…artery is less common but more malignant than an anomalous right coronary artery. Anomalous origin of a coronary artery from the pulmonary artery can result…

…Adjust so that the total exercise time is 8–12 minutes — a shorter test gives insufficient information, a longer one is limited by local muscle…

…the flow of a fine needle, and collapsed veins mean that the fine needle is in addition the only one that will go in. The…

…leg raising with an increase in stroke volume 10%, or inferior vena cava variability . In the absence of responsiveness, fluid does more harm than good.

…used as a filtration marker. CKD is one of the strongest independent risk factors for cardiovascular disease (CVD) and cardiovascular mortality. Cardiovascular risk rises progressively…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…and 7 night time values, and with a measurement interval of no more than 30 minutes throughout the 24 hours. Phenotype Office blood pressure ABPM…

…of one or both ventricles. Dilation of the left ventricle is virtually always accompanied by impaired left ventricular systolic function. It should be noted that…

…It has been the number one killer in Western and high income countries for more than half a century, causing approximately 20% of all deaths…

…doses of an inhaled short acting β2 agonist, ipratropium in more severe attacks, and a systemic steroid given early [2,3]. Grading Grade the severity…

…in the control group. In another randomized trial involving 1002 patients with established coronary disease, a Mediterranean diet was associated with more than a one…

…more than 170 countries and caused unprecedented damage to humans and societies. The number of confirmed cases is approaching one million and the number of…

…in the number of kringle IV type 2 repeats. Lp(a) concentration is predominantly genetically determined, with heritability estimated at approximately 85% to more than…

…more than 5 seconds. The effect of cricoid pressure and gastric insufflation remains uncertain ( Panchal et al ). Nasopharyngeal airways ("trumpets") should be inserted carefully. The…

…transient abnormal vasoconstriction of one or more coronary arteries. Epicardial spasm produces a reversible functional occlusion and usually causes transmural ischaemia. The resulting abnormalities in…

…alters the natural history of the disease. In lateral epicondylitis the effect is in fact worse than no treatment at all at one year . The…

…and resources Recognizing that many visitors are interested in other books and online resources, we have plowed through more than 30 of the most popular…

…to the vast majority of cardiac arrest patients—can induce such pupillary responses. In a comprehensive study by Javaudin et al., involving more than 11…

…and of vascular injury; always an orthopaedic surgeon, and usually general anaesthesia. An open dislocation. Inadequate analgesia or sedation — the procedure must not then be…

…one should suspect hypertrophic cardiomyopathy if the degree of hypertrophy is disproportional to the load (i.e., if hypertrophy is more pronounced than the load…

…rupture risk; one guideline summary describes approximately a four fold greater risk. This difference informs the use of sex specific surveillance and repair thresholds. Clinical…

…young adulthood, resulting in a greater lifetime burden of hypertension. Hypertension becomes more prevalent in women than men after approximately 65 years of age. Hypertension…

…classes. By acting on more than one pathophysiological pathway, combinations generally lower blood pressure more effectively than simply increasing the dose of a single drug…

…More than one mechanism may coexist. Supply–demand mismatch MINOCA may result from a mismatch between myocardial oxygen supply and demand. The clinical history should…

…treatment with a controlled reduction, as a rule no more than 25% during the first hour. The exception is aortic dissection, where a systolic pressure…

…If more than that is required without effect, reconsider the pain mechanism instead of continuing to increase the dose. The level of sedation is scored…

…for more than half of the population attributable risk of cardiovascular mortality and approximately one fifth of the risk of all cause mortality in the…

…one or more of the following patterns: Angina at rest, usually prolonged for more than 20 minutes. New onset severe angina. Previously established angina that…

…also display the highest risk of experiencing malign ventricular arrhythmias. Brugada syndrome is hereditary with an autosomal dominant inheritance pattern, meaning that only one mutated…

