…and elevated Lp(a) may confer greater risk per particle or unit of cholesterol than LDL cholesterol. Clinical implications High Lp(a) is independently associated…

…Blood then propagates along the wall, creating a true lumen and a false lumen separated by an intimal flap. Propagation may be antegrade or, less…

…Edrophonium is a very short acting cholinesterase inhibitor: the effect appears within less than a minute and has gone after 5–10 minutes. That makes…

…protocol Avoid tight targets in inpatients. Hypoglycaemia on the ward is more dangerous than moderate hyperglycaemia over a few days. Principles Insulin component Function Who…

…low in healthy subjects; the 99 th percentile is less than a few nanograms per liter of blood (typically <5 ng/L). This is explained…

…Dyslipidemia (including high LDL, total cholesterol and triglycerides) Atrial fibrillation BMI categories The World Health Organization defines BMI categories as follows: Underweight : Less than 18…

…platelet rich and less occlusive, often presenting clinically as Non ST Elevation Myocardial Infarction (NSTEMI) rather than STEMI [4] . Calcified Nodules: A less common mechanism…

…with nonspecific intraventricular conduction delays were at particularly high risk of death due to arrhythmias. Note that other causes of wide QRS complex must always…

…mL Rapid 2–6 hours A bloodless field, less bleeding Mepivacaine 10 mg/mL Rapid Somewhat longer than lidocaine A common alternative Bupivacaine 2.5…

…ischaemia would occur at workloads greater than those achieved during testing. Exercise ECG has become less prominent as a primary diagnostic test for obstructive coronary…

…The transition from a stable plaque to a high risk, vulnerable plaque (VP)—specifically the thin cap fibroatheroma (TCFA)—is driven by an imbalance between…

…Agatston Score The score should be interpreted both by its absolute value and in relation to age and sex. A score that is high fo

…from a lesion less than 48 hours old Also take a biopsy for immunofluorescence Panniculitis Excision or a deep punch down into the fat A…

…and Pathophysiology Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a hepatic protein that regulates the availability of the low density lipoprotein receptor (LDL receptor…

…weight loss. Cardiovascular Outcomes Associated With Dietary Patterns Cardiovascular disease and mortality The strongest long term evidence supports Mediterranean or DASH style patterns that emphasize…

…Treatment should begin as soon as possible, with a target of less than 10 minutes from STEMI diagnosis to the fibrinolytic bolus. In suitable systems…

…collapse Lesion specific angiographic features Residual dissection at a stent margin, impaired flow into or out of the stent, stent diameter less than 3 mm…

…starts discharging. Less than 3 consecutive beats (or from a latent pacemaker (or any other ectopic focus) are referred to as escape beats. Three or…

…thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference ; a cuff that is too narrow overestimates the pressure. Measure the circumference, do…

…progressively more complex. Older adults, often defined in cardiovascular practice as those older than 75 years, are not a homogeneous population: biological age, frailty, multimorbidity…

…is associated with a particularly low dose, approximately 1–2 mSv, while contemporary combined coronary, pulmonary, and aortic angiography can achieve less than 5 mSv…

…with symptoms related to high ventricular rates and the loss of the atrial kick. The rapid ventricular response can lead to a reversible depression of…

…rather than a replacement for, established secondary prevention treatment. Its potential role is greatest when cardiovascular risk remains high despite optimal or maximally tolerated guideline…

…pre test likelihood of obstructive CAD is moderate or high, generally greater than 15% and less than 85% Baseline ECG abnormalities make exercise ECG interpretation…

…based, high and symmetric. Their duration is short; they typically disappear within minutes after a total occlusion in a coronary artery occurs (then of course…

…IVR; Figures 1 and 2). When the ventricular pressure is less than the left atrial pressure, the mitral valve opens and the cycle is repeated…

…is regular, typically ranging from 100 to 250 beats per minute in atrial tachycardia and less than 100 beats per minute in atrial rhythm. Refer…

