…rare cases, TTP has been reported with ticagrelor treatment. TTP is characterized by thrombocytopenia and microangiopathic hemolytic anemia associated with neurological findings, renal failure, or…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

…of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting medications The SLCO1B1 rs4149056 polymorphism is associated with higher statin…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…Patients with acute coronary syndrome should be offered cessation support during hospitalization. Depression and adverse environmental exposures are associated with continued or resumed smoking after…

…molecular weight heparin is the first choice in pregnancy and an alternative in cancer associated thrombosis. Warfarin in antiphospholipid syndrome and in marked renal failure…

…its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV infection, cirrhosis, and sickle cell disease. The…

…2 minutes Duration of action 10 to 30 minutes Delivery IV Dose Bolus injection : 5 to 15 mg every 5 to 15 minutes as necessary…

Myocardial ischemia and infarction Definition and Pathophysiology Intravascular imaging comprises catheter based techniques that directly visualize the coronary lumen, vessel wall, plaque, thrombus, and implanted…

…signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are commonly mild. A rapidly developing or large effusion is…

…ST elevation myocardial infarction cases. Despite their rarity, they remain immediately life threatening; reported in hospital mortality was 42.4% for STEMI associated mechanical complications…

…source material does not provide a detailed catalogue of specific embolic syndromes. Clinical suspicion should be heightened after: Anterior STEMI. A large or transmural infarction…

…PCI. Type 4b MI: MI caused by stent thrombosis. Type 4c MI: MI associated with in stent restenosis. Type 5 MI: MI related to CABG…

…also influence prognosis. Major depression after infarction is associated independently with increased mortality, while inadequate emotional support is associated with recurrent cardiac events. One possible…

…intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI is associated with approximately a 25% reduction in recurrent infarction, stroke…

…concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS…

…territory. Clinical Presentation and Symptoms The source material addresses posterior infarction primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients…

…for a type 1 MI. Type 5 MI: Represents a periprocedural myocardial infarction associated with coronary artery bypass grafting (CABG). Clinical Presentation and Symptoms The…

Clinical chemistry & laboratory medicine Myocardial ischemia and infarction Definition and Pathophysiology Myocardial injury Myocardial injury is a biochemical diagnosis defined by at least one cardiac…

ECG Myocardial ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic…

…a high negative predictive value (93%) for myocardial infarction. Moreover, fragmented QRS is associated with an increased risk of sudden cardiac death and ventricular arrhythmias…

…pathological examination. Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia. The first cellular abnormalities of ischaemia include depletion of glycogen, relaxation of myofibrils…

…procedures overall. It is particularly associated with intervention on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG…

…but not 6 month DAPT, was associated with higher rates of myocardial infarction or stent thrombosis in ACS patients. Extension beyond 12 months DAPT beyond…

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…

Myocardial ischemia and infarction Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for…

Myocardial ischemia and infarction Definition and therapeutic rationale Multivessel coronary artery disease (CAD) refers to clinically significant atherosclerotic disease affecting two or more major epicardial…

…probable, and possible stent thrombosis for clinical research and outcome assessment. Predisposing factors Domain Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus…

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

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…preferred for coronary angiography and PCI because it is associated with fewer vascular and bleeding complications than femoral access. In patients with acute coronary syndrome…

Myocardial ischemia and infarction Introduction Drug eluting stents (DES) are the predominant device used during percutaneous coronary intervention (PCI). They evolved from balloon angioplasty and…

…one fifth of clinically recognized ISR presentations are ACS. ISR may occasionally be associated with myocardial infarction. The presentation can also be an ischaemic eve

Emergency medicine Myocardial ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the…

…infective endocarditis, and cardiac amyloidosis using appropriate radiopharmaceuticals. Functional perfusion imaging primarily identifies haemodynamically important disease. Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia…

…that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS), myocardial infarction (MI), or, rarely…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Vasospastic angina (VA), formerly termed Prinzmetal or variant angina, is myocardial ischaemia caused by transient abnormal vasoconstriction…

…acute coronary syndrome The major mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material. Superficial plaque erosion. Thrombosis associated with a…

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…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

Cardiology Myocardial ischemia and infarction Introduction Clinical assessment of coronary artery disease (CAD) requires integration of symptoms, cardiovascular risk, coronary anatomy, myocardial ischaemia, ventricular function…

Cardiology Myocardial ischemia and infarction Definition and Clinical Role Coronary computed tomographic angiography (CCTA) is a non invasive anatomical examination that depicts the coronary arterial…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Fractional flow reserve (FFR) is an invasive, lesion specific physiological index used to estimate the functional significance…

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

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Angina with non obstructive coronary arteries (ANOCA) describes anginal symptoms in patients whose epicardial coronary arteries are…

Cardiology Myocardial ischemia and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

ECG Myocardial ischemia and infarction The ECG in the assessment of myocardial reperfusion The ECG is an invaluable tool to assess whether an occlusion has…

Emergency medicine Myocardial ischemia and infarction Definition and Clinical Framework Chest pain is a broad clinical syndrome rather than a narrowly defined symptom. It includes…

…coronary syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated…

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

…level, producing atrioventricular (AV) or intraventricular blocks. Isolated sinus bradycardia in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic…

Cardiology Interpreting myocardial perfusion SPECT images involves a systematic comparison of rest and stress images to assess myocardial ischemia and infarction. The key steps in…

…ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care. Despite their proven morbidity and mortality benefits, their use…

…effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias…

…myositis, Sjögren syndrome, gout and antiphospholipid syndrome (APS). Collectively, these disorders are associated with excess cardiovascular disease (CVD), although the cardiovascular phenotype varies substantially between…

… inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However, association is not the same…