…whereas fixed, dilated pupils can signal severe global ischemia or even herniation of the brain stem. Physiological Basis of the Pupillary Reflex in Cardiac Arrest…

…Adverse left ventricular (LV) remodeling Ischemic cardiomyopathy is the leading cause of heart failure with reduced ejection fraction (HFrEF) in developed countries. New ischemic events…

…sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In contrast, modalities…

…Although myocardial ischemia may affect every aspect of the ECG – from heart rhythm to QTc interval – the most prominent and reliable ECG changes occur in…

…the atherosclerotic artery. Whenever oxygen demand exceeds oxygen (blood) delivery ischemia occurs and this manifests with chest discomfort referred to as angina pectoris. If the…

…article will deal with the physiology of exercise and emphasis will be placed on myocardial oxygen consumption and the development of myocardial ischemia during exercise…

…Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a…

All patients with NSTE ACS (NSTEMI or unstable angina) are treated similarly with respect to anti ischemic and anti thrombotic drugs. Management must, however, be…

…ECG blog Coronary artery disease: On LDL cholesterol, dietary fat & statins You are probably aware that ischemic heart disease, also known as coronary artery disease…

…therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial…

…coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury can disrupt the conduction system at any level, producing atrioventricular (AV) or intraventricular blocks. Isolated…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the…

…chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness…

…driver of global cardiovascular morbidity and mortality, primarily due to its association with ischemic stroke and systemic embolism. The contemporary understanding of AF has evolved…

…atrial fibrillation is more common. Atrial flutter occurs almost exclusively among persons with significant heart disease, predominantly ischemic heart disease. However, most cardiac conditions may…

…1). Emboli originating in the atria, left atrial appendage (LAA), ventricles, valves, and proximal aorta can cause stroke, TIA (transient ischemic attack), coronary artery occlusion…

…Ischemic cardiomyopathy should be suspected if there is significant stenosis ( 75% luminal obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries…

…majority of cases, it is only possible to determine the ischemic/infarct area (and thus the culprit) if the ECG displays ST segment elevations. However…

…To address these challenges, researchers have developed ECG criteria designed to identify ischemia in the presence of left bundle branch block. The most widely recognized…

…warranted. The normal T wave will be described first. Then, ischemic T wave changes – i.e hyperacute T waves, inverted T waves, flat T waves…

…75 years (2 points) D iabetes Mellitus (1 point) S₂ troke, Transient Ischemic Attack (TIA), or Thromboembolism history (2 points) V ascular Disease (1 point)…

…hour. Adverse effects Tachycardia. Flushing. Headache. Angina pectoris. Caution Heart failure. Angina pectoris (ischemic heart disease). Hydralazine doses and administration in hypertension (hypertensive crisis/emergency).

…such as gastrointestinal bleeding or intracranial hemorrhage. History of stroke or transient ischemic attack (TIA). Severely impaired liver function classified as Child Pugh Class C…

…elevations simulating acute ischemia or infarction may also occur in the following conditions [15]: Myocarditis Early repolarization patterns Left bundle branch block Left ventricular hypertrophy…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…

…in the myocardium. The electrical potential difference exists between ischemic and normal myocardium and it results in displacement of the ST segment. The ST segment…

ECG Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms…

…to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat…

…hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand, typically exercise…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

ECG Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS…

…most common indications are as follows: Assessment of cardiovascular risk in screening. Detection of coronary artery disease (ischemic heart disease). Evaluation of coronary artery disease…

…artery (Coronary arteries). Chronic myocardial ischemia may also lead to left ventricular dilation, which is referred to as ischemic cardiomyopathy (Dilated Cardiomyopathy). Ventricular dilation leads…

…requires continuous blood flow to maintain cellular function. Myocardial ischemia occurs when there is insufficient oxygen available. Insufficient oxygen supply results in diminished ATP production…

ECG Myocardial ischemia and infarction Pathological R wave progression Normal R wave progression implies that the R wave amplitude increases gradually from V1 to V5…

…angina at rest are not suitable candidates for perfusion imaging. Detecting ischemic regions requires provocation using pharmacologic agents or physical exercise. Pharmacologic agents include dipyridamole…

…ischemia persists for 20 minutes, myocardial infarction ensues, resulting in permanent wall motion abnormalities. Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left…

…Cause of cardiac arrest : Shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) are mostly due to acute myocardial ischemia or myocardial infarction, and in these cases…

…subendocardial ischemia. Refer to Exercise Stress Testing for details. Hyperventilation Hyperventilation causes ST segment depressions very similar to those normally seen during physical exercise. Left…

…Current guideline criteria for ischemic ST segment elevation: New ST segment elevations in at least two anatomically contiguous leads: • Men age ≥40 years: ≥2 mm…

…hallmark of stable coronary artery disease is exercise related angina pectoris (chest pain); symptoms of ischemia appear during circumstances with increased myocardial demand, typically exercise…

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…

…disease (ischemic heart disease), heart failure, cardiomyopathy or valvular heart disease. In these populations, one of the strongest predictors of sudden cardiac death is left…

…CHADS VASc Score Risk of ischemic stroke Risk för stroke/TIA/systemisk tromboembolism 0 0.2% 0.3% 1 0.6% 0.9% 2 2…

…patients without ST segment elevations, urgent angiography is considered after resuscitation if there is a high probability of ongoing myocardial ischemia. IIa C Pre hospital…

…patients treated with ticagrelor. Patients with a history of ischemic stroke can be treated with ticagrelor for up to 12 months. Use with caution in…

…ventricular tachycardia (including torsades des pointes), ventricular fibrillation arrests and moderate left ventricular dysfunction. This patient died at age 17 years due to complications related…

…follow up Main risk of management Overtreatment may impair autoregulation and cause ischemia Acute rapid reduction may cause harm without prognostic benefit Clinical Presentation and…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…tissues and organs. A few decades later Cohnheim demonstrated that ligation of the left anterior descending artery in dogs resulted in myoardial infarction. An important…

Myocardial ischemia and infarction Definition and pathophysiology Periprocedural myocardial infarction (MI) is myocardial necrosis temporally related to coronary revascularization. It may follow percutaneous coronary intervention…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

…and asymmetric T waves. These must be differentiated from hyperacute T waves seen in the very early phase of myocardial ischemia. Hyperacute T waves are…

…electrolyte derangements is essential [4]. Volume Removal and Revascularization : Managing volume overload and performing coronary revascularization can relieve ischemic triggers [4]. Overdrive Pacing : This technique…

…is not an absolute rule. While it often holds true for cardiac arrests caused by chronic or acute ischemic heart disease, it is often not…

…victim's outcome: Neurological injury Myocardial dysfunction Systemic response to reperfusion and ischemia Effects of the underlying cause of cardiac arrest Neurological injuries may cause…

…emergence of ventricular tachycardia or ventricular fibrillation is, therefore, the result of a perfect storm scenario , where ischemia, hemodynamics, the autonomous nervous system, electrolyte concentrations…

…Lung disease (COPD, pulmonary hypertension, etc). Ischemic heart disease (coronary artery disease). Structural heart disease, any. Treatment of atrial tachycardia Discontinuation of digoxin is typically…

…fraction <55%. This implies that left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection…

…For example, exercising patients with ongoing myocardial ischemia may provoke life threatening ventricular arrhythmias. Patients with previous acute coronary syndromes (ACS) Exercise stress testing is…