…of out of hospital cardiac arrest ranges from 20 to 140 cases per 100,000 inhabitants ( Ahern et al ). In the United States, more than…

…one normal sinus interval. The P wave of a premature atrial contraction has the following characteristics ( Figure 1 ): A premature P wave occurs earlier than…

…Otherwise, ischemia is unlikely to be the cause of the ST segment depression. The horizontal ST segment depression is more specific than the downsloping depression…

…C = total cholesterol − HDL C Apolipoprotein B (apoB) reflects the concentration of circulating atherogenic particles because each apoB containing particle carries one apoB molecule…

…specified by counting the number of flutter waves preceding each QRS complex. If 3 flutter waves occur before each QRS complex then it is 3…

…it is still one of the most frequently confused ECG findings. This is largely due to the fact that a universal definition of early repolarization…

…examination The diagnosis of pericarditis is clinical and is supported by additional findings. A definite diagnosis requires a compatible clinical presentation plus more than one…

…than one third of cases in the pregnancy related source material. Types 2 and 3 are diagnostically more challenging because they may not display the…

…embolism of cardiac or non cardiac origin. Oxygen supply–demand mismatch, including demand related events in the presence of fixed coronary disease. More than one…

…than one who is taken by surprise. Procedure 1. Connect the patient to the 12 lead ECG as usual and record a resting ECG of…

…tourniquet . Without a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications…

…when the need is more than brief: continuing pacing dependence, inadequate or unachievable transcutaneous capture, or when the patient cannot tolerate the pain of transcutaneous…

…lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when…

…participants who were described as frail generally had no more than mild frailty, limiting the applicability of trial findings to people with substantial functional impairment…

…FH). Heterozygous FH results in high LDL cholesterol levels (but nothing else) and increases the risk of acute myocardial infarction by more than 50 times…

…is defined by: cTn greater than 5 times the 99th percentile upper reference limit; and At least one of the following: New ischemic ECG changes…

…is representative of ischemia (but in that scenario, it is actually the ST segment deviation that signals that the ischemia is ongoing). Then one might…

…every time, reduces the risk of missing abnormalities. The eight steps below go through the rhythm and then the waveforms one by one, and conclude…

…dL higher than corresponding LDL C goals. Apolipoprotein B ApoB is the principal structural apolipoprotein of atherogenic lipoproteins. Each atherogenic lipoprotein particle carries one apoB…

…a substantially more diverse genetic basis. Pathogenic or likely pathogenic variants in relevant DCM genes were identified in approximately 22% of cases in one large…

…a syncytium , which implies that the entire network of cells functions as one unit. If one cell in the syncytium is activated, all cells will…

…latent pacemakers, the one with the fastest intrinsic rate of depolarization will be the pacemaker, which means that it usually is atrial myocardium. Asystole occurs…

…oxygen from the blood in the ventricular cavity. The right bundle branch then runs deeper into the myocardium, where roughly one third of its length…

…gradual inversion of the T waves. These T waves are called post ischemic T waves and they indicate that the infarction process is more or…

…one that heavily integrates early catheter ablation and sophisticated device therapy [1] [2] . This exhaustive review provides a comprehensive synthesis of the current state of…

…of red cells within 1 hour. An actual requirement of more than 3 units of red cells during any continuous hour. This corresponds to the…

…usually more dangerous than a corresponding stable chronic value [4]. The grading must not be used mechanically. A patient with a plasma potassium of 6…

…and prevention of their potentially lethal arrhythmic consequences, may be more important than restoration of global LV function. Clinical presentation and symptoms The presentation is…

…of the corrected QT interval be used. Such QTc intervals are derived by all modern ECG machines and the formulas used are more precise than…

…rather than a routine referral being made. Two or more magnets constitute the same kind of urgency by a different mechanism. They attract one another…

…The central therapeutic aim is symptom control rather than modification of long term cardiovascular outcomes. With the important exception of beta blockers in selected patients…