…important differences in ischemic events or stent thrombosis. Stable coronary disease and elective PCI For chronic coronary syndromes treated with elective PCI, the standard DAPT…

…pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not undergo exercise stress tests; these patients should…

…particularly stroke In ACS, AF may be present before the acute event, detected for the first time during its management, or arise during the course…

…or Additional leads in acute myocardial infarction). Importance of performing ECG during ongoing chest pain It is of paramount importance to record the ECG during…

…often check pupil size and reactivity as part of initial and ongoing evaluations of patients in cardiac arrest or after return of spontaneous circulation (ROSC)…

…73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the critically ill patient. Intravenous antibiotics…

…approximately a 25% reduction in recurrent infarction, stroke, or cardiovascular death. In the cited evidence, this corresponded to 36 fewer events per 1000 treated patients…

…in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or…

…blood flow in the myocardium, simply because ST T changes directly reflect myocardial perfusion. ST segment return is particularly important to assess in patients treated…

…instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several concurrent causes. In older patients delirium is often multifactorial…

…or damp textiles. Administer cardiopulmonary resuscitation (CPR) following standard protocols, emphasizing concurrent rapid rewarming of the patient. Consider extracorporeal membrane oxygenation (ECMO) in unstable patients…

…materially different by age or sex in the overall trial analyses. Some data from a study of healthy women suggested a reduction in ischaemic stroke…

…to either the primary or secondary outcomes. Primary outcome events occurred in 49% of patients in the milrinone group and 54% in the dobutamine group…

…GY. A novel user friendly score (HAS BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey…

…and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of heart failure—particularly heart failure with preserved…

…The strongest established predictors of ischaemic stroke and systemic embolism are previous stroke or TIA and mitral stenosis. In patients with AF and previous ischaemic…

…symptoms start (suddenly or gradually)? When did the patient first note the symptoms and how have the symptoms developed over time? In stable ischemic heart…

…inhibitor if the goal remains unmet despite maximally tolerated statin plus ezetimibe. Consider bempedoic acid in selected patients, particularly those with statin intolerance or persistent…

…toxins, thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in cardiac arrest. High quality compressions with minimal…

…regarding the physical examination or general evaluation of patients with bradycardia. Diagnostics Electrocardiographic assessment is fundamental to the diagnosis and management of bradyarrhythmias. In the…

…cardiovascular events per 1000 patient years, compared with 15.0 per 1000 patient years in age matched controls without autoimmune disease. The greatest risks were…

…of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in the…

…independent of baseline HbA1c or the magnitude of HbA1c reduction. 7 Instead, these agents exert multifaceted effects through direct activation of receptors in target tissues…

…clear echocardiographic windows during active compressions is challenging; however, subcostal windows might be feasible, particularly during brief pauses. An enlargement of the right ventricle is…

…adherence to antithrombotic treatment. Whether the patient is suitable for PCI, CABG, or an initial medical strategy. In haemodynamically unstable patients, evaluation must also consider…

…a treatment strategy used in younger adults, whereas a markedly frail 65 year old may require the more cautious approach generally applied to older patients…

…and patient populations The evidence for anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute…

…asynchronous pacing may rarely result in pacing during ventricular repolarization and provoke ventricular tachycardia or ventricular fibrillation. The likelihood of clinically significant EMI is generally…

…depressions, T wave changes) are typically concealed in the setting of LBBB. A patient with acute STEMI may therefore display a normal LBBB pattern. LBBB…

…change in weight. Assessment should integrate the history, physical examination, laboratory data and diagnostic testing. Examination for congestion Useful bedside indicators of persistent or improving…

…as MDMA (ecstasy) or amphetamines. In either scenario, there is sustained muscle activation, leading to marked heat generation, acidosis, and the subsequent development of hyperkalemia…

…gradual alteration in the QRS amplitude, often with twisting of the QRS complex around the isoelectric line. Most patients display QTc 500 ms during sinus…

…whereas clinical restenosis refers to recurrent angina caused by disease in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary…

…gradual alteration in the QRS amplitude, often with twisting of the QRS complex around the isoelectric line. Most patients display QTc 500 ms during sinus…

…Confirm cardiac arrest In case of a collapse (out of hospital or in hospital) the first task is to determine if a cardiac arrest has…

…care units and other units caring for resuscitated patients. Figure 1. The chain of survival in out of hospital cardiac arrest. Although the required skills…

…be considered. The immediate clinical categories include: Non cardiac diagnosis Chronic stable angina Possible ACS Definite ACS In patients with ST segment elevation, immediate reperfusion…

…roles: Supporting or excluding the diagnosis of HF Estimating disease severity and prognosis Contributing to longitudinal assessment and risk stratification They are useful in both…

…troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed highly sensitive troponin assays for troponin I (cTnI) and troponin T (cTNT). The…

…associations, emphasizing that the three measures are closely related in many patients. The practical distinction is that: LDL C estimates cholesterol within LDL particles. Non…

…and the severity and manifestations of disease may differ substantially among carriers. Consequently, a normal examination or cardiac investigation at one point in time does…

…if the initial rhythm is asystole or PEA. Most current protocols for ECMO exclude patients presenting with asystole or PEA. Duration of cardiac arrest : In…

…branch block in a patient presenting with chest discomfort is strongly suggestive of ongoing ischemia/infarction. Among all patients with acute myocardial infarction the prevalence…

…In patients with a high probability, testing may add little diagnostic value and invasive coronary angiography may be more appropriate when symptoms, risk or anatomical…

…In chronic coronary disease, the principal symptomatic indication for revascularization is angina that remains refractory despite medical therapy when significant stenoses are anatomically or physiologically…

…patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to rich collateral circulation in the ischemic area…

Procedurer Catheterisation is straightforward in most patients and dangerous in a few. The male urethra is about 25 cm long with two curves and a…

Info This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…

Cardiology This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…

…is used in children and adult patients. Recommendations for ECG recording in children Pediatric patients frequently have difficulties being still during clinical examinations. The youngest…

…catheterization. Principles of management of congenital heart disease and GUCH Complex malformations often require intervention (surgical or catheter based intervention). In addition to the malformation…

…T waves) do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should…

…and 1 year mortality in patients with NSTE ACS. TIMI, GRACE and PURSUIT are such risk models. The higher the estimated risk, the earlier should…

…then activates calcium sensitive potassium channels in the cell membrane. Nitroglycerin is similar in action and pharmacokinetics to nitroprusside, although the latter is more potent…

…including prasugrel, in ACS patients treated with PCI can increase the risk of thrombosis, myocardial infarction, or death. Treatment for up to 12 months is…