…However, most cardiac conditions may be associated with atrial flutter. As compared with several other supraventricular tachyarrhythmias, atrial flutter does not occur among otherwise healthy…

…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…

…93%) for myocardial infarction. Moreover, fragmented QRS is associated with an increased risk of sudden cardiac death and ventricular arrhythmias. Figure 2. Fragmented QRS complex…

…sudden cardiac arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of the ventricular arrhythmias…

…separate from those in Brugada syndrome and the risk of ventricular arrhythmias and sudden cardiac death is considerably lower than the risk among patients with…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and Pathophysiology Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors…

…slow rate. Acute treatment is generally unnecessary unless the cardiac output is inadequate, hypotension is present, or secondary arrhythmias result from the slow rate. In…

…when other therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of digitalis toxicity, which manifests across multiple organ systems. Non cardiac…

…and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic symptoms but without cardiac specific troponin elevation above the…

…Atrial arrhythmias Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac…

…severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole, Regadenoson : Should be avoided in patients with active…

…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…

…0.07 Arrhythmias 0.38 Vascular complications 0.43 Contrast agent reaction 0.37 Haemodynamic complications 0.26 Cardiac chamber perforation 0.03 Other complications…

…syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular complications Symptoms are determined…

…and other emergency instruments. Personnel conducting the test must be formally trained to assess cardiovascular response, symptoms, and ECG changes. Although the risk of cardiac…

…Atrial Fibrillation and Atrial Thromboembolism Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a profound driver of global cardiovascular morbidity and mortality…

…changes. Specific electrolyte disorders 1. Sodium Increased (hypernatremia) and decreased (hyponatremia) sodium levels do not have any effect on the ECG, nor cardiac rhythm, or…

…ECG and clinical examination, blood tests and other radiological examinations are most often required, in particular computed tomography (DT) and/or magnetic resonance imaging (MRI…

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

…the preferred biomarkers because they are extremely sensitive and specific for myocardial injury. Elevated levels of cardiac troponins is firm evidence of myocardial necrosis (i…

…aspirin or referral to cardiac rehabilitation and are less likely to attain blood pressure treatment goals. Female specific and female predominant risk factors Risk assessment…

…present Factors that may be contributing to elevated blood pressure Other cardiovascular risk factors and relevant comorbidities Evidence of hypertension mediated organ damage Existing cardiac…

…assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease. It combines a structured family history, clinical evaluation, cardiac investigations…

…Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated…

…injury. Myocardial injury Myocardial injury is defined by at least one cardiac troponin (cTn) concentration above the assay specific 99th percentile upper reference limit (URL)…

…examination, other examinations (which are not included in the standard examination), may be warranted. For most pathological conditions, there are specific guidelines (see links below)…

…channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia…

…other methods fail to open the airway. Figure 1. Methods to open the airway. No large study has compared oropharyngeal and nasopharyngeal airways in cardiac…

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

…thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features that may not be evident on angiography alone…

…used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich…

…dangerous differential diagnoses [1,2]. STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based…

…a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint…

…Criteria for ST Elevation Myocardial Infarction (STEMI) The diagnosis of STEMI relies on specific electrocardiographic thresholds for ST segment elevation measured at the J point…

…Despite their proven morbidity and mortality benefits, their use is limited by specific adverse effects. Most of these adverse events are related to the suppression…

…reserve (FFR) is an invasive, lesion specific physiological index used to estimate the functional significance of an epicardial coronary stenosis. It is defined during maximal…

…responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor neurone disease, myopathies and Lambert–Eaton syndrome…

…containing lipoproteins, including: LDL Intermediate density lipoprotein (IDL) Lipoprotein(a) [Lp(a)] Very low density lipoprotein (VLDL) Chylomicrons and other triglyceride rich particles Thus, non…

…Documented atherosclerotic cardiovascular disease (ASCVD) Diabetes mellitus in circumstances where diabetes specific risk assessment or risk categorization is applicable Moderate or severe chronic kidney disease…

Arrhythmias and arrhythmology ECG Sinoatrial arrest & sinoatrial pause (sinus pause/arrest): ECG characteristics & clinical implications A sinoatrial arrest occurs when the sinoatrial node does not…

…to be the cause of the ST segment depression. The horizontal ST segment depression is more specific than the downsloping depression. Refer to Figure 1 …

…intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis and can also be seen when the bleeding is slow or has stopped. The…

…disease The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of possible revascularization A proximal lesion jeopardizes…

…Other guideline formulations similarly define resistant hypertension as blood pressure above goal despite three or more antihypertensive drugs from different classes at maximally tolerated doses…

…of the nine parameters listed above. Many of the diagnoses mentioned below are discussed in detail in other chapters, to which links are provided throughout…

…patient is drowsy, difficult to rouse, hypervigilant, or has reduced orientation to the surroundings Other cognitive disturbance Disorientation, memory impairment, disorganised thinking, language disturbance or…

…Corneal arcus and xanthelasma can also occur, although they are less specific for FH. Corneal arcus is particularly informative when it occurs before age 45…

…potentially indicating microvascular dysfunction or other pathologies. The software allows for detailed regional analysis of myocardial perfusion, highlighting specific segments of the left ventricle that…

…and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and HHS are dynamic…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and pathophysiology Atrial fibrillation (AF) is a major independent risk factor for thromboembolism, including ischaemic stroke. This risk applies…

…Focal chest pain or unilaterally reduced breath sounds Consider pneumothorax New arrhythmia or ischaemic ECG changes Concomitant cardiac disease Oxygen targets Patient Initial target saturation : …

…administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for…

…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…

…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…

…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…

…Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the effect of anticoagulants, increasing bleeding risk. Monitor coagulation…

…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…

…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…

…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…

…Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction…