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

…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…

…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…

…1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation…

…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…

…Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated in patients with severe hypertension…

…bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need…

…controversial. Epidemiological studies have often described a J shaped association between consumption and cardiovascular outcomes, with apparently lower overall cardiovascular risk around one drink daily…

…The European definition uses BP ≥180/110 mmHg with acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence…

…measures and maximally tolerated statin therapy, with or without other LDL C lowering drugs, when additional LDL C reduction is required, including in patients with…

…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…

…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…

…Table 1: Myocardial and ECG reaction in various settings with ischemia or increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery…

…and progress in our understanding of the pathophysiology of cardiac disease. Ultrasound systems have become cheaper, more portable, more powerful, equipped with an increasing number…

…the sinoatrial node. They may also induce conduction defects (e.g. AV block). Increased intracranial pressure (manifests with sinus bradycardia and hypertension). Hypothyroidism . Hypothermia . Hyperkalemia …

…be seen. This is pathognomonic (unique) to ventricular fibrillation and must not be confused with any other arrhythmia. Figure 1. Ventricular fibrillation and asystole. ECG…

…two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal…

…Associated With Dietary Patterns Cardiovascular disease and mortality The strongest long term evidence supports Mediterranean or DASH style patterns that emphasize minimally processed foods and…

…intraluminal mass and lesion haziness raise suspicion of thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features…

…zone (the outermost and less ischemic area), which may receive oxygen from collateral vessels. In cardiac arrest, there is no cerebral perfusion, with an equal…

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small 5–10 mL syringe…

…canal is characterised by: A latency of 1–5 seconds before the nystagmus begins. Upbeating and rotatory (torsional) nystagmus with the fast phase beating towards

…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…

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

…in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic arrest and asystole represent severe manifestations of impulse generation or…

…cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment…

…access. In patients with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and blood transfusion with radial access…

…considered and treated in the same broad category as a patient with coronary artery disease when clinically appropriate. Other coronary anomalies Anomalous coronary origin and…

…and necrotic components. Virtual histology IVUS has also been used to identify thin cap fibroatheroma, a plaque phenotype associated with subsequent major adverse cardiovascular events…

…younger and more often female than patients with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional…

…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…

…The terms “controlled resistant hypertension,” referring to blood pressure controlled with four or more medications, and “refractory hypertension,” referring to uncontrolled blood pressure despite five…

…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…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

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

…by DeBehnke et al. and Safar et al. The majority of all asphytic cardiac arrests begin with PEA and progress to asystole. Shockable rhythms (ventricular…

…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…

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

…wide with discordant ST T segment and the rhythm is regular (in most cases). Idioventricular rhythm starts and terminates gradually. It occurs in other situations…

…the more myocardium can be salvaged. Call the PCI service in parallel with drug treatment and transport planning [1,5]. Symptom duration Under 12 hours…

…cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance…

…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…

…haemodynamic collapse, and death. The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The…

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

…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…

…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…

…and other familial forms associated with adrenal adenoma or bilateral adrenal hyperplasia. A family history is therefore important, particularly in patients with early onset hypertension…

…and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with…

…for cardiovascular and kidney disease All patients with diabetes should be assessed for: ASCVD Severe target organ damage (TOD) HF AF CKD Other clinically relevant…

…for conducting the test. All personnel must be appropriately trained and the laboratory must be equipped with defibrillators and other emergency instruments. Personnel conducting the…

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

…rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…the adverse effects and the important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination with new or progressive acute…

…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…

…is dynamic and may improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular…

…particularly informative when it occurs before age 45 years. Homozygous familial hypercholesterolaemia HoFH typically presents with: Extensive cutaneous and tendon xanthomas. Markedly elevated LDL C…