…of cardiac arrest and light reactivity is lost when cerebral blood flow ceases. In other words, during prolonged cardiac arrest without effective perfusion, one expects…

…below). In addition to exercise capacity, stress testing also provides information on electrocardiographic (ECG) reaction, the occurrence of arrhythmias, symptoms, physiological reactions (blood pressure, heart…

…wave inversions and often by the development of Q waves in the same lead distribution [15]. Differential Diagnosis of ST Elevation Several nonischemic conditions can…

…Recognizing that many visitors are interested in other books and online resources, we have plowed through more than 30 of the most popular ECG books…

…waves are positive in lead II, comparison of P wave morphology during tachycardia and sinus rhythm is typically required. The isoelectric baseline lacks the saw…

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

…percent No risk of hypercapnia and a normal blood gas Usually 94 to 98 percent An individually documented target prescription, for example in chronic hypercapnia…

…a summary of the indications, contraindications, dosage, administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination…

…Definition and scope Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition…

…should incorporate the estimated risk, risk enhancing factors and a clinician–patient discussion regarding the expected net benefit of therapy. Lifestyle modification is appropriate across…

…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…

…diagnosis. With a longer expected delay and a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed…

…spot, in three minutes, without drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The…

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

…the clinical importance of non fatal gastrointestinal and intracranial haemorrhage is substantial, particularly because the absolute cardiovascular benefit is small in many primary prevention populations…

…or other atherosclerotic disease; diabetes and other cardiovascular risk factors; smoking, hypertension, hypercholesterolaemia, and sedentary behaviour; family history, particularly in the broader assessment of peripheral…

…although some series report 10–20%. Other life threatening cardiopulmonary conditions account for approximately 5% of presentations in some populations. Despite this relatively low prevalence…

…1960s. In 1948 the NHLBI initiated the Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were…

…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…

…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

…prevent the development of new proximal atherosclerosis. The choice between procedures therefore depends on the balance between: Anatomical completeness and complexity of revascularization Expected effects…

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

…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…

…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…

…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…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…transducer during systole (systole starts at the peak of the R wave on the electrocardiogram). This Doppler signal represents a pronounced mitral regurgitation. In summary…

…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…

…entire electrocardiographic (ECG) development in STE ACS/STEMI. Note that a patient with STEMI may present during any of the phases illustrated in this figure…

…features of third degree AV block On the ECG P waves have no relation to the QRS complexes. The QRS complexes may be normal or…

…in older people with lost muscle mass (where a normal BMI may conceal sarcopenia), in oedema and ascites, and in people under 18 years of…

…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…

…of the specimen — an aspirate that clots before the smears are made is unusable, no matter how well the puncture went. Indications Unexplained cytopenia in…

…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…

…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…

…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…

…assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired…

…duration of effect, the dosing, the adverse effects and the important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…Persistent nausea Moderately reduced consciousness Marked gait instability The specificity of the symptoms is limited. In a patient with moderate symptoms the physician must judge…

…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…

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than the conditions in which the procedure…

…Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…3. Correct the hypokalaemia. Aim for a serum potassium in the upper normal range, around 4.0–4.5 mmol/L, and continue replacement throughout…

…Assessment The sinus of Valsalva diameter (SOVd) is a critical measurement in evaluating aortic root morphology. Age stratified formulas help determine expected normal values based…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…CHA₂DS₂ VASc score. As of 2025, it is recommended to use the CHA₂DS₂ VA score for stroke risk assessment in atrial fibrillation patients. By excluding…

…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…

…performance of HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and HAS BLED: HAS BLED Score: In a study evaluating bleeding risk prediction in…

…bradykinin and other tachykinins, such as substance P. When ACE is inhibited, the resulting accumulation of these peptides irritates afferent neural pathways in the respiratory…

…syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms or clinical signs…

…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…

…associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and…

…alter the local vascular environment. The extracellular matrix is an active component of lesion development rather than merely a structural scaffold. Smooth muscle cells and…

…may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and a higher risk of complications than…

…illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular disease, including heart failure and ischaemic heart disease…