…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…

…and blood transfusion with radial access. Radial access has also been associated with lower overall major adverse cardiac events and mortality in pooled analyses of…

…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…

…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…

…myocardial injury , demonstrated by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence of…

…true bradyarrhythmic or asystolic arrest from other tachyarrhythmic events. On the surface electrocardiogram, sinus bradycardia may appear at rates of 40 to 48 beats per…

…of STEMI relies on specific electrocardiographic thresholds for ST segment elevation measured at the J point. The diagnostic criteria require new ST elevation in at…

…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…

…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…

…tachyarrhythmia at 150 beats per minute. Note that with a paper speed of 25 mm/s, which is standard in the US and many other…

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

…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…

…Any type of infarction may cause pathological R wave progression. However, the specificity for pathological R wave progression is considerably lower than pathological Q waves…

…care, clinical assessment and treatment. These influences are particularly important because women have historically been perceived as being at lower cardiovascular risk, including after menopause…

…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…

…specific adverse effects. Most of these adverse events are related to the suppression of the renin angiotensin aldosterone system (RAAS), such as decreases in blood…

…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…

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

…gaze palsy — that can be assessed before and during the window of effect. The muscarinic effect may at the same time produce marked bradycardia and…

…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…

…impairment increase the likelihood of digitalis intoxication even at therapeutic doses. Diagnostics Electrocardiography and Electrophysiology Electrocardiographic evaluation of patients receiving digoxin reveals specific electrophysiologic profiles…

…both reduced clearance and the high prevalence of structural heart disease in this population. Obesity is associated with lower than expected BNP and NT proBNP…

…is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities…

…or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated…

…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…

…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…

…product of area (a) of the cylinder and the velocity (v) of the fluid (i.e blood). The volume (V) that passes a specific segment…

…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…

…Because these vessels perfuse a large proportion of the left ventricular myocardium, left main disease carries a substantial prognostic significance. The myocardial territory at risk…

…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…

…however, and an abnormal result is not specific to delirium. Symptoms are often worse in the evening and at night, but diurnal variation is not…

…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…

…reduced. Dosage and Dose Escalation To terminate tachycardia, adenosine is rapidly injected intravenously at initial doses of 6 to 12 mg, followed by a flush…

…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…

…worse at rest than during stress, potentially indicating microvascular dysfunction or other pathologies. The software allows for detailed regional analysis of myocardial perfusion, highlighting specific…

…sign of hyperkalemia is the pointed T waves. This is most pronounced in the precordial (chest) leads. Pointed T waves are tall and narrow at…

…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…

…from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory support . At the same…

…or treatment with another adenosine diphosphate (ADP) receptor inhibitor for patients who had coronary syndrome and are at high risk of developing a new event…

…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…

…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…

…The test presupposes that the patient has spontaneous nystagmus at the time of examination and that the examiner is experienced with the head impulse test…

…Discontinue acetylsalicylic acid at the first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates…

…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…

…affecting at least two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic…

…with homozygous FH typically die from acute myocardial infarction at 20 to 30 years of age. People with familial hypercholesterolemia have no other metabolic aberration…