…cigarette smoking, hypertension and diabetes mellitus—disturb endothelial function and favour the accumulation of fat, smooth muscle cells, fibroblasts and extracellular matrix beneath the endothelium…

…ST segment elevation myocardial infarction; extensive vascular calcification; female sex; low body mass index; larger arterial sheaths; greater intensity of procedural anticoagulation; complex coronary anatomy…

…and spotty calcification. However, the concept has important limitations. Although thin capped fibroatheromas may have imaging characteristics associated with rupture, fewer than 5% of such…

…atrial fibrillation, and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms linking CKD to cardiovascular disease The association is…

…all cause mortality. The excess risk is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with…

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

…the image. Acoustic shadowing Some structures have very high echogenicity (e.g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too…

…ischemia. Inverted U waves are even more typical of ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes…

…Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood…

…Dosage: Acute Coronary Syndromes Treatment with Ticagrelor should start with a loading dose of 180 mg (two 90 mg tablets) followed by 90 mg twice…

…Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease…

…189 mg/dL, 10 year risk of a first hard ASCVD event—fatal or nonfatal myocardial infarction or stroke—should be estimated. The risk categories…

…and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine…

…primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia, heart failure, electrical instability or a large area of myocardium at…

…to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can otherwise…

…NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory reactions that promote plaque formation and progression. As the burden of retained…

…nonsteroidal anti inflammatory drugs Corticosteroid therapy Other antiplatelet or antithrombotic drugs Selective serotonin reuptake inhibitors Patient selection Aspirin should not be prescribed routinely to individuals…

…initial components of assessment. The history should include: previous TIA or stroke; symptoms suggesting current or recent cerebral ischaemia; known CAD, PAD, or other atherosclerotic…

…and other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around…

…with homozygous FH typically die from acute myocardial infarction at 20 to 30 years of age. People with familial hypercholesterolemia have no other metabolic aberration…

…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…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures…

…than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the…

…Clinical presentation and assessment Identifying tobacco exposure Every cardiovascular assessment should establish: Current smoking status. Cigarettes smoked per day. Duration of smoking and cumulative exposure…

…which yields a ventricular rate of about 150 beats per minute. One should always consider atrial flutter when confronted with a regular tachyarrhythmia at 150…

…show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest left ventricular hypertrophy (LVH), one should suspect concomitant…

…myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An…

…1). This is possible by using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves…

…tomographic images of the left ventricle. In PET (Positron Emission Tomography), radiotracers emit positrons. When a positron collides with an electron, they annihilate each other…

…that a patient with STEMI may present during any of the phases illustrated in this figure, which is why it should be studied in detail…

…atrial impulses are conducted to the ventricles. The atria and the ventricles are electrically dissociated from each other. This condition is referred to as atrioventricular…

…22 above 70 years, and reduced food intake together form the basis of most screening instruments and should prompt a nutritional assessment. See also unintentional…

…min, the other DOACs at eGFR <15 mL/min) at least 96 hours should have elapsed since the last dose before an invasive procedure. Exact…

…smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about 0.5 mL…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…high grade AV block without pacemaker protection. Asthma and other marked obstructive airways disease — relative; the risk of bronchospasm is real. Hypotension and haemodynamic instability…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…rise can cause osmotic demyelination syndrome [1,2]. Hyponatraemia is primarily a disorder of water balance. The plasma sodium reflects the ratio between the body…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

…pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response…

…tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than the conditions in which…

…nothing documented but increase the risk of skin and fat atrophy. Lederspan states in addition that the dosing interval should not be shorter than four…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic…

…SOVd} = 1.92 + 0.74 \times \text{BSA} ) Definition of aortic aneurysm Sinus of Valsalva 45 mm. Any other segment 40 mm in diameter…

…6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist…

…chadsva] The CHA₂DS₂ VA score has superseded the CHA₂DS₂ VASc score. As of 2025, it is recommended to use the CHA₂DS₂ VA score for stroke…

…patients, regardless of the type of oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such…

…3 Interpretation of HEMORR₂HAGES score. Comparison with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk…

…Symptoms of retrosternal burning after meals or on recumbency, frequent eructation, hoarseness, and throat pain may point toward gastroesophageal reflux. Physical examination should include a…

…neck, jaw, shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or vomiting. Persistent shortness of breath. Weakness, dizziness…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…drinking in either sex. Other definitions of unhealthy drinking include at least two drinks daily in women or three in men, or at least four…

…itself. It may cause symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other thromboembolic events. Subclinical…