…the sensitivity is low). U wave changes always accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI. QTc prolongation The…

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…

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

…cytokine signalling and recruitment of inflammatory cells to vascular lesions. The interleukin 1β pathway, with downstream effects involving interleukin 6 and C reactive protein…

…stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard post ACS regimen is DAPT for 12…

…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…

…spike is followed by a wide QRS complex and a pulse that can be felt. The other predictable error is forgetting that pacing hurts a…

…sex and genetic predisposition. Acute cardiovascular effects Acute ethanol exposure has a negative inotropic effect and promotes peripheral vasodilation through reduced systemic vascular resistance. The…

…impair autoregulation and cause ischemia Acute rapid reduction may cause harm without prognostic benefit Clinical Presentation and Symptoms Symptoms depend on the organ system involved…

…The effect was consistent in patients with and without diabetes. A pooled analysis of studies involving patients with heterozygous familial hypercholesterolaemia or ASCVD found an…

…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…

…the ultrasound system performs several calculates based on these parameters (e.g adjusting various dimensions/volumes to body surface area). Heart rate and blood pressure…

…risk of developing symptoms. The most common non reversible causes of sinus bradycardia are sinus node dysfunction, side effects of medications and acute myocardial infarction…

…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…

…homeostasis, lipids and apolipoproteins, endothelial function, systemic inflammation, liver fat synthesis, adiposity, thrombosis and coagulation, cardiac function, satiety, appetite, the gut microbiome and metabolic expenditure…

…stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed or non obstructive coronary arteries, possible…

…be assessed using several different scoring systems. To date, the most used systems are the cerebral performance category (CPC) Score and modified Ranking Score (mRS…

…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…

…well the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging…

…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…

…et al. A new risk scheme to predict warfarin associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study. J Am Coll Cardiol…

…It is removed from the extracellular space via washout, enzymatic degradation to inosine, phosphorylation to AMP, and reuptake into cells through a nucleoside transport system…

…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…

…mortality is generally below 0.1% in contemporary series. Reported risks vary according to the population and definitions used. Complication Reported risk (%) Mortality 0.11…

…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…

…images by transmitting ultrasound from an intracoronary catheter and recording echoes reflected from the vessel wall. Contemporary systems use frequencies ranging from approximately 20 to…

…physiological or systemic stressors, with treatment directed at the precipitating condition. Myocardial and non ischaemic mimics Takotsubo syndrome, myocarditis, and cardiomyopathies may present with symptoms…

…distal flow and myocardial perfusion. Continuous assessment of ischemia, ventricular function, blood pressure, and signs of shock. A coronary dissection that extends into the media…

…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…

…other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately…

…with recent changes in symptoms or signs, with or without ECG abnormalities and with or without an elevation in cardiac troponin. The underlying pathological mechanism…

…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…

…than the risk among patients with Brugada syndrome. It follows that Brugada syndrome is a likely diagnosis in patients presenting with these symptoms and typical…

…DW, Wickman LL, Swart GL. The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 1995;30:16975…

…Initial management includes assessing the patient's clinical status (symptoms, hemodynamics), ECG and risk factors (age, previous disease, medications, laboratory results, etc). Considering the ECG…

…on the other hand, are much less likely to be caused by ischemia ( Figure 1 B ). This is noted in both North American and European…

…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…

…STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based on symptoms, the ECG and…

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

…Clinical Presentation and Symptoms ACE Inhibitor Induced Cough ACE inhibitor induced cough occurs in 5% to 30% of patients taking these agents. The cough is…

…and other conditions incorporated into validated clinical risk tools Acute RV failure is a rapidly progressive syndrome characterized by systemic congestion resulting from impaired RV…

…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…

…and newer generation DES have improved outcomes further. Nevertheless, clinically important ISR remains possible after DES implantation. Clinical Presentation and Symptoms The clinical spectrum of…

…The result should be integrated with the history, examination, ECG, echocardiography, and other relevant investigations. Clinical Presentation and Symptoms Natriuretic peptide testing is particularly useful…

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

…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…

…across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular complications Symptoms are determined by the…

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

…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…

…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…

…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…

…creatinine, acid–base status and signs of myocardial ischaemia must be monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute…

…changes in symptoms or clinical signs, with or without diagnostic electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges…

…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…

…Clinical presentation and symptoms Heterozygous familial hypercholesterolaemia Many individuals with HeFH are asymptomatic until ASCVD develops. The clinical phenotype is driven principally by lifelong LDL…