…therapy remains the foundation of lipid lowering treatment for patients with chronic coronary syndrome, acute coronary syndrome (ACS), atherosclerotic peripheral arterial disease, and other very…

…anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position…

…pillow to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can…

…a therapeutic objective. LDL C as the primary treatment target Current lipid management frameworks place LDL C at the centre of treatment. Lifestyle intervention is…

…up of the foci of infection. Vegetations can be found on the flaps and appear as moving masses. Mural vegetations are attached to the endocardium…

…stays in place for days without anyone asking why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir…

…are placed proximally on the upper arm. Placement of chest (precordial) electrodes are not changed but additional leads may be attached in children under the…

…on the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip of…

…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…

…Only clinical signs of herniation halt the puncture, and antibiotics and a corticosteroid are then given immediately after blood cultures. For questions other than acute…

…of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over the…

…and other radiological examinations are most often required, in particular computed tomography (DT) and/or magnetic resonance imaging (MRI). Anatomy of the pericardium The pericardium…

…although the clinical importance of improved adherence remains dependent on sustained follow up and administration. Clinical indications and place in therapy Inclisiran has been approved…

…Place a field block around the abscess. 3. Make the incision along the skin tension lines and make it long enough — as a rule of…

…Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also be used…

…The haemodynamic consequences depend on lesion location, severity, length, the presence of multilevel disease and collateral circulation. Flow limitation may be clinically silent, manifest as…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

…the lead in the other chamber, resulting in inappropriate inhibition of the pacemaker in the latter chamber. This type of oversensing is referred to as…

…by the direction of movement of the sound source. Figure 1 presents three trumpets; one placed on a table, and two are mounted on ambulances…

…Syncope is particularly important as a marker of potentially severe disease. The presence of haemodynamic instability places the patient in the high risk category and…

…is the solid, compact wall. Thus, with regards to measuring ventricular dimensions, trabeculae and papillary muscles are considered part of the left ventricular cavity. Other…

…sequential activation of the piezoelectric crystals. The crystals are activated from one side to the other, as illustrated in Figure 2. The sequence of activation…

…virtually all cases. Ventricular tachycardia causes immense strain on the ventricular myocardium, simultaneously as the cause of the arrhythmia already affects cellular function. This results…

…the base rate should inhibit the pacemaker. P waves The appearance of the P wave depends on where the atrial lead is fixed. Typically, the…

…apical segments, constituting 30% of myocardial mass. The 17 segment model provides the best agreement with anatomic data, as compared with other segmentation models. Figure…

…On the other hand, sinus bradycardia developing during physical exercise is considered abnormal, because heart rate must increase during exercise. Mechanisms of cardiac arrhythmias The…

…leads in the frontal plane. This format of displaying the ECG leads is referred to as the Cabrera format and it has been the existing…

…as early as possible. In out of hospital cardiac arrest (OHCA) ACLS is performed by paramedics, nurses or physicians, depending on the design of the…

…regarded as a cylinder, and the same assumption can be made for the other valves. The area is calculated by measuring the diameter of the…

…stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following…

…diameter of the valve is measured in diastole in apical four chamber view. VTI is obtained in the same view with the sample volume placed…

…genesis of these waves and although it has been discussed previously a brief rehearsal is warranted. Figure 7 illustrates the vectors in the horizontal plane…

…New U waves (in absence of bradycardia) may indicate ischemia. If U waves were present on previous recording, the amplitude must be increased in order…

…and other sedating drugs. Thromboembolic risk, for example immobilisation, cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a…

…interpreting platelet function tests for HIT. Other cosiderations Based on a relationship observed in the PLATO study between the maintenance dose of ASA and the

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

…ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source…

…STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based on symptoms, the ECG and…

…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…

…administered as soon as possible in the absence of contraindications, using a loading dose followed by maintenance treatment. The source material does not specify the…

…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…

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

…substantially on stenosis severity and plaque characteristics. In the general population, the prevalence of asymptomatic carotid stenosis of at least 70% is low, reported as…

…Relevant predispositions, such as connective tissue disease. No single pain descriptor is diagnostic. The severity of pain also has limited discriminatory value. Features suggesting myocardial…

…This knowledge has been translated into remarkable advances in the management of coronary artery disease, as demonstrated in the figure below (from Nabel et al…

…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…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The…

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

…a notch on the apex. Please note that for most clinicians it is not necessary to be able to determine the direction of the re…

…This is because the strong and oppositely directed forces tend to cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy…

…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…

…distinct flow (almost 5 m/s) directed away from the transducer during systole (systole starts at the peak of the R wave on the electrocardiogram)…

…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…

…with the opposite angle of observation. The injury currents are not strong enough to be detected on leads with opposite angle of observation. Other vectors…

…most often not equal (which makes the PR interval appear as varying). Management of third degree AV block Please refer to Management of AV Blocks.

…between the lowest rib and the iliac crest, at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other…

…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…

…of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…