…previously implanted coronary stent. It represents a form of arterial hyperplastic disease arising after percutaneous coronary intervention (PCI). In contemporary practice, ISR remains the most…

…affected, and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure…

…In asystole and PEA as soon as access is available; in VF/VT only after the 3rd defibrillation 0.01 mg/kg (0.1 mL…

…the preparation Avoid in renal failure, heart failure, a history of peptic ulcer, and old age Titrate according to the effect and the respiratory rate…

…risk is especially relevant in older adults. Factors associated with increased gastrointestinal bleeding include: Older age, with risk increasing particularly after 70 years Male sex…

…agonists (GLP 1 RAs) and evolving into multi receptor agonists, has unleashed a new paradigm in cardiometabolic medicine. These therapies are revolutionizing public health strategies…

Echocardiography Ultrasound artifacts The following artifacts are common in ultrasound imaging: The ultrasound image displays non existing structures. The ultrasound image does not display existing…

…often check pupil size and reactivity as part of initial and ongoing evaluations of patients in cardiac arrest or after return of spontaneous circulation (ROSC)…

…Romhilt Este's score system Points Any of the following: R or S in any limb lead ≥20 mm S V1 or S V2 ≥30…

…infarction (STEMI) and non ST segment elevation myocardial infarction (Non STEMI, NSTEMI) in detail. Although myocardial ischemia may affect every aspect of the ECG – from…

…A patient who has become calm, quiet in the chest and stopped struggling may be about to stop breathing. Diminishing wheeze means improvement only if…

…At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…down by three adults. Procedure Batteries and magnets A button battery in the nose or the ear canal is an emergency, not a finding that…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude), and QT prolongation. Ventricular flutter Monomorphic VT at a rate ~300…

…atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI…

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

…the sinus rate is extremely low—such as less than 40 to 50 beats per minute in the first 4 to 6 hours after an…

Cardiology Clinical medicine Definition and Clinical Context Blood pressure management in older adults must account for chronological age, biological age, frailty, multimorbidity, cognitive status, functional…

…become progressively more complex. Older adults, often defined in cardiovascular practice as those older than 75 years, are not a homogeneous population: biological age, frailty…

…half of premature deaths in RA may be directly attributable to CVD. Excess mortality becomes apparent approximately 7–10 years after diagnosis and is associated…

…cardiovascular impact in women. Obesity, physical inactivity and depression are more common in women. Dyslipidaemia, hypertension, diabetes and obesity become increasingly prevalent after the menopausal…

…reported rates are generally 5–10%, although some series report 10–20%. Other life threatening cardiopulmonary conditions account for approximately 5% of presentations in some…

…weight gain, peripheral edema, early satiety, abdominal distension and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress…

…Definition and pharmacological basis Ezetimibe is a non statin lipid lowering agent that inhibits the Niemann–Pick C1 like 1 (NPC1L1) transporter in the intestine…

…relatively uncommon in the first decade, rises progressively through adulthood and becomes less steep in later life, although diagnoses may still occur after the age…

…trained athletes in the absence of symptoms. C: Sinus bradycardia should persist with the onset of physical activity. D: Sinus bradycardia with heart rates between…

…atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also contribute to stroke in patients with AF. Stroke risk…

…results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude), and QT prolongation. Ventricular flutter Monomorphic VT at a rate ~300…

…systole. Transesophageal echocardiography and surgical pathology demonstrate that over 90% of thrombi in non valvular AF originate within this specific anatomical cul de sac [19] …

…Confirm cardiac arrest In case of a collapse (out of hospital or in hospital) the first task is to determine if a cardiac arrest has…

…rate of 0.1°C/min during the cooling process. Malignant hyperthermia Malignant hyperthermia may manifest under two primary circumstances: Due to a genetic mutation in…

…In such instances, favorable neurological outcomes are possible even with prolonged periods of no blood flow, due to the reduced metabolic rate that accompanies declining…

…due to aspiration risks and inconclusive evidence. However, in cases of iron, lithium, or potassium intoxication where lavage might prove beneficial, the procedure should be…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…the term perimyocarditis . Hemodynamic effects of pericardial effusion and cardiac tamponade Intrapericardial pressure increases as fluid accumulates in the pericardial space. Intrapericardial pressure may reach…

…with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial ischemia…

…central venous catheter). The hemodynamic effects persist for 7–10 days after the end of infusion. Refer to Table 2 for a comparison between levosimendan…

…or notch in the descending limb of the R wave and/or notch in the descending limb of the S wave In case of complete…

…down adenosine. These actions result in increased extracellular adenosine concentrations, causing vasodilation. Dobutamine Dobutamine is a chronotropic and inotropic agent. It increases heart rate, myocardial…

…upsloping ST segment. The depression in the J 60 point is usually <1 mm and it resolves rapidly once the exercise is stopped. Some experts…

ECG Myocardial ischemia and infarction ST segment elevation in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment…

ECG Myocardial ischemia and infarction T wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided…

…pronounced improvement in the chain of survival is the dramatic increase in rates of bystander CPR ( Figure 2 ). Bystander CPR was provided in approximately 30…

…segment elevations Successful reperfusion results in rapid and marked normalization (return) of ST segment elevations. If the reperfusion is complete (after a total occlusion) the…

…of the left ventricle has the poorest prerequisites in case of ischemia. The infarction process starts in the subendocardium from where it spreads to the…

CPR Bedside echocardiography in cardiac arrest In the context of cardiac arrest, focused echocardiography entails a swift evaluation of ventricular contractions and the status of…

…Anemia: Hemoglobin <13 g/dL in men or <12 g/dL in women (3 points) Severe Renal Disease: Estimated glomerular filtration rate (eGFR) <30 mL…

…Their clinical importance arises from the causal role of low density lipoprotein cholesterol (LDL C) and other apoB containing lipoproteins in atherosclerotic cardiovascular disease (ASCVD)…

…Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes…

…improve angina and quality of life, but randomized trials have not demonstrated reductions in mortality or myocardial infarction rates. Clinical presentation and symptoms The clinical…

…including non calcified plaques that are not directly visualized by calcium scoring. In contrast, coronary CT angiography (CCTA) can characterize both calcified and non calcified…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…