…always be specified. Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated…

…laboratory medicine Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia…

…with acute coronary syndrome, randomized evidence has demonstrated lower rates of access site bleeding, surgical repair, and blood transfusion with radial access. Radial access has…

…digitalis excess. Biomarkers and Laboratory Findings The source material does not provide information on biomarkers or laboratory findings specific to the evaluation of bradycardia. Treatment…

…Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular hypertrophy or left…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…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…

…downstream, causing microvascular embolization (i.e occluding smaller vessels downstream). The thrombosis causes occlusion of the artery; blood flow may be partially or completely obstructed…

…if there is suspicion of cervical spine injury, in which scenario head tilt chin lift should only be used if other methods fail to open…

…beats per minute. Note that with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2…

…at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose, high sensitivity troponin and, where needed, coagulation tests. Blood sampling must…

…10–20 mg 20–40 mg 1–2 mL The doses follow the summaries of product characteristics: Lederspan specifies 10–20 mg periarticularly in bursitis…

…and guidelines do not state any ECG criteria specific to R wave progression. Figure 1. Pathological R wave progression is indicative of previous myocardial infarction…

…Female specific or female predominant factors associated with later cardiovascular risk include: Premature menopause Premature ovarian insufficiency Hypertensive disorders of pregnancy Preeclampsia Preterm delivery Gestational…

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

…to the suppression of the renin angiotensin aldosterone system (RAAS), such as decreases in blood pressure and mild azotemia. However, two distinct side effects—nonproductive…

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

…presentation and other findings. A reduced CFR may occur with angiographically insignificant epicardial disease because of abnormalities in the coronary resistance vessels. Left ventricular hypertrophy…

…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…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…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…

…competing risk of death from non cardiovascular causes, an important consideration in older populations. Risk prediction is particularly relevant in adults with elevated blood pressure…

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

…control in atrial fibrillation, particularly when other therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of digitalis toxicity, which manifests across…

…plasma concentrations of the two peptides are not interchangeable. Natriuretic peptide concentrations reflect haemodynamic stress, but their release is not specific to left ventricular systolic…

…syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular…

…have specific contraindications: Adenosine, Dipyridamole, Regadenoson : Should be avoided in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and other methylxanthines…

…to risk of embolization Relative contraindications for exercise ECG Severe hypertension (systolic blood pressure 200 mmHg or diastolic blood pressure 110 mmHg). Left main coronary…

…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)…

…all other situations, sinus arrest/pause should be considered abnormal, and the following differential diagnoses are at hand: Sinus node dysfunction. Side effects of drugs…

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

…amount of blood ejected into the aorta during systole. Stroke volume is calculated by measuring the Doppler flow in the aortic valve. In the left…

…the first instance. Give small boluses, for example 250 to 500 mL, with immediate reassessment of the blood pressure, pulse, peripheral perfusion, mental state and…

…and lesion haziness raise suspicion of thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features that may…

…a specific examination profile or diagnostic physical signs for LMCAD. Diagnostic Assessment Coronary angiography Invasive coronary angiography defines: The presence and severity of left main…

…blood pressure despite multidrug treatment rather than through specific symptoms. The clinical importance lies in its association with: Increased cardiovascular disease risk; Greater risk of…

…risk factor [2] . This change reflects robust evidence that female sex alone, in the absence of other comorbidities, does not significantly increase stroke risk. Conversely…

…mentioned below are discussed in detail in other chapters, to which links are provided throughout the text. Heart rate During the first week of life…

…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…

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

…to recite the months of the year backwards. A normal result does not exclude delirium, however, and an abnormal result is not specific to delirium…

…prediction tool currently exists. At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false…

…of supraventricular tachycardias (SVTs), usually within 30 seconds. Doses higher than 18 mg are unlikely to revert a tachycardia and should not be used. Specific…

…history suggesting an autoimmune disorder or known malignancy may suggest specific, nonidiopathic etiologies [2]. Summary of Pain Characteristics The following table synthesizes the key differential…

…The magnitude of untreated LDL C elevation. The presence and age of onset of premature CAD or other vascular disease. A history of myocardial infarction…

…features of Brugada syndrome are fairly specific to the disorder, provided that the clinical characteristics are in line with the disorder. There are however other…

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

…at the top. Refer to Figure 1 . Patients with left ventricular hypertrophy may instead display normalization of secondary T wave inversions (lead V5, V6, aVL…

…of care. The clinical state, the circulation, comorbidity and the precipitating cause carry at least as much weight as the laboratory values [1]. Grade Blood…

…whereas others have brief or asymptomatic episodes that are not detected during routine clinical assessment. The clinical burden of AF does not reliably predict stroke…

…the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory…

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

…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…

…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…

…reversal of the nystagmus is common. 6. Repeat on the left side. A positive test in the posterior canal is characterised by: A latency of…

…the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal…

…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…

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

…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…

…disorder familial hypercholesterolemia (FH), which is caused by genetic mutations affecting the elimination of LDL cholesterol from the blood. Individuals with familial hypercholesterolemia may have…