…of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex The…

…risk of transmitting the relevant variant to each child. However, other inheritance patterns, de novo variants, incomplete penetrance and variable phenotypic expression complicate risk prediction…

…containing lipoproteins, including: LDL Intermediate density lipoprotein (IDL) Lipoprotein(a) [Lp(a)] Very low density lipoprotein (VLDL) Chylomicrons and other triglyceride rich particles Thus, non…

…which is standard in the US and many other countries, a 2:1 block will be difficult to discern because the flutter wave may fuse…

…and impair neutrophil chemotaxis toward inflammatory sites. Its cardiovascular effects therefore appear to reflect modulation of vascular inflammation rather than lipid lowering. Other anti inflammatory…

…acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI…

…severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing…

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

…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…

…sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent or nonspecific Treatment setting Usually…

…biweekly injections. Inclisiran is used as an adjunct to dietary measures and maximally tolerated statin therapy, with or without other LDL C lowering drugs, when…

…ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out…

…and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of AV blocks aims to…

…supply results in diminished ATP production and subsequently disruption of cellular metabolism. In case of ischemia, cardiac myocytes protect themselves by switching to anaerobic metabolism…

…become cheaper, more portable, more powerful, equipped with an increasing number of methods to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become…

…infarction. Sinus Node Dysfunction (SND) – Sinus node dysfunction implies that the cells of the sinoatrial node are defective and fail to generate electrical impulses. Side…

…to ventricular fibrillation and must not be confused with any other arrhythmia. Figure 1. Ventricular fibrillation and asystole. ECG Case 1: Ventricular tachycardia progressing to…

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

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

…revascularization and, in selected patients, identifying microvascular or vasomotor coronary disorders. The investigation should be undertaken when its diagnostic or therapeutic consequences are likely to…

…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…

…sedentary behaviour and loss of independence. Identification of PAD also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention…

…5. Aspiration: advance the needle with the stylet in place perpendicular to the bone surface, angled slightly anteriorly and medially. Rotate under steady pressure until…

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

…atria] The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Bleeding Risk Score is a clinical tool designed to estimate the risk of major bleeding…

…usually within 30 seconds. Doses higher than 18 mg are unlikely to revert a tachycardia and should not be used. Specific dosing adjustments are required…

…ectopy is generally asymptomatic and hemodynamically stable. However, when the sinus rate is extremely low—such as less than 40 to 50 beats per minute…

…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…

…their clinical spectrum ranges from transient arrhythmias and minor access site bleeding to myocardial infarction, stroke, coronary perforation, haemodynamic collapse, acute kidney injury, and death…

…in approximately 0.5–12% of angiographic series and up to 5–75% of CT series; other angiographic descriptions report rates of approximately 5–10…

…imaging provides cross sectional and longitudinal information about the artery. The clinical value of these techniques rests on their ability to characterize the anatomy responsible…

…myocardial injury and troponin elevation but are non ischaemic mimics rather than MINOCA when identified as the final diagnosis. Reported prevalence varies according to the…

…for routine use. No reflow may also occur in association with other procedural complications, including distal embolization, coronary dissection, perforation, and abrupt closure. The clinical…

…pharmacological resistance or contribute directly to persistent hypertension. Resistant hypertension is associated with a higher likelihood of secondary hypertension and with substantially greater cardiovascular risk…

…hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete…

…from other mechanisms. Differential diagnoses and alternative causes of troponin release must therefore be considered throughout assessment. Coronary disease is most commonly related to atheromatous…

…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…

…other disorders that may bring about similar ECG changes, and these are as follows: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/ARVD) – ARVC also tends to…

…downregulating metabolism and thus contractility (a consistent finding in acute coronary syndromes). Between 3 8 minutes, pulseless electrical activity (PEA) develops. PEA progresses to asystole…

…ECG and risk factors (age, previous disease, medications, laboratory results, etc). Considering the ECG, which is fundamental in all arrhythmias, the first task is to…

…injury currents are not strong enough to be detected on leads with opposite angle of observation. Other vectors may interfere with the injury currents, and…

…near the bundle of His, the impulse may be delivered to both bundle branches and subsequently the entire ventricular myocardium normally. This may yield a…

…delay and a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed by direct transfer to a…

…zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor…

…is thought to involve the sensitization of sensory nerve endings due to the accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins…

…is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the intensity…

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

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

…dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac amyloidosis, BNP or NT proBNP may be markedly…

…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…

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

…Endocrinology & metabolism Definition and Pathophysiology Type 2 diabetes mellitus (T2DM) is a major cardiovascular risk condition. It is associated with a two to four fold…

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

…i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable…

…compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue…

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety, urinary retention, hypoxia, drug withdrawal and…

…and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations…

…characterized by reduced physiological reserve and increased vulnerability to adverse outcomes. It is dynamic and may improve or worsen with illness, treatment, or other interventions…

…proteins in the hepatic LDL receptor pathway. Reduced cellular uptake and clearance of LDL leads to increased circulating LDL C. The principal genetic mechanisms involve:…