…Atherosclerotic lesions generally affect large and medium sized arteries. Pathological features include plaque formation with calcium deposition, medial thinning, destruction of muscular and elastic tissue…

…greater risk of progression or rupture than asymptomatic lesions. Predisposing conditions Aortic dissection and its variants are associated with conditions that cause medial degeneration or…

…particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from…

…to established reversible myocardial ischaemia in either of two settings: Obstructive coronary artery disease (CAD) that cannot be controlled despite escalation of antianginal medical therapy…

…CABG. Physical examination findings are not specific to left main disease. The examination should nevertheless assess the consequences of extensive myocardial ischaemia, including heart failure…

…decades, the lesion progresses from a simple fatty streak to a complex fibroatheroma. Smooth muscle cells (SMCs) migrate from the tunica media into the intima…

…infarction rates. Clinical presentation and symptoms The clinical presentation is determined primarily by the ACS syndrome and the haemodynamic consequences of the culprit lesion. Patients…

…followed by disruption of the intima. Intramural haematoma differs from classic dissection because haemorrhage occurs within the media without imaging evidence of an intimal tear…

…lesions Embolic debris obstructs the distal microcirculation and may be accompanied by microvascular constriction and endothelial or myocardial injury. Antithrombotic therapy may reduce embolization of…

…dysfunction (heart failure) and arrhythmias. The annual risk of sudden cardiac arrest is <1% and median survival is 3 years. Long term prognosis in aortiv…

…stenosis. Cutoff ≤ 0.80. Deepest outcome trial evidence base of any physiological index; lesion specific and largely independent of resting hemodynamics; guideline reference standard. Requires…

…the choice of lesion the critical point: never freeze anything whose diagnosis you have not established. Indications Lesion Freeze time per cycle Number of cycles…

…to a single lesion. Consequently, local revascularization must be accompanied by systemic treatment aimed at stabilizing the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary…

ECG Left main coronary artery occlusion Left main coronary artery (LMCA) occlusion is a rare but catastrophic manifestation of acute coronary syndromes. The LMCA supplies…

…a left main coronary stenosis of at least 50% is considered significant. These thresholds describe luminal narrowing, not necessarily the physiological effect of the lesion…

…Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the subcutis Never a shave…

…reserve (FFR) is an invasive, lesion specific physiological index used to estimate the functional significance of an epicardial coronary stenosis. It is defined during maximal…

…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…

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…

…weeks after infarction. Predisposing features Risk features vary by lesion but include: Older age. Female sex. Hypertension. Absence of an adequate collateral circulation. A first…

…minute. Peptic ulcer remains the commonest cause of upper gastrointestinal bleeding, but the differential diagnosis includes oesophagitis, gastritis, a Mallory Weiss tear, a Dieulafoy lesion…

…Heart surgery (can cause permanent bradycardia). Hypothyroidism. Medullar lesion. Increased intracranial pressure. General hypoxia. Autonomic nervous system Neurocardiogenic syncope. Carotid Sinus Hypersensitivity. Electrolyte disturbances Hypokalemia…

…Myocardial bridging is an anatomical variant in which a segment of an epicardial coronary artery passes through the myocardium rather than remaining on the epicardial…

…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…

…despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography…

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI…

…artery. The clinical value of these techniques rests on their ability to characterize the anatomy responsible for a stenosis, define plaque morphology, identify occult lesions…

…ends at T12–L1, so these levels encounter only the roots of the cauda equina. If in doubt: choose a level lower, never higher. 3…

…ability is less robust in CABG treated patients, as surgery can bypass complex lesions irrespective of their angiographic complexity. Evolution: SYNTAX Score II To address…

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

…findings may reflect plaque disruption or thrombus. A rounded or polypoid intraluminal mass and lesion haziness raise suspicion of thrombus, although haziness is not specific…

…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…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…is driven by the sudden destabilization of these lesions, a process known as atherothrombosis [2] . Atherothrombosis represents the acute, life threatening complication of coronary atherosclerosis…

…C reactive protein. Inhibition of neutrophil migration toward inflammatory foci. These effects are mechanistically distinct from the lipid lowering action of statins. Nevertheless, statins and…

…mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac output. Their recognition…

…necrolysis, DRESS syndrome) have been rarely reported with acetylsalicylic acid. Discontinue acetylsalicylic acid at the first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions…

…caused by spasm. The absence of obstructive disease generally indicates a more favourable course than VA accompanied by severe fixed lesions. Nevertheless, patients who develop…

…causes of sinus node dysfunction Age related degenerative disease (fibrosis) Myocardial ischemia/infarction Lesions due to heart surgery Myocarditis Collagen disease Amyloidosis Risk of supraventricular…