…A patient may have: Relatively high apoB despite normal or low LDL C or non HDL C Relatively low apoB despite higher cholesterol concentrations When…

…SPECT or CMR. Relative flow reserve compares perfusion in a stenotic territory with that in a normal reference region under similar haemodynamic conditions. CFR and…

…Myocardial ischemia and infarction Definition and Clinical Role Coronary computed tomographic angiography (CCTA) is a non invasive anatomical examination that depicts the coronary arterial lumen…

…metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients in whom non invasive measurement is unreliable: marked obesity, pronounced vasoconstriction, arrhythmia…

…The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient, ileus…

…analyses show that aspirin can reduce non fatal cardiovascular events, but does not reduce cardiovascular or all cause mortality. Reported relative effects include: Approximately 11…

…bleeding risk, the anticipated need for non cardiac surgery, procedural complexity, and the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and…

…that are taken up by myocardial tissue. The distribution of retained tracer provides tomographic information about relative regional perfusion. Imaging is generally performed at rest…

…cannula bridges the gap until conditions are controlled. Contraindications In life threatening conditions all contraindications are relative — but they govern which site is chosen. Infection…

…and produces reductions in LDL C, non high density lipoprotein cholesterol, apolipoprotein B and high sensitivity C reactive protein (hsCRP). Bempedoic acid also activates adenosine…

…of the lumen. Assessment of total coronary disease burden, including non obstructive plaque, therefore contributes prognostic information beyond identification of focal severe stenoses. Coronary anomalies…

…Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease…

…CVD is related to the number and severity of cardiovascular risk factors. Five modifiable factors—systolic blood pressure, non HDL cholesterol, diabetes, body mass index…

…because myocardial injury may occur without myocardial ischaemia. Non ischaemic myocardial injury may accompany numerous cardiac and systemic disorders, including: Cardiac causes Systemic causes Heart…

…combined incidence of non fatal MI, non fatal ischaemic stroke, and vascular death from 8.2% to 6.7% per year. The relative reductions were…

…work systematically through the possible causes, apply several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress…

…death Cardiac arrest is the mechanism of death for most diseases and conditions, including non cardiovascular conditions. A cardiac arrest can be expected or unexpected…

…Cardiac Death (FHSCD) : A history of SCD in close relatives suggests a genetic predisposition to arrhythmias. Non Sustained Ventricular Tachycardia (NSVT) : Episodes of VT are…

Myocardial ischemia and infarction Definition and clinical concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has…

…total plaque burden or stenosis severity directly. A patient may have little or no calcium despite clinically relevant non calcified plaque, particularly in middle age…

Cardiology Principles of myocardial perfusion imaging Myocardial perfusion imaging (MPI) is a non invasive technique for detecting and quantifying coronary artery disease (CAD). It offers…

…Despite this relatively low prevalence, missed myocardial infarction remains consequential, and historically 2–6% of patients discharged with presumed non ischaemic chest pain were subsequently…

…vascular lesions. The interleukin 1β pathway, with downstream effects involving interleukin 6 and C reactive protein, has been a major therapeutic target. This concept…

…substantial morbidity and mortality, despite often having a greater burden of cardiovascular and non cardiovascular comorbidity than patients with reduced EF. Pathophysiology Abnormal ventricular relaxation…

…large epidemiological analysis, mechanical complications occurred in approximately 0.27% of STEMI cases and 0.06% of non ST elevation myocardial infarction cases. Despite their…

…of the ventricular myocardium to contract simultaneously. Since the membrane potential is relatively unchanged during the plateau phase, the potential differences in the myocardium will…

…In the GRACE ECG substudy of 5000 patients with non ST elevation ACS (Yan et al), ST elevation in lead aVR was relatively uncommon (7%)…

…natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS (NSTEMI, Non STEMI) and STE ACS (STEMI) is slightly simplified. In reality…

…of accumulation and the compliance of the pericardium. Rapid accumulation may cause tamponade with a relatively small volume, whereas a slowly enlarging effusion may reach…

