…or non cardiac . The term “atypical” is discouraged because it may understate the possibility of ischaemia. A focused history should establish: Quality of the discomfort…

…Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins…

…as exercise ECG or exercise tolerance test . Because the vast majority of all exercise stress tests in the United States are performed using a treadmill…

…the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large population study, LDL C, non HDL C…

…STEMI, on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more…

…obstructive stenosis in a major epicardial coronary artery. Non obstructive disease is generally defined as the absence of a stenosis of 50% or more in…

…measurements require interpretation in the context of the clinical presentation and other findings. A reduced CFR may occur with angiographically insignificant epicardial disease because of…

…results. Patients with suspected ACS are categorized into a STEMI pathway or an NSTE ACS pathway according to the initial ECG and clinical presentation. For…

…Its principal clinical effect is therefore reduction of LDL cholesterol (LDL C), through a mechanism complementary to that of statins. Statins reduce hepatic cholesterol synthesis…

…to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications: Hemophilia…

…Non HDL C and apoB are secondary targets or risk refining measures, particularly in patients with: Diabetes or other cardiometabolic risk factors Obesity Insulin resistance…

…ultrasound travels through tissue that behaves as a lens which causes significant refraction, directing the ultrasound to an area interrogated simultaneously by other sound waves…

…a variant inherited from a parent. A de novo variant. Less commonly, autosomal recessive inheritance. X linked or other non autosomal dominant mechanisms. Complex or…

…diagnosis at a non PCI hospital to wire crossing As quickly as possible, primary PCI if the total expected time is 120 minutes or less…

…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…

…does not reduce cardiovascular or all cause mortality. Reported relative effects include: Approximately 11% reduction in cardiovascular events in a meta analysis of primary prevention…

…a calculated 10 year risk of ≥10% is considered sufficiently high to support BP lowering treatment, whether through lifestyle intervention, pharmacological therapy, or both. A…

…through staged intervention. The rationale for complete revascularization is that untreated, flow limiting disease may continue to cause ischaemia, recurrent symptoms, myocardial infarction, or other…

…is DAPT for 12 months, generally consisting of low dose aspirin and a potent P2Y12 inhibitor, preferentially prasugrel or ticagrelor. This strategy reflects the substantial…

…reported a 30% reduction in major cardiovascular events with a Mediterranean diet supplemented with either nuts or extra virgin olive oil compared with a low…

…grow new vessels into the ischemic zone. Newly formed vessels, which may originate from other branches of the same coronary artery or another coronary artery…

…work systematically through the possible causes, apply several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress…

…S, et al. CHA₂DS₂ VASc or a non sex score (CHA₂DS₂ VA) for stroke risk prediction in atrial fibrillation: a cohort study. Eur Heart J …

…of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute…

…with a recent TIA or stroke, particularly when the event occurred within 3 months and the ipsilateral stenosis exceeds 70%. Patients being assessed before non…

…cocaine intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of antihypertensive medication, particularly clonidine, can also precipitate a hypertensive crisis. Pregnancy Hypertensive emergencies in…

…pressure Other cardiovascular risk factors and relevant comorbidities Evidence of hypertension mediated organ damage Existing cardiac, cerebrovascular, or renal disease The possibility of a secondary…

…electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment…

…STEMI may present as sudden onset breathlessness. Other less common presentations, with or without pain, include sudden loss of consciousness, a confusional state, profound weakness…

…a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia. Non…

…associated with a worse prognosis. VA may occur in the presence of obstructive coronary artery disease (CAD), in non obstructive coronary arteries, or in patients…

…erosion. Thrombosis associated with a calcified nodule. Epicardial or microvascular coronary spasm. Spontaneous coronary artery dissection. Coronary embolism of cardiac or non cardiac origin. Oxygen…

…body position or respiration. Triggering factors Symptoms triggered by exercise/effort (what level of exercise)? Symptoms at rest? Symptoms more easily provoked after a meal…

…or pulmonary embolism is often a reversible arrhythmia with low risk of recurrence. Atrial fibrillation in other circumstances (particularly those listed above) is usually a…

…elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions (such as bundle branch blocks…

…refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family history of…

…survive long enough for clinical evaluation often have some residual antegrade flow, a dynamic thrombus, or collateral circulation that limits infarct size. In such cases…

…systolic or 90 mm Hg diastolic (140/90 mm Hg). The discordance between optimal blood pressure and the definition of hypertension is explained by a…

…of death for most diseases and conditions, including non cardiovascular conditions. A cardiac arrest can be expected or unexpected. The most common cause of cardiac…

…SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a six hour half life allowing high doses for better image quality. this tracer diffuses passively into cardiomyocytes…

…and other tachyarrhythmias with discernible QRS complexes. Shockable rhythm : Tachyarrhythmias that can be treated with defibrillation (ventricular fibrillation) or cardioversion (ventricular tachycardia). Non shockable rhythm…

…a mortality benefit. Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non…

…dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window, or when thrombectomy can start at the…

…rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of a leg ulcer — compression in arterial insufficiency can…

…consent if the patient is awake, and scan the vessel with ultrasound before you drape — a thrombosed or non compressible vein changes the plan wh

…and a corticosteroid are then given immediately after blood cultures. For questions other than acute meningitis — an insidious onset, known malignancy, immunosuppression, papilloedema or new…

…inadequate protective reflexes active major haematemesis severe agitation respiratory failure an anticipated difficult or prolonged endoscopic intervention a need for general anaesthesia for other reasons…

…87 95% confidence interval: 0.79–0.96 P = .004 Other summaries of the trial describe a 14% reduction in the same composite outcome…

…heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms linking CKD to cardiovascular disease The…

…and herpes zoster pain are other considerations when assessing chest pain [2]. Autoimmune/Malignancy: A history suggesting an autoimmune disorder or known malignancy may suggest…

…lowers non HDL C by up to approximately 50% and apolipoprotein B by approximately 20–40%. Effects on triglycerides and lipoprotein(a) are variable or…

…are non cardiac. In acute coronary syndrome (ACS), the angiographic culprit lesion may appear as an eccentric stenosis with scalloped or overhanging margins and a…

…other technical factors. Relative perfusion assessment has an important limitation: it requires a normally perfused reference territory. In diffuse coronary disease, balanced multivessel disease, or…

…in young women. Non coronary mechanisms that reduce oxygen supply include severe bradyarrhythmia, respiratory failure with severe hypoxaemia, severe anaemia, and hypotension or shock. Conversely…

…present without prominent discomfort through heart failure, arrhythmias, silent myocardial ischaemia or sudden cardiac death. Important clinical features suggesting UA include a prolonged episode at…

…prerequisite for clinical AF remains the documentation of the arrhythmia via a standard 12 lead ECG or a single lead ECG tracing lasting ≥30 seconds…

…the later the ECG is recorded, the greater the probability that the rhythm has deteriorated into PEA or asystole, and therefore the worse the prognosis…

…syncope or cardiac arrest–particularly during physical activity–in a young adult with T wave inversions in V1–V4, or other ECG changes (see below…

…et al. Epidemiology and outcome of adult out of hospital cardiac arrest of non cardiac origin in Osaka: a population based study. BMJ Open 2014…

…for non pregnant adults. The fetus is not harmed by defibrillation, amiodarone, or adrenaline (epinephrine). In the event of a cardiac arrest in a pregnant…