…for pathological R wave progression is considerably lower than pathological Q waves and guidelines do not state any ECG criteria specific to R wave progression…

…However, other inheritance patterns, de novo variants, incomplete penetrance and variable phenotypic expression complicate risk prediction. Familial clustering may also reflect shared environmental or behavioural…

…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…

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

…prevention because of fatal infections and high cost. Low dose methotrexate did not reduce cardiovascular outcomes, and several other agents, including pexelizumab, losmapimod and darapladib…

…ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably…

…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…

…with airway expertise. Procedure 1. Dry the skin and shave where necessary. Do not clip the hair — small cuts cause burning pain. 2. Position the…

…heart failure, cardiovascular mortality and atrial fibrillation. Consequently, alcohol should not be initiated as a cardiovascular preventive strategy. A drink equivalent contains approximately 12–14…

…and cerebral involvement. Catecholamine excess and drug related presentations Severe hypertension may result from phaeochromocytoma, monoamine oxidase inhibitor crisis, cocaine intoxication, or other sympathomimetic exposure…

…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…

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

…drug. • Effective in sinus bradycardia or AV node block. • Dose <0.5 mg may worsen bradycardia and should not be given. • Relative contraindications are ileus…

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…

…and allows for standardized comparisons of serial examinations. If pathology is discovered during the standard examination, other examinations (which are not included in the standard…

…in healthy young individuals who are not well trained. This is also a normal finding. Abnormal (pathological) causes of sinus bradycardia In all other situations…

…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…

…vegetables, nuts and legumes; unsaturated fatty acids and other bioactive compounds from nuts; and antioxidant and antithrombotic constituents from whole grains. These combined effects may…

…thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features that may not be evident on angiography alone…

…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…

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

…the periosteum that hurts, not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small…

…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…

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

…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…

…and hyperkalemia. For recurrent symptomatic bradycardia, temporary or permanent pacing may be required. However, transcutaneous pacing in the setting of cardiac arrest has not demonstrated…

…HMOD) Probable or definite familial hypercholesterolaemia Other markedly abnormal single risk factors or genetic, rare lipid, or BP disorders Pregnancy Established ASCVD includes previous acute…

…contrast media are injected selectively into the epicardial coronary arteries through a catheter advanced from a peripheral artery to the aortic root and coronary ostia…

…stunning, and sudden cardiac death. It may also be associated with early death after cardiac transplantation. Myocardial bridging is not itself an atherosclerotic lesion, but…

…tissue prolapse, and strut coverage. OCT has limited tissue penetration, generally approximately 1–3 mm, and may not show the EEM through substantial plaque or…

…These disorders require distinction from true MINOCA because their management is different. Takotsubo syndrome and myocarditis should not be classified as MINOCA when they are…

…or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use. No reflow…

…are not included in the European guideline definition. Clinical Presentation and Symptoms The source material does not describe a distinctive symptom profile for resistant hypertension…

…with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption…

…with or without ECG abnormalities and with or without an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion…

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

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

CPR Hypoxia and asphyxiation Hypoxia refers to a reduced partial pressure of oxygen in the blood. Asphyxia is characterized by insufficient ventilation, leading to hypoxia…

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

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

…myocarditis and electrolyte disorders. Because the rate (60–100 beats per minute) is on a par with the rate in sinus rhythm and there is…

…failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis, not an acceptable routine target…

…alpha 2 agonists and antipsychotics, which mainly affect individual symptoms. Initial management ABCDE and immediate tests Assess the withdrawal and other life threatening conditions at…

…the sensitization of sensory nerve endings due to the accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins, such as substance P…

…with both RV dysfunction on imaging and elevated cardiac biomarkers. Intermediate low risk PE includes stable patients who are not low risk but have either…

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

…although its resolution does not consistently permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may…

…cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac amyloidosis, BNP or NT proBNP may be markedly elevated even when overt congestion is not apparent…

…1, formerly termed glucocorticoid remediable aldosteronism, and other familial forms associated with adrenal adenoma or bilateral adrenal hyperplasia. A family history is therefore important, particularly…

…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…

…CKD Other clinically relevant cardiovascular disease, including PAD Conversely, patients with CVD should be screened systematically for diabetes because undiagnosed T2DM is common and has…

…or other professionals. A physician is always formally responsible for conducting the test. All personnel must be appropriately trained and the laboratory must be equipped…

…fibrillation, ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable rhythm : Tachyarrhythmias that can be treated with defibrillation (ventricular fibrillation) or cardioversion (ventricular tachycardia)…

…a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate…

…brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy centre immediately where large vessel occlusion is possible. Do not…

…This is a general principle, not a universal target. Chronic hypertension shifts autoregulation in the brain and kidneys towards higher pressures. Too rapid a normalisation…

…is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial…

…pressure is not markedly elevated. These apparent J shaped associations are considered unreliable for guiding treatment because of potential confounding, reverse causality, and the association…

…the vascular territory involved and may include manifestations of coronary, cerebral or peripheral arterial disease, although the source material does not specify symptom patterns in…