…QRS configurations are also indicate of previous myocardial infarction. New conduction defect Myocardial infarction/ischemia may be complicated with conduction defects (discussed in separate article).

…the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure…

…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…

…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…

…in patients with: Diabetes or other cardiometabolic risk factors Obesity Insulin resistance or metabolic syndrome Elevated triglycerides Low or apparently well controlled LDL C with…

…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…

…change of position — turning over in bed, lying down, standing up, tilting the head backwards. A symptom free interval between attacks, with possible residual unsteadiness…

…reduce the antiplatelet effect of acetylsalicylic acid. Use with caution in patients on low dose acetylsalicylic acid for cardioprotection. Pharmacokinetic interactions Methotrexate: NSAIDs inhibit tubular…

…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…

…that of LDL C. ApoB has also been more closely associated with cardiovascular risk than LDL C in many studies, although the relative advantage of…

…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…

…than in people without diabetes. Carotid disease is also a marker of systemic cardiovascular risk. The presence of a carotid bruit is associated with approximately…

…or belching. Radiation to both arms or shoulders has a particularly strong association with myocardial infarction in the cited clinical data, although right arm radiation…

…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…

…patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably exclude clinically important differences in ischemic…

…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…

…although the SYNTAX score is more widely used. Anatomical assessment should be integrated with clinical variables rather than applied in isolation. A multidisciplinary heart team…

…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…

…complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not…

…standard in the US and many other countries, a 2:1 block will be difficult to discern because the flutter wave may fuse with the…

…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…

…consistent with myocardial ischemia. In other words, chest pain caused by ischemia will always result in ischemic ST T changes. This is acknowledged in the…

Echocardiography Continuous Wave Doppler In continuous wave Doppler (CW Doppler), ultrasound waves are continuously emitted from the transducer and the reflections of these waves are…

…In PET (Positron Emission Tomography), radiotracers emit positrons. When a positron collides with an electron, they annihilate each other, producing two gamma photons emitted in…

ECG Myocardial ischemia and infarction ST segment elevation in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment…

…second degree AV block because escape rhythms in third degree AV block are regular. Regular ventricular rhythm with association between P and QRS and constant…

…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…

…50 Dose reduction as in the table above for rivaroxaban and edoxaban. Check every 6 months 15 30 Dabigatran contraindicated. The other DOACs are possible…

…Chlorhexidine in alcohol, sterile gloves, fenestrated drape, sterile gauze. Local anaesthetic: lidocaine 10 mg/mL, usually 5–10 mL, with a longer needle so that…

…and in the uncontrolled emergency — but it should be changed or removed once the situation has stabilised. Preparation and equipment A central line set with…

…Contact technique with a cryoprobe gives a deeper and more controlled freeze on flat surfaces; spray technique is better on irregular surfaces and in the…

…weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor…

…2 PO 10 days In appendicitis, cholecystitis, diverticulitis and pancreatitis, antibiotics are given only in certain more severe cases. CNS and other Diagnosis Agent Dose…

…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…

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

…In a patient with moderate symptoms the physician must judge the likelihood that the symptoms really are caused by the hyponatraemia. With severe symptoms and…

…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…

…deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with…

…variation in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than…

…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…

…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…

…is disputed and practice differs between units. Poisoning with other weak acids where the poison control centre recommends it, for example certain phenoxy acid herbicides…

…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…

…B, Lane DA, Lip GYH. Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the AFFIRM trial. J Intern Med . 2018;283…

…risk factor for stroke in AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age…

…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…

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

…though it remains a nonspecific finding. In patients presenting with angioedema, a rapid assessment of the airway is paramount to evaluate for impending respiratory compromise…

…accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic symptoms but without cardiac specific…

…10% of cases. Intermediate high risk PE occurs in haemodynamically stable patients with both RV dysfunction on imaging and elevated cardiac biomarkers. Intermediate low risk…

…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…

…and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in…

…dynamic and may improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular disease…

…of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals…

…10% to <20% Very high ≥20% The risk categories are distinct from the treatment threshold used in the BP guidelines. For adults with elevated BP…

…may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to…

…1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation…

…or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD…