…with chronic kidney disease, particularly diabetic kidney disease and advanced CKD. The clinical course is often more rapidly reversible than that of other forms of…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the…

…disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure, shock…

…for intermediate non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and unobstructed…

…ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form of…

…of epicardial flow. The electrocardiographic appearance depends on several interacting factors: The stage of the ischaemic process: acute, evolving or chronic The severity of ischaemia…

Cardiology Coronary Atherosclerosis Coronary atherosclerosis is a chronic, progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental…

…the heart Trauma Tuberculousis Neoplasms (cancer) Post cardiac surgery (hemorrhagic pericarditis). Symptoms of acute pericarditis/myocarditis There are two forms of pericarditis: acute and chronic…

…The cardiovascular burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or…

…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…

…which includes forms that are caused by pre excitation. Myocardial perfusion scintigraphy. Contraindications Asthma and COPD. Adenosine has caused mild to moderate exacerbation of asthma…

…most common indication for heart transplantation. Echocardiography can not distinguish different types of dilated cardiomyopathy. Other causes of ventricular dilation ( e.g ischemic cardiomyopathy) must…

…forms. Primary hyperaldosteronism is identified as the most frequent cause, comprising approximately 20–25% of secondary hypertension cases. Coarctation of the aorta and renovascular disease…

…potassium, and resistant to suppression by sodium loading. It is the most common form of secondary hypertension. Aldosterone acts principally through the mineralocorticoid receptor (MR)…

…Recessive forms exist, although they are rare (Naxos disease, Carvajal syndrome). The prevalence of ARVC is between 0.02 and 0.05% in Europe (Corrado…

…congenital heart disease and catecholamine induced ventricular tachycardia . The vast majority of patients with ventricular tachycardia either have coronary artery disease (ischemic heart disease), heart…

…Many of the diagnoses mentioned below are discussed in detail in other chapters, to which links are provided throughout the text. Heart rate During the…

…dissection. Coronary embolism of cardiac or non cardiac origin. Oxygen supply–demand mismatch, including demand related events in the presence of fixed coronary disease. More…

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

…often necessary to normalize blood pressure. Management of hypertension requires careful consideration of other cardiovascular risk factors and coexisting conditions. Therapy must be tailored to…

…case of ischemia, cardiac myocytes protect themselves by switching to anaerobic metabolism. This is possible because cardiac myocytes store glycogen (a storage form of glucose…

…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…

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

…largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow…

…should be considered within a stepwise, target based lipid lowering strategy: Dietary and lifestyle interventions form the foundation of treatment. Statins are the preferred first…

…and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions incorporated into…

…Causes of ectopic atrial tachycardia and ectopic atrial rhythm Side effect of digoxin. Heart failure. Lung disease (COPD, pulmonary hypertension, etc). Ischemic heart disease (coronary…

…once the exercise is stopped. Some experts believe that these ST segment depressions represent a benign form of subendocardial ischemia. Refer to Exercise Stress Testing…

…Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes…

…somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant…

…in the form of a sound wave. If the sound waves encounter a new medium, some sound waves will be reflected while others will transfer…

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

…New arrhythmia or ischaemic ECG changes Concomitant cardiac disease Oxygen targets Patient Initial target saturation : : Known COPD or another clear risk of hypercapnic respiratory failure…

…patients with asthma/chronic obstructive pulmonary disease (COPD). Dyspnea has been reported in patients treated with ticagrelor. Patients with a history of ischemic stroke can…

…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…

…is the principal therapeutic target in lipid management because LDL and other apolipoprotein B containing lipoproteins play a causal role in atherosclerotic cardiovascular disease (ASCVD)…

…continuing ischaemia, heart failure, electrical instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia…

…the side lying variant of the Dix–Hallpike test. Marked obesity or spinal disease that makes positioning impossible. Severe angina, heart failure or recent myocardial…

…moderate heart failure, kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic…

… reduce ischaemic stroke and cardiovascular mortality; prevent stent thrombosis after PCI; reduce recurrent atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention…

…Their clinical importance arises from the causal role of low density lipoprotein cholesterol (LDL C) and other apoB containing lipoproteins in atherosclerotic cardiovascular disease (ASCVD)…

…that inhibit other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to individuals without established atherosclerotic cardiovascular disease (ASCVD…

…of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other cardiopulmonary causes , including myopericardial disease…

…Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…

…ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease, the principal symptomatic indication for revascularization is angina that remains refractory despite medical therapy…

…the presence of multilevel disease and collateral circulation. Flow limitation may be clinically silent, manifest as exertional symptoms, or progress to chronic limb threatening ischaemia …

…smoking carries a substantial proportion of the excess ischaemic heart disease risk associated with heavy smoking. Consequently, reducing the number of cigarettes smoked does not…

…with significant heart disease, predominantly ischemic heart disease. However, most cardiac conditions may be associated with atrial flutter. As compared with several other supraventricular tachyarrhythmias…

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

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

…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…

…significant coronary artery disease, potentially resulting in false negative findings. Radiotracers in myocardial perfusion imaging Radiotracers are designed to identify ischemic areas of the myocardium…

…ischemia. Other features of ischemic ST segment elevations In STE ACS (STEMI) the level of the J point is typically close to the level of…

…AV block (complete heart block, AV dissociation). Figure 2. Example of third degree AV block. Click to zoom. ECG features of third degree AV block…

…the bleeding risk of the procedure and by renal function. In markedly reduced renal function (dabigatran at eGFR <30 mL/min, the other DOACs at…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…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…

…Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia, cold agglutinin disease…

…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…