…angiographic reduction of coronary obstruction. Intensive lipid lowering improves endothelial function, lowers circulating high sensitivity C reactive protein, reduces thrombogenicity, and favourably modifies inflammatory and…

…Indeed, studies demonstrate that the relation between contractility and blood flow is virtually linear (there are rather few linaer associations in physiology). Refer to Figure…

…approximately 20–25% of secondary hypertension cases. Coarctation of the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension…

…Swedish Cardiopulmonary Resuscitation Registry, 30 days survival in OHCA, in relation to initial rhythm, is as follows ( Rawshani et al ): Overall survival : 11%. Shockable rhythm …

…within the subendothelial space, LDL C particles undergo oxidative modification by reactive oxygen species (ROS) and enzymes such as myeloperoxidase and lipoxygenase. Oxidized LDL (oxLDL…

…severity of symptoms in STEMI patients, compared to those with Non ST Elevation Myocardial Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater…

…to fluid retention and worsening congestion The clinical course may be chronic and relatively stable or punctuated by episodes of worsening heart failure requiring hospitalization…

…coronary angiography or other invasive procedures, and affected patients may be relatively painless compared with those with spontaneous dissection. Clinical manifestations may result from rupture…

…homocysteine, white blood cell count, proinflammatory cytokines and C reactive protein. Increased urinary albumin/creatinine ratio reflects altered endothelial and renal pathophysiology in insulin resistance…

…caused by subtotal coronary artery occlusions. This is discussed in detail in the chapter NSTEMI (Non ST Elevation Myocardial Infarction). Orientation of myocardial fibers The…

…blunt, non penetrating blow to the chest, typically over the precordium. The mechanical impact can induce ventricular fibrillation, even if the force seems relatively minor…

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

ECG Myocardial ischemia and infarction Non ST Elevation Acute Coronary Syndromes (NSTE ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus…

…coronary microvascular dysfunction or vasospasm. A normal or non obstructive coronary anatomy does not necessarily exclude an ischaemic mechanism. Clinical assessment and estimation of pre…

…coronary syndromes (ACS) into ST segment elevation myocardial infarction (STEMI), non STEMI (NSTEMI), and unstable angina (UA) has guided clinical decision making for decades but…

Cardiology Pharmacology & dosing Definition and pharmacological basis Ezetimibe is a non statin lipid lowering agent that inhibits the Niemann–Pick C1 like 1 (NPC1L1) transporter…

…patterns. Patients may present with: exertional angina or angina like chest discomfort; symptoms suggestive of myocardial ischaemia despite normal or non obstructive coronary arteries; dyspnoea…

…for a selective invasive approach? Is the clinical likelihood of true NSTE ACS low enough that non invasive evaluation is more appropriate? The presence of…

Echocardiography Ultrasound artifacts The following artifacts are common in ultrasound imaging: The ultrasound image displays non existing structures. The ultrasound image does not display existing…

…®, Rogitine ® Indications Hypertensive crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces blood pressure while increasing catecholamine activity…

…focuses principally on ASCVD prevention and reduction of LDL C, non HDL C and apolipoprotein B. Causes and secondary contributors A search for secondary contributors…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or…

…including: Unstable angina (UA) Non ST elevation myocardial infarction (NSTEMI) ST elevation myocardial infarction (STEMI) This applies to patients undergoing either primary or delayed percutaneous…

…onset atrial fibrillation to sinus rhythm. Vernakalant is used in the following settings: Non surgery patients: atrial fibrillation ≤7 days duration. Post cardiac surgery: atrial…

…used in adults aged ≥70 years. SCORE2 OP accounts for the competing risk of death from non cardiovascular causes, an important consideration in older populations…

…exclusively at the infarct related artery (IRA), or it may extend to additional non infarct related lesions. Culprit only revascularization treats the artery responsible for…

…the most favourable patterns generally contain more minimally processed, fibre rich and bioactive foods, including fruits, non starchy vegetables, beans, whole grains, nuts and seeds…

…troponin elevation, ACS are classified into unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). While the…

…an intraluminal thrombus. The clinical spectrum includes unstable angina, non ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). The traditional…