…death, and among those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF…

…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…

…reflex for predicting a poor neurological outcome was 68.8%. This implies that approximately one third of the patients who ultimately had a favorable neurological…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…trial participants who were described as frail generally had no more than mild frailty, limiting the applicability of trial findings to people with substantial functional…

…observed in patients with elevated TnT levels who had underlying cardiovascular disease, of which 69.4% died. Guo et al also report a significant association…

…Outcomes was a randomized, double blind, placebo controlled study of 13,970 patients at high cardiovascular risk who were unable or unwilling to take statins…

…CPR in patients with refractory out of hospital cardiac arrest. Patients aged 18 to 70, who received bystander CPR and initially presented with a ventricular…

…often the very question at issue A patient who needs steroid cover simply to get through the day of the test can therefore be given…

…to die (JAMA, 1961). A total of 500 cases of fatal myocardial infarction were examined. The authors reported that 60–70% of all cases had…

…risk of cerebrovascular complications. Seizures in a patient with preeclampsia indicate eclampsia. Postpartum disease is clinically important. Hypertension is most frequent in women who had…

…likely to generate EMI. Assess pacing dependence Determining pacing dependence is central to planning. If EMI causes oversensing and pacing inhibition, a patient who has…

…studied patients with ROSC who did not display ST segment elevations and randomized them to urgent angiography. These trials did not show any benefit of…

…now a permanent part of the programme and is widely used — a woman who does not attend for a gynaecological examination, or who prefers to…

…level of care for the absolute majority. The CCU may be suitable for stable (hemodynamically and respiratory) and fully conscious patients who experienced a brief…

…therefore mimic pharmacological resistance or contribute directly to persistent hypertension. Resistant hypertension is associated with a higher likelihood of secondary hypertension and with substantially greater…

…A short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary…

…as a reason to withhold anticoagulation therapy. Instead, it serves as a tool to identify patients who may require more careful monitoring and management of…

…comorbidities and a higher risk of complications than patients without AF; both short and long term prognosis are worse than in patients who remain in…

…dL (≥1.4 to <1.8 mmol/L). Non statin treatment for patients who are statin intolerant. Possible concurrent initiation of ezetimibe with maximally tolerated…

…used in patients who do not achieve satisfactory effects using first line therapies. Digoxin is also used frequently in the emergency setting to control ventricular…

…who encounter patients with pacemakers only have access to conventional surface ECGs. Being able to assess pacemaker function and perform troubleshooting should be considered a…

…is a common cause of chronotropic incompetence. Definition of chronotropic incompetence: the age expected maximal heart rate Chronotropic incompetence is defined as failure to reach…

…varies from one minute to another, which may cause variations in the size of the thrombus. This means that a patient who experienced chest pain…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…49% of patients in the milrinone group and 54% in the dobutamine group, with a relative risk of 0.90 (95% CI: 0.69 to…

Echocardiography Cardiomyopathy caused by tachycardia A prolonged tachycardia can cause cardiomyopathy with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy…

…A patient who remains unconscious (with no meaningful response to speech) after the return of spontaneous circulation , whether the arrest occurred in or out of…

…Definition of aortic aneurysm Sinus of Valsalva 45 mm. Any other segment 40 mm in diameter. Thresholds for surgery Threshold for surgery Relevant patient category…

…Syncope is particularly important as a marker of potentially severe disease. The presence of haemodynamic instability places the patient in the high risk category and…

…toxicity. Several underlying conditions increase a patient's sensitivity to digitalis related arrhythmias. The clinician must evaluate for the presence of worsening renal function, advanced…

…abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood…

…required to achieve the patient’s LDL C goal. Complete intolerance is uncommon. Most patients who report intolerance can ultimately take some form of statin…

…sufficient to provoke overt ischemic signs during stress testing (Bourque et al.). Thus, patients who undergo exercise stress testing must achieve at least 85% of…

…benefit of its administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of clonidine may lead to rebound…

…whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP…

…medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease. It combines a structured family history…

…international cohort evidence. Metabolic risk factors make a particularly large contribution to cardiovascular disease. Hypertension is a major component of this burden, followed by non…

…risk of peripheral artery disease, myocardial infarction, premature death, recurrent infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop…

…Infarction). Patients with NSTE ACS who do not develop infarction are classified as unstable angina (UA), which is an imminent precursor to myocardial infarction. NSTEMI…

…nature of myocardial remodeling. The designation "Heart Failure with improved Ejection Fraction" (HFimpEF) is now applied to patients with a baseline LVEF ≤40% who have…

…heterogeneous, and some patients may benefit from a more individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care…

…Addition of a PCSK9 inhibitor when the target remains unmet despite maximally tolerated statin therapy and ezetimibe. For patients with a recurrent atherothrombotic event while…

…masked” PAD in patients who do not exert themselves sufficiently to provoke symptoms. Intermittent claudication Intermittent claudication is exertional discomfort in a limb muscle that…

…of atherosclerotic obstructive CAD. CAC is therefore not merely an incidental imaging finding; it can refine the decision to test and may identify patients who…

…stable, asymptomatic patients without severe ischaemia. Evaluation and Physical Examination The initial evaluation should be structured to establish a working diagnosis of STEMI rapidly, identify…

…The absence of obstructive disease generally indicates a more favourable course than VA accompanied by severe fixed lesions. Nevertheless, patients who develop serious arrhythmias during…

…ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial region, which…

…ensuing atherothrombosis, causes a complete occlusion of the coronary artery. Ischemia will extend from the endocardium to the epicardium in the affected myocardial region, which…

…transplant service. Contraindications An expressed refusal by the deceased — in the donation register, on a donor card, or through statements made to the next of…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…

…calculator helps identify patients at high risk of SCD who may benefit from preventive interventions, such as ICD implantation. For example: A 5 year SCD…

…settings, while the broader lipid lowering recommendation refers to a recurrent event without requiring that it be of the same type as the initial event…

…selected according to the magnitude of additional LDL C lowering needed and the patient’s prior treatment. Inclisiran is particularly attractive when a durable treatment…

…in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular conduction defect. In severe cases, bradycardia may progress to hemodynamic instability…

…and gardening may provide useful activity for individuals who are reluctant to undertake formal exercise. Increasing movement during daily living is a practical initial strategy…

…Evaluation and risk assessment The evaluation of a patient with AF who may require anticoagulation should establish: Whether AF is clinical or device detected subclinical…

…3 rd assessment (reliable assessment of pulses requires training and experience). Thus, for laypeople, examinations 1 and 2 are sufficient to confirm a cardiac arrest…

…the case of cardiac masses. The characteristics of the patient, the size and localization of the mass are indicative in diagnostics. A patient who exhibits…

…or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms…