…typical of ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes. They may occur in both NSTEMI and…

Cardiology Genetic and miscellaneous conditions Definition and scope Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who…

…disease (ASCVD). Atherosclerosis develops through the progressive deposition and retention of LDL C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory…

…of 25 mm/s, which is standard in the US and many other countries, a 2:1 block will be difficult to discern because the…

…colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…

…is viable and could benefit from revascularization. Evaluating the success of revascularization : Myocardial perfusion imaging can assess effectiveness of procedures such as coronary artery bypass…

…anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position…

…Progressive dilation can subsequently impair left ventricular ejection fraction. Enlargement of the left ventricle predisposes to atrial and ventricular arrhythmias. In advanced alcohol related cardiomyopathy…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…target based lipid lowering strategy: Dietary and lifestyle interventions form the foundation of treatment. Statins are the preferred first line pharmacological therapy for patients at…

…This is because the strong and oppositely directed forces tend to cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy…

…order to evaluate ventricular function, since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management…

ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

…breakthroughs in engineering, software development, and progress in our understanding of the pathophysiology of cardiac disease. Ultrasound systems have become cheaper, more portable, more powerful…

…severity and situational dependence of sinus bradycardia. If sinus bradycardia is likely due to drug side effects, it is necessary to weigh the risk of…

…as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, early repolarization. Electrolyte disorders, acidosis, hypoxemia and…

…and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack (TIA) or stroke. The…

…result from the cumulative influence of multiple modest dietary changes. Mediterranean type diets provide polyphenols from extra virgin olive oil, fruits, vegetables, nuts and legumes…

…measurements permit assessment of the physiological significance of selected stenoses using fractional flow reserve (FFR) and instantaneous wave free ratio (iFR). Other invasive techniques can…

…and in these cases, the likelihood of ROSC is higher as compared to other etiologies and presentations. Asystole and pulseless electrical activity (PEA) often have…

…the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic…

…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…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…Lane DA, Lip GYH. Evaluation of the HAS BLED, ATRIA, and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin. Am J Med . 2016…

…from the extracellular space via washout, enzymatic degradation to inosine, phosphorylation to AMP, and reuptake into cells through a nucleoside transport system. Because of these…

…50 beats per minute in the first 4 to 6 hours after an acute infarction—patients may develop hypotension and signs of end organ hypoperfusion…

…adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast…

…segment elevation myocardial infarction, and cardiogenic shock. Patient related and procedural risk factors The risk of adverse events is increased by: advanced age; diabetes mellitus…

…the diagnostic method. Myocardial bridging has been identified in approximately 0.5–12% of angiographic series and up to 5–75% of CT series; other…

…recognition of edge dissection, tissue prolapse, thrombus, or other acute complications; investigation of restenosis and stent thrombosis. Intravascular imaging may also clarify the mechanism of…

…are not apparent on conventional angiography. Coronary vasomotor disorders may involve epicardial spasm or abnormalities of the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused…

…association with other procedural complications, including distal embolization, coronary dissection, perforation, and abrupt closure. The clinical consequences depend heavily on the amount of viable myocardium…

…angiotensin system blocker; A calcium channel blocker; and A thiazide or thiazide like diuretic, with all agents prescribed at maximum or maximally tolerated doses. The…

…medicine Definition and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled…

…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…

…regardless of all other circumstances. The initial rhythm is an indicator of the underlying etiology, duration of cardiac arrest, quality of CPR, and a prognostic…

…provided that the clinical characteristics are in line with the disorder. There are however other disorders that may bring about similar ECG changes, and these…

…of hospital cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL. The hemodynamic and…

…through the bundle of His, and hence it originates in the atria. In other words: tachycardias with narrow QRS complexes originate in the atria. the…

…angle of observation. Other vectors may interfere with the injury currents, and inhibit them from being detected by leads with opposite angles of observation. The…

…wide simply because the ectopic impulses that cause these rhythms spread partially or entirely outside of the ventricular conduction system, and thus the ventricular depolarization…

…within 120 minutes Fibrinolysis within 10 minutes of the diagnosis, if symptom duration is under 12 hours and there is no contraindication After successful fibrinolysis…

…treatment and treatment of the precipitating illness the prognosis is considerably better [3,5]. Pathophysiology Alcohol enhances inhibitory signalling via gamma aminobutyric acid, GABA, and…

…bradykinin and other tachykinins, such as substance P. When ACE is inhibited, the resulting accumulation of these peptides irritates afferent neural pathways in the respiratory…

…the extent of circulatory compromise. Features associated with an unfavourable short term prognosis include: Tachycardia Low systolic blood pressure Respiratory insufficiency, manifested by tachypnoea and…

…anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of…

…permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention…

…lives therefore differ substantially: approximately 20 minutes for BNP and 90 minutes for NT proBNP. Consequently, plasma concentrations of the two peptides are not interchangeable…

…Reliance on hypokalaemia alone therefore misses a substantial proportion of cases. The cardiorenal and cerebrovascular consequences of unrecognized PA make early case detection clinically important…

…plaque morphology and location, comorbidities, environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial…

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

…Decompensated heart failure – due to the risk of circulatory collapse and arrhythmias Pulmonary embolism in acute phase – due to risk of aggravation of the condition…

…Use of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…Measure the blood pressure, initially in both arms if this can be done without losing time. 7. Perform urgent CT of the brain and CT…

…Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic blood pressure towards 100 to 120 mmHg…

…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…

…Consequently, isolated systolic hypertension and widening pulse pressure are common in later life. These changes contribute to the complexity of defining an appropriate treatment target…

…history. The evaluation should establish: The magnitude of untreated LDL C elevation. The presence and age of onset of premature CAD or other vascular disease…