…occur as late as 2 weeks after infarction. Predisposing features Risk features vary by lesion but include: Older age. Female sex. Hypertension. Absence of an…

…be integrated with lesion anatomy, clinical presentation, bleeding risk, the anticipated need for non cardiac surgery, procedural complexity, and the relative merits of PCI and…

…crush technique, stent fracture or collapse Lesion specific angiographic features Residual dissection at a stent margin, impaired flow into or out of the stent, stent…

…report. A shave biopsy of a pigmented lesion that turns out to be a melanoma can make the Breslow thickness unmeasurable and staging therefore impossible…

…alter the local vascular environment. The extracellular matrix is an active component of lesion development rather than merely a structural scaffold. Smooth muscle cells and…

…size A small post procedural luminal diameter A high degree of residual stenosis Long lesion length Diabetes Untreated edge dissection DES have reduced restenosis compared…

…The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the albumin and the bilirubin — and they become abnormal late…

…of myocardial infarction (MI) has evolved significantly over the past century. Initial post mortem observations in the late 19th century first linked thrombotic occlusion of…

…is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is…

…haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage meeting the criteria for activation of the…

…likelihood of arrhythmia onset. However, beta blockers do not fully eliminate the risk. In LQT3 patients, where arrhythmias often occur at rest due to late…

…likelihood of arrhythmia onset. However, beta blockers do not completely eliminate the risk. In LQT3 patients, where arrhythmias often occur at rest due to late…

…heart failure armamentarium. Its use has declined over time due to the advent of more efficacious agents with wider therapeutic to toxic windows, and its…

…early systole, decelerating flow in late systole, and no flow during diastole. Doppler is capable of recording these flow variations with high precision. To calculate…

…creatinine. Limitations of creatinine and urine output Creatinine is a late marker of function and may rise only after a substantial fall in glomerular filtration…

…time of onset, a late time window, or when thrombectomy can start at the earliest after 6 hours, according to the local protocol MRI of…

…apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis, where a long half life…

…morphine Morphine has an active renally excreted metabolite that causes late sedation and respiratory depression Marked liver failure A reduced dose of all of them…

…strategy should be considered in patients presenting late (12–48 h) after symptom onset. IIa B In asymptomatic patients, routine PCI of an occluded in

…Late gadolinium enhancement cardiac magnetic resonance imaging has demonstrated procedural injury in patients undergoing either procedure, and postprocedural cTnI elevation correlates with evidence of injury…

…laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis…

…older patients also have more contraindications and a greater risk of bleeding and myocardial rupture. Late presentation For patients presenting more than 12 hours after…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

…Epsilon wave , a late depolarization/potential occurring between the end of the QRS complex and the beginning of the T wave, in leads V1 and…

ECG Hypertrophy and dilatation Principles of atrial and ventricular enlargement (hypertrophy and dilatation) Cardiac chamber enlargement refers to abnormally large atria or abnormally large ventricles…

…stress. Approximately 30% of patients died in the hospital and fatal tachyarrhythmias was presumably the leading cause. Animal studies conducted in the late 1950s, 1960…

…term to describe a reduction of blood flow to tissues and organs. A few decades later Cohnheim demonstrated that ligation of the left anterior descending…

…Lane Australian site with one of the most impressive ECG libraries available. A must for anyone interested in ECG interpretation. Also includes vast amounts of…

…can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can cause a stroke hours to weeks later. Everything else in the…

…preparation) or 2 hours (tablets). With very large quantities of an extremely toxic preparation, lavage can be discussed later. Lavage must never be performed routinely…

…an additional absolute contraindication: the slightest suspicion of septic arthritis. If the picture is unclear — aspirate, send a culture, await the result and inject later…

…and the test is performed later. Contraindications Known hypersensitivity to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…decline later in life. Consequently, isolated systolic hypertension and widening pulse pressure are common in later life. These changes contribute to the complexity of defining…

…first decade, rises progressively through adulthood and becomes less steep in later life, although diagnoses may still occur after the age of 65 years. Overall…

…years later in females. Untreated HoFH is associated with extensive premature and progressive ASCVD; CAD and aortic stenosis may occur before the age of 20…

…impulse is discharged in the ventricles it will spread partly or entirely outside of the conduction system and thus produce a wide QRS complex (QRS…

…ECG criteria, only to develop magnificent ST segment elevations a few minutes later. Indeed, a dynamic (varying) ST segment is suggestive of myocardial ischemia. It…

Echocardiography Generating the ultrasound image The ultrasound transducer generates short bursts (pulses) of ultrasound waves. Reflected ultrasound waves are analyzed by the machine during the…

Cardiology The ischemic cascade The ischemic cascade describes the sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain…

…90 percent of withdrawal seizures occur within 48 hours. Seizures later than this, focal seizures or status epilepticus should raise strong suspicion of another or…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

…limit of 6–8 hours for primary closure rests on weak evidence. More recent data suggest that clean, well cleaned wounds can be closed later…

…V, Olshansky B, Lane DA, Lip GYH. Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the AFFIRM trial. J Intern Med …

…High 10.8 9 High 12.2 Table 1. Interpretation of CHADS VA score References Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ…

…Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major…

…specific or female predominant factors associated with later cardiovascular risk include: Premature menopause Premature ovarian insufficiency Hypertensive disorders of pregnancy Preeclampsia Preterm delivery Gestational diabetes…

…shockable), and the probability of survival is higher (since these arrhythmias can be defibrillated). Likewise, the later the ECG is recorded, the greater the probability…

…elevations a few minutes later. It is important to note that a traditional 12 lead ECG only presents a few seconds of myocardial electrical activity…

…endocarditis. With 2D and later 3D ultrasound, the technology has been greatly refined. Similarly, the development of transesophageal echocardiography (TEE) has been extremely valuable. Echocardiography…

…case of a partial occlusion. Coronary artery anatomy There is individual variation in the coronary artery anatomy. These details will be discussed in later chapters…

…In many parts of the world, the bicycle is preferred over the treadmill, as will be discussed later. Role of the electrocardiogram (ECG) in exercise…

…the ventricles. First degree AV block is rarely serious and may be left untreated in the vast majority of cases (exceptions are discussed later). Second…

…vectors to become evident. These vectors manifest in the later part of the QRS complex as an R’ wave (pronounced "R prime"), which is directed…

…completed. Post ischemic T wave inversions emerge at the earliest 4–6 hours after an episode of ischemia/infarction, but no later than 24 hours…

…sound waves reflected from myocardium have high amplitude. This is due to the high density of myocardium. It follows that myocardium generates reflections with high…