…Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple arterial territories. The arterial wall is biologically active…

…heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or cardiogenic shock Life threatening arrhythmias or cardiac arrest after presentation Mechanical complications of…

…accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral…

…association with other procedural complications, including distal embolization, coronary dissection, perforation, and abrupt closure. The clinical consequences depend heavily on the amount of viable myocardium…

…In cardiogenic shock, the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when…

…if there is suspicion of cervical spine injury, in which scenario head tilt chin lift should only be used if other methods fail to open…

…of several possibilities: Extension of the original infarction or reinfarction Acute native vessel thrombosis Stent thrombosis Mechanical complications of myocardial infarction Pericarditis Dynamic recurrence of…

…the anticoagulation indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure, hypertension, diabetes and vascular…

…Use of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias…

…target INR 2.0 3.0 A mechanical valve may require a higher target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and…

…Mechanical obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other…

…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…

…endotracheal intubation, mechanical chest compressions, targeted temperature management, etc.) and are much less effective in terms of the number needed to treat (NNT). The Number…

…except in a mechanical valve prosthesis and in moderate to severe mitral stenosis, where warfarin applies. Apixaban is often preferred, among other reasons because it…

…mechanical tricuspid prosthesis the lead must not be passed through the valve. The order of management in acute bradycardia Atropine is given in doses of…

…risk factor [2] . This change reflects robust evidence that female sex alone, in the absence of other comorbidities, does not significantly increase stroke risk. Conversely…

…g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too few waves to explore the area behind the reflector. This results…

…that ensures that no other sound waves affect the transducer. The crystals are supported by a backing layer that suppresses the vibrations of the crystals…

…The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms Mechanical abnormalities may…

…use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic heart failure…

…while others will transfer the mechanical (pressure) energy to the new medium, which may also start to vibrate (Figure 1). Figure 1. The principle of…

…or other ECG changes (see below) should lead to a suspicion of ARVC. The gradual loss of myocardium leads to ventricular dilation and right heart…

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

…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…

…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…

…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…

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

…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…

…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…

…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…

…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…

…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…

…of vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in the brain, retina, heart, aorta, kidneys, or other…

…ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures. Both…

…Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather…

…and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of those who…

…vast majority of cases, the re entry circuit in atrial flutter is located in the right atrium and it typically loops around the tricuspid valve…

…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…

…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…

…Continuous wave doppler along the left ventricle, the opening of the mitral valve and the left atrium. Recall that velocities (flows) directed away from the…

…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…

…opposite angle of observation. Other vectors may interfere with the injury currents, and inhibit them from being detected by leads with opposite angles of observation…

…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…

…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…

…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…

…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…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…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…

…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…

…rise can cause osmotic demyelination syndrome [1,2]. Hyponatraemia is primarily a disorder of water balance. The plasma sodium reflects the ratio between the body…

…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…

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

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