…and serotonin. In patients with CAD, endothelial disruption may convert normal vasodilator responses to vasoconstriction; however, endothelial dysfunction alone is not sufficient, and an additional…

…may present with symptoms of digitalis toxicity, which manifests across multiple organ systems. Non cardiac symptoms include headache, nausea, vomiting, generalized malaise, and visual disturbances…

…with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor neurone disease, myopathies and…

…level of care , with readiness for respiratory support. 5. Treatment of the alcohol use disorder and planned follow up , not merely detoxification. Benzodiazepines reduce the…

…for pathological R wave progression is considerably lower than pathological Q waves and guidelines do not state any ECG criteria specific to R wave progression…

…other cardinal symptoms and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not…

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

…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…

…C pharmacologically has not been shown to reduce cardiovascular events. Very high HDL C may paradoxically be associated with increased risk, and HDL C should…

…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 fibrinolysis, not an acceptable routine target. The shorter the ischaemic time, the more myocardium can be salvaged. Call the PCI service in parallel with…

…vertigo HINTS is not a test for BPPV. It is used in the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus, nausea and difficulty walking…

…not administer to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other…

…maintenance treatment. The source material does not specify the loading dose. Efficacy and harms In secondary prevention trials involving patients with previous vascular disease, aspirin…

…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…

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

…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…

…elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin, so biomarker interpretation must be integrated with the clinical…

…blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However, association is not the…

…ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably…

…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…

…with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and…

…also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention. Clinical assessment should include functional status and walking capacity…

…with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption…

…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…

…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…

…is given. An ECG without ischemic ST T changes when recording during chest pain is not consistent with myocardial ischemia. In other words, chest pain…

…ultrasound is emitted and analyzed continuously in the former. This allows much higher velocitites to be measured. Continuous wave Doppler is therefore not limited by…

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

…currents are not strong enough to be detected on leads with opposite angle of observation. Other vectors may interfere with the injury currents, and inhibit…

…electrically dissociated from each other. This condition is referred to as atrioventricular (AV) dissociation. Importantly, for the ventricles to have any electrical (and thus pumping)…

…lowest rib and the iliac crest, at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement…

…discuss with the on call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is not contraindicated, and contact with the…

…the periosteum that hurts, not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small…

…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…

…it will disappear, and the documentation is all that remains. 3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4…

…single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period…

…organ damage should not normally be lowered rapidly with intravenous drugs. Such treatment has not been shown to improve the prognosis and can cause hypotension…

…meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating…

…really are caused by the hyponatraemia. With severe symptoms and marked hypotonic hyponatraemia, however, treatment must not be delayed [1,3]. Severe symptoms: treat immediately…

…GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance. Synthetic function and…

…A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as neutropenic sepsis even if the temperature criterion is not met…

…tamponade — not on how wide the rim of fluid looks. With ultrasound guidance, the point at which the fluid lies most superficially is chosen and…

…local availability. Betamethasone (Betapred 4 mg/mL) is water soluble and short acting, not a depot preparation, and gives a shorter duration of effect. Lidocaine…

…during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes. Standby pacing — pads applied but the device not…

…Poisoning with other weak acids where the poison control centre recommends it, for example certain phenoxy acid herbicides (2,4 D, MCPA) and methotrexate overdose…

…mm. Limitations Formulas assume normal body habitus Ethnic variations may require adjusted thresholds Always correlate with imaging measurements Not valid for pediatric patients <15 years

…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…

…AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age rather than sex alone. Consequently…

…BLED score is a widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF)…

…Comparison with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and…

…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…

…and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations…

…haemodynamically stable patients with both RV dysfunction on imaging and elevated cardiac biomarkers. Intermediate low risk PE includes stable patients who are not low risk…

…associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although the exact exposure threshold and duration required are not established…

…cells and macrophages; a thin fibrous cap; positive remodelling; neovascularization; intraplaque haemorrhage; adventitial inflammation; spotty calcification. Nevertheless, the presence of these features does not imply…

Arrhythmias and arrhythmology Critical care Definition and pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and…

…and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age alone…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…SCORE2 and SCORE2 OP apply SCORE2 and SCORE2 OP are intended for apparently healthy people or for individuals with elevated BP who do not already…