cause the bradycardia; in such scenarios, it is generally considered to be evidence based to implement an artificial p

…trial demonstrated the safety and efficacy of an approach based on starting and titrating oral medical therapy for heart failure within 2 days before anticipated…

…are available. Further diagnostic imaging solely because calcified plaque is present in an asymptomatic individual is not supported by the available evidence described here. Systematic…

…observed during office based assessments may coexist with asymptomatic episodes. Consequently, the absence of AF during intermittent monitoring is not sufficient evidence that thromboembolic risk…

…For patients on beta blocker therapy, consider administering 1 2 mg of glucagon intravenously. Currently, there is insufficient evidence to support the use of steroids…

…understanding of differential diagnoses, therapeutic strategies, and evidence based interventions. Many tachyarrhythmias carry a potential risk of serious morbidity or mortality, underscoring the need for…

…By excluding the sex parameter, the CHA₂DS₂ VA score addresses concerns about overestimating stroke risk in women based solely on gender. This aims to prevent…

…Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after selective intracoronary contrast injection under…

…cognitive impairment, and reduced physiologic reserve may dominate clinical outcomes and limit tolerance of otherwise evidence based interventions. Hypertension and vascular disease Hypertension is the…

…Dr Rob Mac Sweeney's superb website which is a must for anyone interested in critical care medicine. Content is evidence based, comprehensive and qualitative…

…tests, and versatile study tools. From basic cardiac physiology to the nuanced strategies of evidence based management, this book and course have been meticulously crafted…

…the European Society for Cardiology (ESC). A large body of evidence, based on randomized controlled clinical trials, supports the concepts and recommendations presented in this…

…lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide…

…device based management strategy (implantable cardioverter defibrillators) to one that incorporates pharmacological and interventional (substrate ablation) therapies [5] . This review synthesizes the current evidence base…

…underlying evidence for many of the recommendations is based on few randomized trials and the evidence is often conflicting. Many recommendations are therefore based on…

…suspected coronary artery disease (i.e CCS). The new guidelines are based on data derived from studies conducted mainly in North America and Europe. Moreover…

…while a distinct evidence base has emerged for coronary microvascular and vasospastic disease using coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR…

…benefits are uncertain. Myocardial perfusion imaging is based on the principle that myocardial blood flow demonstrates marked differences between rest and stress conditions, particularly in…

…disease (i.e. CCS). The new guidelines are based on data derived from studies conducted mainly in North America and Europe. Moreover, the guideline committee…

…are introduced, although the effect on 24 hour mortality is uncertain and the evidence for non traumatic bleeding is weaker [2,3,4]. Do the…

…impaired autonomic compensation limits tolerability. Evidence Base and Its Limitations Few adults aged 85 years or older have been included in randomized controlled trials. Moreover…

…Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in…

…pandemic. Indeed, a growing body of evidence suggests that heart failure is now the most frequent complication of diabetes ( Shah et al, McMurray et al )…

…pandemic. Indeed, a growing body of evidence suggests that heart failure is now the most frequent complication of diabetes ( Shah et al, McMurray et al )…

…e.g. trauma unit). Careful and evidence based planning at the societal level (e.g. CPR education programs) and local level (e.g. EMS protocols…

…establishing a diagnosis of inappropriate sinus tachycardia. Although there are no evidence based treatments for inappropriate sinus tachycardia, patients frequently benefit from obtaining a diagnosis…

…more difficult, which explains why individuals with bundle branch blocks are treated sub optimally (in terms of evidence based medications and use of PCI), as…

…must be coupled with clinical evidence of acute myocardial ischaemia. The Fourth Universal Definition classifies MI into five distinct subtypes based on pathophysiology and clinical…

…contamination, not poor suture technique — and the commonest cause of permanent loss of function is a tendon injury that was sutured over without being found…

…cardiac arrest, as evidenced by the fact that only 0.5% of all hangings exhibit VF on the initial ECG recording ( Kitamura et al, Deasy…

…in the inferior wall. This finding is referred to as inferior wall motion abnormality and it may evidence of myocardial infarction, which would have implications…

…status, the concentration, the dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department…

…ECG changes in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). Note that ventricular hypertrophy is primarily evident in the chest leads (V1, V2…

…segment depression in the inverted lead aVR). A notch is evident in the ascending part of the ST segment. A male patient (Figure 1) presented…

…perfusion differences. Perfusion assessment The assessment of myocardial regions in myocardial perfusion imaging (MPI) is based on principles similar to those used in echocardiography. The…

…addition of bempedoic acid to statin therapy reduced LDL C by approximately 16.5%; the reduction in a subgroup with diabetes was approximately 19.1%…

…clinically evident restenosis, manifested by recurrent angina attributable to the treated segment, occurred in 10–15% during the first year. The dominant mechanism was excessive…

ECG Myocardial ischemia and infarction Pathological Q waves are evidence of myocardial infarction Myocardial infarction – particularly if extensive in size – typically manifests with pathological Q…

…PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the…

…Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia, electrocardiographic findings…

…I C Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent…

…This causal relationship is supported by genetic, observational and interventional evidence. The relationship between LDL C exposure and ASCVD risk is characterized by several principles…

…of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive stenosis in a major…

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI…

…of ≥50%, accompanied by objective evidence of structural and/or functional cardiac abnormalities and/or elevated natriuretic peptides (NPs) [1] [2] . The evolution of HF…

…cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within…

…an asymptomatic rise in blood pressure must be treated urgently, which is not supported by evidence. The patient may need active treatment and prompt follow…

…international guidelines on neutropenic fever [2]. The direct evidence for exactly one hour in neutropenic fever is limited, but delayed antibiotics are associated with a…

…mortality, but most of the evidence was observational and the results must not be taken to mean that an electronic alert replaces clinical judgement [5]…

…The evidence Trial Question Result : : : TTM (2013) 33 °C versus 36 °C No difference in mortality or neurological outcome TTM2 (2021) 33 °C versus normothermia…

…fibrillation with marked renal failure or on dialysis, where DOACs lack documentation or have only weak evidence. Venous thromboembolism when a DOAC cannot be used…

…in serious bleeding in the populations studied. There was no evidence of a different aspirin effect according to sex. P2Y12 inhibitor monotherapy A P2Y12 inhibitor…

…anti inflammatory drugs Corticosteroid therapy Other antiplatelet or antithrombotic drugs Selective serotonin reuptake inhibitors Patient selection Aspirin should not be prescribed routinely to individuals without…