…treat (NNT) for the ACLS specific interventions is much higher or uncertain, meaning that the efficacy of these interventions is much lower or uncertain. Indeed…

…ISR remains the most frequent cause of PCI failure, despite its substantially lower incidence with drug eluting stents (DES) than with bare metal stents (BMS…

…the baseline, regardless of whether its other parts are above the baseline. T wave inversions are frequently misunderstood, particularly in the setting of ischemia. Normal…

…features of Brugada syndrome are fairly specific to the disorder, provided that the clinical characteristics are in line with the disorder. There are however other…

…a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral arterial…

…longer episodes, a lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI…

…Example of third degree AV block. Click to zoom. ECG features of third degree AV block On the ECG P waves have no relation to…

…third vector: the ventricular free wall The vectors resulting from activation of the ventricular free walls is directed to the left and downwards ( Figure 7 )…

…or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia, antiarrhythmic drugs, or electromagnetic disturbance caused by other…

…often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high after hip fracture, major…

…of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge dissection, overlapping stents, crush technique, stent fracture…

…left coronary cusp (LCC), and noncoronary cusp (NCC), showing the same branches as in panel A for cross modality comparison. Clinical features Occlusion of the…

…can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with a pleural friction rub…

…with or without left ventricular hypertrophy. Among patients with NSTE ACS undergoing angiography, approximately 10% have no critical epicardial stenosis. In some of these patients…

…impulse reaches the atrioventricular node when there are two pathways, one being refractory and the other capable of conducting the impulse, re entry may arise…

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

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

…perimyocarditis: ECG changes and clinical features The pericardium is a double walled sac in which the heart and the roots of the great vessels are…

…of dilated cardiomyopathy. Other causes of ventricular dilation ( e.g ischemic cardiomyopathy) must be excluded before establishing a diagnosis of DCM. Patient characteristics, clinical features…

…favorable prognosis, as compared with other forms of ventricular tachycardia. Mechanisms of ventricular tachycardia Ventricular tachycardia (VT) may emerge due to increased/abnormal automaticity, re…

…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…

…of inflammatory cells. Dyslipidaemia, cigarette smoking, hypertension, diabetes mellitus and other adverse influences disturb these functions. The resulting endothelial dysfunction promotes inappropriate vasoconstriction, adhesion of…

…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…

…cardiac arrest. Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic…

…Other coronary anomalies Anomalous coronary origin and course can impair coronary perfusion, particularly during vigorous exercise. In AAOCA, high risk anatomical features include an interarterial…

…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…

…early phases of ischemia). To conclude, concave ST segment elevation is atypical of ischemia, but they do not rule out ischemia. Other features of ischemic…

…care early with life threatening features or an inadequate response. First line treatment is oxygen in hypoxaemia, repeated doses of an inhaled short acting β2…

…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…

…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)…

…microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism…

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

…risk of stroke; Increased risk of end stage renal disease; Increased mortality; and A higher probability of secondary hypertension. Patients may also have comorbid features…

…To address these challenges, researchers have developed ECG criteria designed to identify ischemia in the presence of left bundle branch block. The most widely recognized…

…prediction tool currently exists. At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false…

…whereas others have features overlapping with HFpEF, including abnormalities of LV relaxation and filling. Hypertension and diabetes can contribute to the development of heart failure…

…hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left ventricular (LV) remodeling Ischemic cardiomyopathy is the leading cause of heart failure with reduced ejection fraction …

…the specificity was lower for fragmented QRS (89% vs 99%). The absence of fragmented QRS has a high negative predictive value (93%) for myocardial infarction…

…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…

…and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for the prevention of…

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

…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…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…The patient sits upright on the couch, far enough forward that the head will extend beyond the end of the couch when laid down. 2…

…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…

…aggregation. Because aspirin affects only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The…

…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…

…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…

…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…

…arteries. It frequently coexists with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous…

…coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to chronic limb threat

…beats per minute. Note that with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2…

…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…

…at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist…

…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…