ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

…and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs…

…between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another stressor. Manifestations include angina, other chest discomfort, dyspnoea, or no symptoms…

…syndromes, which may present with recent changes in symptoms or signs, with or without ECG abnormalities and with or without an elevation in cardiac troponin…

…The severity of the symptoms governs the emergency treatment Severe symptoms The following symptoms indicate hyponatraemic encephalopathy and warrant immediate treatment in the absence of…

…is associated with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening…

…50 beats per minute in the first 4 to 6 hours after an acute infarction—patients may develop hypotension and signs of end organ hypoperfusion…

…threatening tachyarrhythmias. Evaluation and Physical Examination Physical examination of a patient on digoxin therapy should focus on identifying signs of heart failure decompensation, which may…

…Symptom burden and functional limitation Evidence of heart failure Haemodynamic stability Diabetes status Renal dysfunction and other important comorbidities Frailty Liver cirrhosis Cognitive function and…

…may cause symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other thromboembolic events. Subclinical cerebral injury…

…Obesity and/or diabetes. Psychosocial stress. Alcohol abuse. Physical inactivity. Unhealthy diet. Cerebral / peripheral vascular disease. Cancer. Acute coronary syndromes cause symptoms already at rest…

…cardiac tamponade. The classical signs of cardiac tamponade are hypotension, muffled heart sounds and jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction…

…6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…cognitive decline and increased mortality [3,4]. Do this first 1. Assess vital signs and level of consciousness immediately. 2. Check oxygen saturation and capillary…

…be considered in consultation with a cardiothoracic surgeon. Myocardial rupture after myocardial infarction, and traumatic haemopericardium — these require surgery; pericardiocentesis is at best a bridge…

…utilized to assess whether there is any residual ischemia or angina pectoris. Patients may undergo repeated stress tests to assess symptoms and signs of ischemia.

…Other Moderate work of breathing Accessory muscle use Cyanosis, exhaustion, hypotension or collapse The classification is based on a combination of clinical findings, oxygenation and…

…Ask specifically about: Neurological symptoms: confusion, visual loss, focal neurological signs, seizures, severe or sudden headache. Chest pain, back pain, dyspnoea, orthopnoea and new sweating…

…infarction) Lead Definition of pathological Q wave Normal variants V2–V3 ≥0,02 s or QS complex None All other leads ≥0,03 s and…

…Diagnostic phenotype Criterion HFmrEF Symptoms and/or signs of heart failure Required LVEF 41–49% Natriuretic peptides BNP ≥35 pg/mL or NT proBNP ≥125…

…Addison's disease and digoxin intoxication may also cause hyperkalemia. ECG in mild hyperkalemia (potassium 6,0 mmol/L) The earliest sign of hyperkalemia is…

…first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance…

…changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can…

…acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI…

…and cerebral involvement. Catecholamine excess and drug related presentations Severe hypertension may result from phaeochromocytoma, monoamine oxidase inhibitor crisis, cocaine intoxication, or other sympathomimetic exposure…

…patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive…

… symptoms suggesting current or recent cerebral ischaemia; known CAD, PAD, or other atherosclerotic disease; diabetes and other cardiovascular risk factors; smoking, hypertension, hypercholesterolaemia, and sedentary…

…ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or…

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

…and Clinical Context Blood pressure management in older adults must account for chronological age, biological age, frailty, multimorbidity, cognitive status, functional capacity, orthostatic symptoms, and…

Myocardial ischemia and infarction Procedurer Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after…

…adults, approximately 40% are asymptomatic, 50% report atypical leg symptoms and fewer than 10% have classic claudication. Asymptomatic or atypical PAD remains clinically important. Reduced…

…arrhythmias. Unstable angina pectoris in the acute phase (before stabilization of symptoms) – due to the risk of developing acute myocardial infarction and inducing ventricular arrhythmias…

…the sensitization of sensory nerve endings due to the accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins, such as substance P…

…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…

…AAOCA), coronary fistulae, and myocardial bridging. Although many are clinically silent, some produce myocardial ischaemia, ventricular arrhythmias, myocardial infarction, or sudden cardiac death. Myocardial bridging…

…of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms…

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

…newly discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk…

…stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3. Assess airway, breathing and circulation. 4. Measure…

…alpha 2 agonists and antipsychotics, which mainly affect individual symptoms. Initial management ABCDE and immediate tests Assess the withdrawal and other life threatening conditions at…

…detailed description of the presenting symptoms of NSTEMI. It does identify several clinical manifestations that indicate particularly high risk and should influence the urgency of…

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

…health care provider. A family history of any of the above listed symptoms and manifestations must always raise suspicion of serious hereditary arrhythmias. Although clinicians…

…haemodynamic collapse, and death. The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The…

…develop premature CAD. Symptoms therefore depend on the vascular territory involved and may include manifestations of coronary, cerebral or peripheral arterial disease, although the source…

…acute outpatient symptoms. Natriuretic peptides supplement, rather than replace, clinical assessment. The result should be integrated with the history, examination, ECG, echocardiography, and other relevant…

…1, formerly termed glucocorticoid remediable aldosteronism, and other familial forms associated with adrenal adenoma or bilateral adrenal hyperplasia. A family history is therefore important, particularly…

…these events. Clinical presentation and symptoms Most patients with stent thrombosis present with ACS. Clinical manifestations therefore commonly include recurrent myocardial ischaemia, recurrent infarction, or…

…context of acutely decompensated heart failure, shortness of breath is the cardinal symptom and may act as an ischaemic equivalent, though caution is advised in…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Vasospastic angina (VA), formerly termed Prinzmetal or variant angina, is myocardial ischaemia caused by transient abnormal vasoconstriction…

…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…

…persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke's encephalopathy, other central disease Neurological examination, gait and truncal stability…

…risk of developing symptoms. The most common non reversible causes of sinus bradycardia are sinus node dysfunction, side effects of medications and acute myocardial infarction…

ECG Myocardial ischemia and infarction ST segment depression due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or…

…Cardiac surgery and other iatrogenic cardiovascular procedures Acute aortic disease, particularly ascending or type A aortic dissection Myocardial free wall rupture after infarction Anticoagulant associated…

…may be accompanied by rhabdomyolysis, with potential renal failure and increased mortality. Clinical presentation and symptoms Symptoms commonly develop rapidly, often within an hour of…

…which is why expeditious management is warranted. Initial management includes assessing the patient's clinical status (symptoms, hemodynamics), ECG and risk factors (age, previous disease…

…establish: The nature and stability of symptoms Exercise capacity The presence of active chest pain or other evidence of ongoing ischaemia Symptoms suggesting haemodynamic compromise…