…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…

…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…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…

…an obstructive coronary lesion without avoidable delay. In contrast, haemodynamically stable patients without ST segment elevation after successful resuscitation from out of hospital cardiac arrest…

…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…

…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…

…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…

…epicardial lesion. Once conventional anti ischaemic targets have been exhausted, proposed therapeutic approaches act through several broad mechanisms: Promotion of coronary collateral growth. Redistribution of…

…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…

…The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of possible revascularization A proximal lesion jeopardizes more…

…in patients with diabetes. The haemodynamic consequences depend on lesion location, severity, length, the presence of multilevel disease and collateral circulation. Flow limitation may be…

ECG Indications for pacemaker implantation Bradyarrhythmia is the main indication for the implantation of a pacemaker. When considering a permanent pacemaker for bradyarrhythmia, it is…

…of these foam cells forms the earliest macroscopically visible lesion of atherosclerosis: the fatty streak [5] . Ruptured atherosclerotic lesion with atherotrombosis. Over decades, the lesion…

…ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media. The lesion may produce a localized…

…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…

…of herniation — deep unconsciousness with unreactive pupils, an altered breathing pattern, a rising blood pressure with bradycardia. A known or suspected intracranial space occupying lesion…

…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…

…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…

…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…

…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…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…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…

…typical rise and/or fall of high sensitivity cardiac troponin (hs cTn), with at least one value above the 99th percentile upper reference limit (URL…

…important inflammatory components. Inflammation contributes to atherothrombosis through activation of innate immune pathways, cytokine signalling and recruitment of inflammatory cells to vascular lesions. The interleukin…

…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…

…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…

…with intermediate lesions that do not produce physiologically significant flow limitation. The mechanisms are incompletely defined. Proposed contributors include hypercontractility or hypersensitivity of coronary vascular…

…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…

…complication of rheumatic fever, which is caused by streptococcal infections (group A Streptococcus ). Rheumatic heart disease can occur at any age and multiple valve lesions…