…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…

…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…

…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…

…obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and AVRT (pre excitation, WPW syndrome) being the most…

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

…and subject preparations. We will also discuss the relevance of withholding specific cardioactive medications during exercise testing (exercise ECG). Indications for exercise stress test Indications…

…The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE…

…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…

…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…

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

…and thus the selection between them may be guided by individual patient needs rather than by a distinct advantage of one drug over the other…

…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…

…of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical conditions (pulmonary…

…by the bleeding risk of the procedure and by renal function. In markedly reduced renal function (dabigatran at eGFR <30 mL/min, the other DOACs…

…of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary…

…monitored during treatment [4,6]. Important exceptions Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic…

…pro BNP may be used as prognostic markers during the disease course. In summary, the risk of severe disease and death is several times higher…

…Other congenital anomalies include anomalous origin of a coronary artery from the pulmonary artery and anomalous origin of one coronary artery from the opposite aortic…

…the clinical state during treatment with an angiotensin receptor–neprilysin inhibitor. Clinical Applications Natriuretic peptides have three principal roles: Supporting or excluding the diagnosis of…

…of acute myocardial ischaemia, electrocardiographic findings, cardiac biomarkers, imaging, angiography, and, occasionally, pathological examination. Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia. The…

…dissection Pneumothorax Pulmonary embolism Mediastinitis (rare condition) In addition to these five conditions, there are numerous other causes of chest pain, but the other causes…

…sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular diseases Anemia The natural course of asphyxia Should ventilation be…

…Dialysis is then the way forward. Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive…

…or other evidence of ongoing ischaemia Symptoms suggesting haemodynamic compromise, such as near syncope or poor perfusion Known arrhythmia or electrical instability The presence of…

…if the axis is between 45° and 90° with qR complex in aVL and QRS duration is 0,12 s, provided that other causes of…

…often not true in other circumstances (e.g. pulmonary embolism, trauma, respiratory causes, drug overdoses, etc.). Among victims in whom the cardiac arrest was caused…

…severe LMCA stenosis exacerbated by other conditions, and these must also be recognized. Prompt identification of LMCA involvement is therefore critical. The 12 lead electrocardiogram …

…also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine states…

…Evaluating the success of revascularization : Myocardial perfusion imaging can assess effectiveness of procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI…

…all other causes have been ruled out. Inappropriate sinus tachycardia is presumably more common than previously thought and the condition may hamper the quality of…

…excellent, with the vast majority of patients recovering completely after restoration of sinus rhythm (or any other rhythm with normal ventricular rate and activation). Recovery…

…treatment during an attack and aborts most attacks within 15–20 minutes. An undrained pneumothorax. A high oxygen concentration washes nitrogen out of the pleural…

…occur even in the absence of pulmonary congestion. Patients may obtain relief by sitting forward. Other symptoms depend on the extent of reduction in cardiac…

…While dyspnea is the cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation…

…not radiate below the umbilicus. It is often accompanied by sweating, nausea, vomiting, anxiety, and a sense of impending doom. When pain begins during exertion…

…if the axis is between 45° and 90° with qR complex in aVL and QRS duration 0,12 s, provided that other causes of left…

…lead to compression of the ventricles during diastole; cardiac tamponade occurs if excess pericardial fluid causes hemodynamic effects. Electrical alternans – i.e the beat to…

…The diameter of the aortic valve is relatively constant during systole; this is important because a representative diameter is crucial for calculation of the area…

…uniform across the HFmrEF population. Some patients have a pathophysiological profile closer to HFrEF, whereas others have features overlapping with HFpEF, including abnormalities of LV…

…leads P pulmonale Figure 1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left ventricle…

…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…

…C = total cholesterol − HDL C Apolipoprotein B (apoB) reflects the concentration of circulating atherogenic particles because each apoB containing particle carries one apoB molecule…

…during exercise. Thus, supply and demand are balanced and no ischemia occurs. (Some individuals display a benign form of ischemia located in the subendocardium during…

…unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…atherothrombotic events in chronic coronary disease; preserve the benefit of coronary intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI…

…disease (ASCVD). Atherosclerosis develops through the progressive deposition and retention of LDL C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory…

…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…

…discovered during targeted duplex ultrasound (DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of…

…FH). Heterozygous FH results in high LDL cholesterol levels (but nothing else) and increases the risk of acute myocardial infarction by more than 50 times…

…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…

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

…secondary prevention. Observational evidence indicates that cessation lowers the risk of peripheral artery disease, myocardial infarction, premature death, recurrent infarction and limb threatening complications. Among…

…of 25 mm/s, which is standard in the US and many other countries, a 2:1 block will be difficult to discern because the…

…changes always precede symptoms of ischemia. In summary, if an ECG recorded during chest pain does not display ischemia, then the chest pain is not…

…using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous…

…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…

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

…in reduced cardiac output and risk of hypoperfusion. Distinguishing AV block 2 and AV block 3 In case the distinction between second degree AV block…