Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

…caused by ischemia/infarction : There are numerous causes of LBBB, such as heart failure, structural heart disease, fibrosis of the conduction system and acute myocardial…

…of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and coronary artery disease (CHD) are synonyms. These terms refer to symptomatic coronary…

…of chronic coronary syndromes (CCS). Ischemic heart disease, coronary heart disease (CAD) and coronary artery disease (CHD) are synonyms. These terms refer to symptomatic coronary…

…Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and…

…Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest…

…with significant heart disease, predominantly ischemic heart disease. However, most cardiac conditions may be associated with atrial flutter. As compared with several other supraventricular tachyarrhythmias…

…by heart disease, other medical conditions (pulmonary embolism, bleeding, stroke, etc.) as well as cases where the cause does not fall into the other categories…

…PCI). Contraindications for myocardial perfusion imaging Exercise stress testing is contraindicated in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure…

…the prevention of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of developing an…

…stroke and the possibility of thrombolytic treatment. Cardiac and pulmonary complications Acute hypertension may precipitate myocardial ischemia or infarction, acute heart failure, or pulmonary oedema…

…reduction of coronary flow caused by acute atherothrombosis. Table 1: Myocardial and ECG reaction in various settings with ischemia or increased workload STATUS OF CORONARY…

…Cerebral / peripheral vascular disease. Cancer. Acute coronary syndromes cause symptoms already at rest. Stable ischemic heart disease does not cause symptoms at rest unless the…

…grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart disease as well as estimating the extent of ischemia. After revascularization procedures…

…as follows: Assessment of cardiovascular risk in screening. Detection of coronary artery disease (ischemic heart disease). Evaluation of coronary artery disease. Assessment of therapeutic response…

…The most common causes are coronary heart disease (acute coronary syndromes or ischemic heart disease), heart failure , cardiomyopathy (dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy), valvular disease …

…million deaths annually worldwide. The most common cause of sudden cardiac death is acute or chronic coronary artery disease (ischemic heart disease). Cardiomyopathies (dilated or…

…with acute severe mitral regurgitation—predominant right ventricular (RV) infarction, cardiac rupture with tamponade, and less common causes such as severe pre existing valvular disease…

…it often holds true for cardiac arrests caused by chronic or acute ischemic heart disease, it is often not true in other circumstances (e.g…

…syndrome Silent ischaemia Heart failure, particularly when left ventricular function is impaired Haemodynamic or electrical instability in advanced or acute presentations Left main disease may…

…In cardiogenic shock, the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when…

…multivessel CAD varies from stable angina or exertional limitation to acute coronary syndrome (ACS), ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas…

…the presence of substantial pre existing CKD, particularly when congestive heart failure or other causes of ischaemic AKI coexist. Risk assessment Patient related risk factors…

…coronary microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include…

…adverse events is increased by: advanced age; diabetes mellitus; chronic kidney disease or renal failure; congestive heart failure; prior stroke; emergency coronary angiography or PCI…

…may coexist, and certain disease entities can span both categories; for example, acute heart failure may occur in the context of acute myocardial ischaemia, though…

…with stent thrombosis present with ACS. Clinical manifestations therefore commonly include recurrent myocardial ischaemia, recurrent infarction, or acute coronary occlusion. Stent thrombosis may occur within…

…establish: The nature and stability of symptoms Exercise capacity The presence of active chest pain or other evidence of ongoing ischaemia Symptoms suggesting haemodynamic compromise…

…myocardial ischaemia. Non ischaemic myocardial injury may accompany numerous cardiac and systemic disorders, including: Cardiac causes Systemic causes Heart failure Sepsis Myocarditis Chronic kidney disease…

…of heart failure Haemodynamic instability Myocardial ischaemic symptoms or electrocardiographic changes Thromboembolic complications, particularly stroke In ACS, AF may be present before the acute event…

…and cardiovascular disease. Its relationship with cardiovascular risk is nonlinear: even light smoking carries a substantial proportion of the excess ischaemic heart disease risk associated…

…Established ASCVD includes previous acute coronary syndrome, chronic coronary syndromes, coronary revascularization, stroke, transient ischaemic attack, and peripheral arterial disease. Heart failure is also considered…

…since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease…

…chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with…

…hypertension Ischaemic heart disease Atrial arrhythmias Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other…

…Non acute heart failure in which an ischaemic or cardiometabolic cause is suspected. Selected asymptomatic individuals in whom coronary disease is detected incidentally or during…

…A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock and cerebral or visceral malperfusion. Type B disease…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…

…predictors include previous stroke or transient ischaemic attack (TIA), mitral stenosis, hypertrophic cardiomyopathy, diabetes mellitus, hypertension, heart failure, older age, vascular disease and renal dysfunction…

…the same broad category as a patient with coronary artery disease when clinically appropriate. Other coronary anomalies Anomalous coronary origin and course can impair coronary…

…be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g. arterial line…

…while other studies have failed to establish such a relation. The most cited study to date, Botker et al62001 8/abstract) , reported that remote ischaemic…

…characterized by an inappropriately slow heart rate. Within the context of acute coronary syndromes, particularly ST elevation myocardial infarction (STEMI), ischemic injury can disrupt the…

Myocardial ischemia and infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the…

…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…Haemodynamic and electrical status Haemodynamic instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest after presentation are markers…

…NSTEMI and unstable angina have been discussed previously (refer to Classification of Acute Coronary Syndromes, and Ischemia and the ST Segment and ST segment depressions)…

…causes & management Definition of sinus bradycardia Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute…

…For example, if there is acute ischemia located in the anterior wall and there is ST segment elevation in lead V3, then there should also…

…can often be established by examining fewer leads. On the other hand, for the purpose of diagnosing morphological changes (e.g. myocardial ischemia, ventricular hypertrophy)…

…tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction sounds…

…AV block Mobitz type 2, newly discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or…

…toe pressure < 30 mmHg. Decompensated heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis…

…may be prolonged, shortened or unchanged in ischemia. R wave amplitude Acute transmural ischemia may transiently increase the amplitude of the R waves. This is…

…strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other hand, are much less likely to be caused by ischemia …

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…