…to clopidogrel; reducing the dose of prasugrel; extending DAPT beyond 12 months in carefully selected patients with high ischemic risk and low bleeding risk. These…

…of antiplatelet therapy, particularly in the perioperative period, may increase risk. The risk is greatest relatively soon after implantation and declines over time. Evolution of…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…revascularization, while avoiding unnecessary procedural complications and bleeding in those at lower risk or in whom the hazards of revascularization outweigh its potential benefit. A…

…plasma or platelets are not needed — the INR does not predict bleeding risk in paracentesis. Follow the local protocol Ileus with distended bowel loops Ultrasound…

…approximately 0.5%, and major vascular complications approximately 1%. These figures illustrate the variation produced by differences in patient selection, procedural definitions, and institutional practice…

…as soon as possible, with a target of less than 10 minutes from STEMI diagnosis to the fibrinolytic bolus. In suitable systems, pre hospital fibrinolysis…

…with extensive subcutaneous fat require harder pressure. Orientation index marker All ultrasound transducers have an index marker, which is used for orienting in the ultrasound…

…instability. Evaluation and physical examination The objective of decongestion is clinical euvolemia rather than an isolated numerical change in weight. Assessment should integrate the history…

…In particular, it cannot distinguish adipose tissue from lean mass. Waist circumference and the waist to hip ratio provide additional information about visceral adiposity and…

…effects Excessive sedation. Confusion. Hallucinations. Hypotension. Bradycardia. AV block. Constipation Contra indications Bradycardia. Caution • Clonidine may induce severe hypotension. • Clonidine is not recommended in most…

…include: Diabetes and insulin resistance Thyroid disease Kidney disease Excessive alcohol consumption Diets high in carbohydrate or fat Glucocorticoids Beta blockers Oestrogen therapy Some antiretroviral…

…may be comparable to amiodarone in preventing recurrences of AF after cardioversion. It has also been used successfully to decrease the incidence of AF after…

…prolonged, produces multiorgan dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction…

…acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

…present). High voltage (excessive amplitudes) is present if the S wave in V1 or V2 + the R wave in V5 is 35 mm. Q waves…

…unknown or excessive duration without adequate anticoagulation or exclusion of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic…

…inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular activation, transient rate related conduction abnormalities…

…The relationship between blood pressure and outcome in older adults is not linear at very low pressures. Excessive reduction in diastolic blood pressure may compromise…

…Dyspnoea. Reduced exercise tolerance. Excessive fatigue. These non chest pain manifestations are reported more frequently in females, older adults and people with diabetes. Ischaemic heart…

…borders but excessive use of gain results in deterioration of image quality. Time gain compensation / control (TGC) Time gain control / compensation (TGC) adjusts the gain…

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

…The agent undergoes extensive hepatic metabolism, yielding desethylamiodarone as a major active metabolite. Both the parent drug and its metabolite accumulate extensively in various tissues…

…Brief coronary occlusion or relatively prolonged moderate ischemia may produce post ischemic stunning. In the absence of infarction, contractile recovery can occur rapidly after reperfusion…

…conditions that favour thrombus formation. Extensive transmural septal infarction may also permit mural thrombi to develop over infarcted myocardium in either ventricle. With contemporary imaging…

…Extensive involvement is less common in patients with inferoposterior left ventricular infarction, while infarction confined predominantly to the right ventricle is rare. The clinical spectrum…

…flow to both the left anterior descending (LAD) and left circumflex (LCx) coronary artery territories, resulting in extensive myocardial ischemia or infarction involving the anterior…

…avoided in the acute phase. A leg that has recently been operated on, is in a cast or has extensive wounds so that the cuff…

…sits above the obstruction and solves nothing. A mouth opening below about 2 cm. Extensive pharyngeal pathology: tumour, abscess, marked swelling, previous radiotherapy. In the …

…a sacral pressure sore or extensive perineal wounds where urinary leakage prevents healing. Voiding problems in neurogenic bladder dysfunction, in the first instance with clean…

…10 years later in females. Untreated HoFH is associated with extensive premature and progressive ASCVD; CAD and aortic stenosis may occur before the age of…

Cardiology Pharmacology & dosing Definition and pharmacological basis Ivabradine is a selective inhibitor of the If, or “funny,” current in sinoatrial node pacemaker cells. This current…

…with extensive myocardium at risk, severe baseline stenosis, multivessel coronary artery disease, or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the absence…

…present in approximately 2%–24% of patients with CAD. The pathophysiology of refractory angina is heterogeneous. In obstructive CAD, symptoms may result from extensive or…

…must be assessed after initiation of medical treatment LV function requires evaluation in the setting of suspected ischaemia or previous infarction Dyspnoea requires assessment of…

…in the peri operative setting, patients at high risk for malignant arrhythmias should undergo continuous electrocardiogram monitoring throughout the entire peri operative period to assess…

…The primary concern in correcting hyponatremia is the prevention of osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis. Excessively rapid correction of sodium…

…focus on the ECG waves in terms of morphology (appearance), durations and intervals. A rather extensive discussion is provided in order to give the reader…

…i.e the degree of artery obstruction): The greater the obstruction the more extensive the ischemia/infarction. The location of the thrombus in the artery…

…affecting the papillary muscle or its connected myocardium may also result in mitral prolapse. Extensive myocardial infarction may lead to papillary muscle rupture. The risk…

…radiolucent, tolerates moisture better, more expensive and stiffer to mould Elastic bandage Holds the slab in place; wound on without tension Tepid water, plastic gloves…

…bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin…

…The lesion may produce a localized medial haematoma and can progress to IMH, pseudoaneurysm, dissection, aneurysm, or rupture. PAUs are usually located in the middle…

…pitfall arises because typical circuits occurring in diseased atria—most frequently following surgery or extensive ablation, or under the influence of antiarrhythmic drugs—can produce…

…stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non obstructive coronary arteries, possible…

…Impact LBBB causes extensive reorganization of left ventricular activation [2]. This leads to abnormal LV mechanical function [7]. Furthermore, LBBB significantly complicates the electrocardiographic diagnosis…

…with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary syndrome, revascularisation…

…myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and…

…to the myocardium via tines (Figure 1). Unipolar vs. bipolar pacing Pacemakers can utilize either a unipolar or bipolar mode of pacing (Figure 3). In…

…which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet, the pain caused by…