…has a high negative predictive value (93%) for myocardial infarction. Moreover, fragmented QRS is associated with an increased risk of sudden cardiac death and ventricular…

…X linked or other non autosomal dominant mechanisms. Complex or multifactorial genetic architecture. The inheritance pattern affects the appropriate scope and duration of family surveillance…

…low density lipoprotein (VLDL) Chylomicrons and other triglyceride rich particles Thus, non HDL C provides a broader estimate of atherogenic cholesterol than LDL C alone…

…beats per minute. Note that with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2…

…ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine appears to exert several anti inflammatory effects relevant to…

…from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies…

…in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at…

…to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position also works and is

…and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of…

…and drug related presentations Severe hypertension may result from phaeochromocytoma, monoamine oxidase inhibitor crisis, cocaine intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of…

…should be considered within a stepwise, target based lipid lowering strategy: Dietary and lifestyle interventions form the foundation of treatment. Statins are the preferred first…

…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…

…instability is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions are often futile…

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…

…increases the quality of the examination, and allows for standardized comparisons of serial examinations. If pathology is discovered during the standard examination, other examinations (which…

…dysfunction, side effects of medications and acute myocardial infarction. Holter ECG is useful to determine the frequency, severity and situational dependence of sinus bradycardia. If…

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

…peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack…

…of multiple modest dietary changes. Mediterranean type diets provide polyphenols from extra virgin olive oil, fruits, vegetables, nuts and legumes; unsaturated fatty acids and other…

…testing and the anticipated effect of the result on management. ICA with available coronary pressure assessment is recommended in patients with a very high clinical…

…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…

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

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds…

…of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED, HEMORR2HAGES, and…

…the sinus and atrioventricular (AV) nodes. In addition to these direct effects, adenosine antagonizes catecholamine stimulated adenylate cyclase. This inhibition decreases the accumulation of cyclic…

…true bradyarrhythmic or asystolic arrest from other tachyarrhythmic events. On the surface electrocardiogram, sinus bradycardia may appear at rates of 40 to 48 beats per…

…risk High risk Very high risk Correct selection of the country risk cluster is therefore essential. The clusters include different European and surrounding countries, and…

…peripheral artery to the aortic root and coronary ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides…

…Other coronary anomalies Anomalous coronary origin and course can impair coronary perfusion, particularly during vigorous exercise. In AAOCA, high risk anatomical features include an interarterial…

…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…

…in other reports. It is more frequent in women and in patients presenting with NSTEMI than in those presenting with STEMI. Approximately one third of…

…of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other…

…kidney function; Excess dietary sodium and volume overload; Concomitant drugs or conditions that increase blood pressure; or An undiagnosed secondary cause of hypertension. White coat…

…or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding cardiovascular effects and potential…

…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…

…are easy to separate from those in Brugada syndrome and the risk of ventricular arrhythmias and sudden cardiac death is considerably lower than the risk…

…Pneumonia High altitude sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular diseases Anemia The natural course of asphyxia…

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

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

…after reperfusion in an occluded coronary artery. It also occurs as side effect of drugs, hypoxia, myocarditis and electrolyte disorders. Because the rate (60–100…

…pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose, high sensitivity troponin and…

…occurs after an abrupt reduction or cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration…

…accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins, such as substance P. When ACE is inhibited, the resulting accumulation of these…

…high risk PE and therefore requires an emergency management pathway. Patients without haemodynamic instability require more detailed prognostic evaluation using two complementary domains: Indicators of…

…effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of its high blood flow and…

…luminal diameter A high degree of residual stenosis Long lesion length Diabetes Untreated edge dissection DES have reduced restenosis compared with BMS, and newer generation…

…generally increase with age and are higher in patients with impaired renal function, reflecting both reduced clearance and the high prevalence of structural heart disease…

…macrophages, neurons and other tissues. This distribution helps explain why PA produces cardiovascular injury beyond its effects on blood pressure and potassium balance. The principal…

…inflammation and other systemic influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the…

…is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities…

…defibrillators and other emergency instruments. Personnel conducting the test must be formally trained to assess cardiovascular response, symptoms, and ECG changes. Although the risk of…

…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…

…anaesthetic. Place a field block in healthy skin around the abscess instead of injecting into it, and expect the procedure to hurt even so. Offer…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect, the dosing, the adverse effects and the important precautions. A hypertensive…

…definition of MI. Type 1 MI is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and…

…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…

…The magnitude of untreated LDL C elevation. The presence and age of onset of premature CAD or other vascular disease. A history of myocardial infarction…