…modest absolute reduction may be clinically important in individuals at high or very high risk. Prolonged exposure to lower LDL C concentrations is associated with…

…In many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses…

…ritonavir, and atazanavir) can lead to a significant increase in exposure to ticagrelor. Dosage: Acute Coronary Syndromes Treatment with Ticagrelor should start with a loading…

…women or five for men on one occasion. Pharmacokinetics and pathophysiology Approximately 95% of ingested ethanol undergoes hepatic metabolism. Alcohol dehydrogenase converts ethanol to acetaldehyde…

…for smoking and anticipated barriers to cessation. Exposure to second hand smoke. Use of cannabis, electronic cigarettes or other inhaled products. Readiness to attempt cessation…

…P gp or CYP3A4 inhibitors and inducers (azole antifungals, HIV protease inhibitors, rifampicin, carbamazepine, St John's wort) alter DOAC exposure substantially. Thrombolysis in stroke…

…demand. In many cases, the initiating process is plaque disruption with thrombosis; other cases result from spasm, microvascular dysfunction, embolism, dissection, hypotension or shock, respiratory…

…they annihilate each other, producing two gamma photons emitted in opposite directions. PET scanners detect these gamma rays to construct images with high spatial and…

…XX and XY individuals and are reflected in cardiovascular structure and function. Sociocultural factors contribute independently to differences in exposure to risk, access to care…

…intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of antihypertensive medication, particularly clonidine, can also precipitate a hypertensive crisis. Pregnancy Hypertensive emergencies in pre

…abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood…

…causes transmural ischaemia. The resulting abnormalities in left ventricular function may lead to myocardial infarction, ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. Spasm may…

…lifelong exposure to high LDL C is central to the disease burden. In untreated HeFH, CAD commonly develops during the third or fourth decade in…

…in medication or an exposure Concussion, temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This corresponds to…

…suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with…

…meals, or exposure to cold. Relieving factors, including rest or medication. Time of day and temporal pattern. Change in frequency, severity, or exercise threshold. Potential…

…in order to suggest ischemia. Inverted U waves are even more typical of ischemia (but the sensitivity is low). U wave changes always accompany other…

…Finding Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal breathing Impending muscle fatigue Respiratory…

…in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease. It combines a structured…

…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…

…a non PCI hospital to wire crossing As quickly as possible, primary PCI if the total expected time is 120 minutes or less If PCI…

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

…administer to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications…

…term interventions intended to reduce recurrent infarction, ischaemic stroke, cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular…

…LDL C or non HDL C, cardiovascular risk may be misestimated if cholesterol measures alone are used. Risk in these circumstances appears to track more…

…prevented was similar to the number of major bleeding events caused. The evidence is not materially different by age or sex in the overall trial…

…compromise leading to transient ischaemic attack (TIA) or stroke. The risk associated with asymptomatic disease depends substantially on stenosis severity and plaque characteristics. In the…

…in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen, or epigastrium. Dyspnoea, nausea, vomiting, diaphoresis, fatigue, faintness, and other…

…completely different. It took roughly 50 years for researchers to finally conclude that high cholesterol levels caused coronary artery disease and atherosclerosis in general. This…

…be assessed in a structured manner. Within the ARC HBR framework, HBR is defined by the presence of at least one major criterion or two…

…left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment…

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

…wave. Increasing the paper speed to 50 mm/s or applying carotid massage (which increases the atrioventricular block) will be helpful in such situations. Figure…

…tend to cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other…

…ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or other…

…wave Doppler and pulsed wave Doppler is that ultrasound is emitted and analyzed continuously in the former. This allows much higher velocitites to be measured…

…may have a concave appearance if the T wave is prominent (such as in hyperkalemia, early repolarization or even early phases of ischemia). To conclude…

…3. In third degree AV block, no atrial impulses are conducted to the ventricles. The atria and the ventricles are electrically dissociated from each other…

…height in cm × weight in kg / 3600) m². Normal adult 1.6–2.0 m². Nutritional screening Unintentional weight loss 5 % over three months or…

…into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position is necessary. After previous…

…until conditions are controlled. Contraindications In life threatening conditions all contraindications are relative — but they govern which site is chosen. Infection, burns or trauma over…

…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…

…Measure the size of the ptosis in millimetres, the time to diplopia on upward gaze, or the number of seconds the patient can hold the…

…has been achieved, 7 days in bacteraemia or cefotaxime plus metronidazole 1 g × 3 IV plus 1.5 g for the first dose, then 1…

…important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination with new or progressive acute target organ damage. Common manifestations…

…glucose has already begun to rise by the time it is measured, for example after relatives have given carbohydrate or glucagon. In a person without…

…is to relieve the cerebral oedema quickly, not to normalise the plasma sodium. Chronic or minimally symptomatic hyponatraemia must be corrected in a controlled fashion…

…the suspicion to bone, pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs…

…neutropenia related to cancer treatment. Children, pregnant women, patients after allogeneic stem cell transplantation and patients treated with CAR T cells or other advanced immunotherapies…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…prosthesis in the adjacent joint. Known hypersensitivity to the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days. Suspected or…

…delay pacing in order to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice…

…must be corrected first or in parallel; otherwise the treatment is ineffective. Hypocalcaemia , symptomatic. Alkalosis increases the binding of calcium to albumin and lowers ionised…

…Definition of aortic aneurysm Sinus of Valsalva 45 mm. Any other segment 40 mm in diameter. Thresholds for surgery Threshold for surgery Relevant patient category…

…to anticoagulants. Components of the ATRIA Score The ATRIA score assigns points based on five clinical factors: Anemia: Hemoglobin <13 g/dL in men or…

…risk in women is more closely associated with other comorbidities and age rather than sex alone. Consequently, the CHA₂DS₂ VA score was developed to provide…

…bleeding risks in AF patients, regardless of the type of oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding…

…to guide clinicians in balancing estimating the risks of bleeding. Components of the HEMORR₂HAGES Score The acronym HEMORR₂HAGES represents the following parameters: H epatic or…

…in 5% to 30% of patients taking these agents. The cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in…

…other chest discomfort, dyspnoea, or no symptoms. Although chronic coronary disease may remain stable for prolonged periods, it can progress or destabilize abruptly, leading to…