…Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation—predominant right ventricular (RV) infarction…

…coronary occlusion. Plaque rupture typically involves a thin, collagen poor fibrous cap overlying a large lipid core with many macrophages, resulting in a red, fibrin…

…environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial injury is determined not only…

…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…

…hypertension, heart failure, and the arrhythmia itself. This remodeling manifests as interstitial fibrosis, atrial dilation, and endocardial denudation, which collectively promote local inflammation and create…

…other cytokines. Within the intima, SMCs undergo a phenotypic switch from a contractile to a synthetic state, producing abundant extracellular matrix (ECM) components, primarily interstitial…

…substantially 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 ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI…

…a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute…

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

…channelopathies, heritable aortopathies, selected congenital heart diseases, pulmonary arterial hypertension and thromboembolic disorders. Most recognised heritable cardiovascular conditions demonstrate autosomal dominant transmission, in which an…

…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)…

…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…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity reactions, such as asthma attacks, angioedema, or urticaria with…

…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 in atherosclerotic cardiovascular disease (ASCVD). Atherosclerosis develops through the progressive deposition and retention of LDL C and other apoB…

…only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and…

…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…

…structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other cardiopulmonary causes , including myopericardial disease, pulmonary embolism, aortic emergencies, and pneumothorax…

…which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However…

…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…

…with HFpEF, acute hypertension is a frequent trigger of decompensation and may produce abrupt pulmonary oedema, sometimes requiring non invasive ventilation or intubation. Aortic disease…

…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, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine…

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

…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…

…two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave…

…administration. Radiotracers with higher levels of redistribution can move from areas of higher concentration to regions with lower concentration, for reasons other than perfusion differences…

…with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other…

…block: ECG criteria, clinical characteristics and management This chapter discusses third degree AV block, which is synonymous with AV dissociation, complete AV block, AV block…

…expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist / hip Men 0.90…

…creatinine ≥133 µmol/L Rivaroxaban 20 mg once daily with food 15 mg once daily at eGFR 15 49 mL/min Edoxaban 60 mg once…

…skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A patient who cannot lie…

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

…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…

…sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked obstructive airways disease — relative; the risk of bronchospasm is real…

…3 IV Pneumonia, in chronic lung disease amoxicillin 750 mg × 3 PO 5–7 days or benzylpenicillin 3 g × 4 IV Pneumonia, suspected atypical pathogen…

…organ damage. Isolated malignant retinopathy without other acute organ damage can often be treated more cautiously with oral drugs under careful observation [3,4]. A…

… 2. Is the hyponatraemia acute or chronic? Severe symptoms require immediate treatment with hypertonic sodium chloride, whether the hyponatraemia is acute or chronic. The aim…

…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…

…Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must therefore be managed as…

…overt tamponade with shock there are no absolute contraindications other than the conditions in which the procedure is the wrong treatment : Aortic dissection with haemopericardium…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…The other predictable error is forgetting that pacing hurts a great deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise…

…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…

…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…

…8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED…

…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…

…widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants…

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

…medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care…

…takotsubo cardiomyopathy, valvular disease, arrhythmias, and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS…

…acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions incorporated into validated clinical risk tools Acute RV failure…

…synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…reserved primarily for instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of…