…five times higher in males than females, although the sex difference becomes less pronounced in older age. Cigarette smoking is a major modifiable risk factor…

…is associated with a worse prognosis than termination due to chest pain. Leg fatigue Leg fatigue is particularly pronounced on bicycle, and less pronounced on…

…The pressure that drives cerebral blood flow. CerPP is determined by intracranial pressure (ICP) and mean arterial blood pressure (MABP). Low ICP and high MABP…

…or are associated with high event risk. The apparent differences between thresholds reflect different guideline frameworks and clinical pathways rather than a single universal classification…

…the left coronary artery is less frequent but is considered more malignant than anomalous origin of the right coronary artery. High risk anatomical features include…

…as atorvastatin less than 10 mg daily or an equivalent dose of another statin. Approximately 45% of participants had type 2 diabetes. Over a median…

…a high coronary origin, acute angle take off, and an intramural course. An anomalous left coronary artery is less common but more malignant than an…

…high bleeding risk, because newer DES provide greater efficacy with acceptable safety even when shorter DAPT regimens are used. BMS now account for less than…

…are less likely to cause STEMI because collateral vessels may develop over time. By contrast, an acute thrombus may form at a site that was…

…120 minutes of the STEMI diagnosis. With a longer expected delay and a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in…

…patients weighing less than 50 kg, the dosing should be 0.05 to 0.3 mg/kg. Central venous access: When injected into a central…

…atrioventricular node may discharge impulses. Less than three consecutive beats are referred to as junctional beats (also called junctional escape beats). Three or more consecutive…

…greater ventricular wall stress, probably because of suppression of natriuretic peptide production or post translational modification rather than a simple clearance effect. Treatment also affects…

…to 3 block, which is less common. 5 to 4 block is even more uncommon. Note that the higher the degree of block, the more…

…the probability that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients with a very high probability…

…legs uncrossed, no conversation Cuff width ≥ 40% of the upper arm circumference — a cuff that is too narrow gives a falsely high reading The cuff…

…leucocytosis or a positive culture. Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ…

…often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major…

…high body mass index (BMI) was linked to approximately 4.0 million deaths worldwide, with more than two thirds—roughly 67%—of these fatalities resulting…

…Voiding problems in neurogenic bladder dysfunction, in the first instance with clean intermittent self catheterisation rather than an indwelling catheter. A catheter is not, however…

…does not provide a detailed description of the presenting symptoms of NSTEMI. It does identify several clinical manifestations that indicate particularly high risk and should…

…and the ventricle should expand substantially. This requires that the myocardium has high compliance , a term used to describe myocardial elasticity. The greater the compliance…

…ventricular tachycardia is always a potentially life threatening arrhythmia that requires immediate attention. The ventricular rate is typically very high (100–250 beats per minute…

…By inhibiting SGLT2, these drugs produce coupled sodium and glucose loss in approximately a 1:1 stoichiometric relationship. The resulting glucosuria and natriuresis reduce proximal…

…Less common sites of radiation include the abdomen, back, lower jaw, and neck. The pain may radiate as high as the occipital area but does…

…the greater the refraction. Refraction artifacts occur when ultrasound travels through tissue that behaves as a lens which causes significant refraction, directing the ultrasound to…

…Loss of function (LOF) mutations in SCN5A lead to a reduction in the inward sodium current ($I {Na}$) and are identified in 20% to…

…LAA). The LAA is a highly trabeculated, windsock like embryonic remnant that exhibits uniquely low flow velocities during the loss of organized atrial systole. Transesophageal…

…genetic mechanisms involve: Loss of function variants in the LDL receptor gene, LDLR, which account for most cases. Variants in APOB that impair apolipoprotein B…

…is less clearly defined, although triglycerides may contribute to the development and progression of aortic pathology. Severe HTG, especially when associated with chylomicronaemia, has a…

…rises; the left ventricle becomes volume overloaded since less blood is ejected into the aorta. Thus, acute regurgitation results in a sudden increase in preload…

…and bundle branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for…

… 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…