…chronic kidney disease (CKD), and multiple non cardiovascular conditions are frequent features. A proposed disease pathway involves systemic and coronary microvascular endothelial inflammation associated with…

…ACE inhibitors) constitute a cornerstone in the management of cardiovascular disease, heart failure, and chronic kidney disease (CKD). These agents interfere with the renin angiotensin…

…and kidney disease All patients with diabetes should be assessed for: ASCVD Severe target organ damage (TOD) HF AF CKD Other clinically relevant cardiovascular disease…

…heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and peripheral artery disease (PAD). Figure 1 (below) shows weight loss effects of novel…

…Diabetes 120–130 70–79 Chronic kidney disease 130–139 70–79 Avoid a systolic pressure < 120 mmHg and a diastolic pressure < 70…

…risk of end stage renal disease; Increased mortality; and A higher probability of secondary hypertension. Patients may also have comorbid features associated with a greater…

…treatment with an angiotensin receptor–neprilysin inhibitor. Clinical Applications Natriuretic peptides have three principal roles: Supporting or excluding the diagnosis of HF Estimating disease severity…

…shock. Patient related and procedural risk factors The risk of adverse events is increased by: advanced age; diabetes mellitus; chronic kidney disease or renal failure…

…cause of symptoms. CCS is a clinical syndrome rather than a permanently stable state. Patients may remain stable for prolonged periods, but chronic coronary disease…

…Chronic: more than 90 days. The central clinical danger is progressive aortic wall disruption, rupture and compromise of branch vessels. Type A disease may cause…

…patients with STE ACS exhibit elevated troponin levels, and are thereby diagnosed as ST elevation myocardial infarction (STEMI) . Chronic Coronary Syndromes (CCS) Coronary artery disease…

Cardiology Diagnosis and treatment of bradycardia (bradyarrhythmia) Acute bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should…

…or progress to chronic limb threatening ischaemia (CLTI). Clinical presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical…

…can shorten the time to diagnosis and facilitate triage of patients with suspected ST segment elevation myocardial infarction to a percutaneous coronary intervention capable hospital…

…not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an…

…chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical…

…pacing in the setting of cardiac arrest has not demonstrated clear benefit. Long term pharmacological management of chronic sinus bradycardia with a pacemaker is usually…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

…comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms or clinical signs, with or…

…Chronic venous oedema, lipodermatosclerosis, stasis dermatitis. Prevention of recurrence after a healed venous ulcer. After deep vein thrombosis with post thrombotic syndrome. Differential diagnosis Feature…

…In patients presenting with angioedema, a rapid assessment of the airway is paramount to evaluate for impending respiratory compromise. Diagnostics The diagnosis of ACE inhibitor…

…diagnostic pathway. The unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with…

…1, not 200%). Conclusion Echocardiographic calculation of Qp/Qs is a cornerstone in managing patients with intracardiac shunts. By integrating anatomical measurements and Doppler hemodynamics…

…presentation of ACS is generally similar to that in non pregnant patients, although symptoms may be atypical. Pregnant patients with SCAD may have a more…

…stressor superimposed on the patient's baseline cardiovascular state. For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia following…

…diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury, not a disease…

…support . At the same time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia…

…patients with STE ACS exhibit elevated troponin levels, and are thereby diagnosed as ST elevation myocardial infarction (STEMI) . Chronic Coronary Syndromes (CCS) Coronary artery disease…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic disease…

…a non pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent…

…injury with impaired consciousness, biliary tract disease. There is no contraindication to analgesia in the acute abdomen . The notion that an opioid masks the diagnosis…

…Venous thromboembolism is a chronic and serious condition. Mortality in pulmonary embolism is up to 20%, and roughly 30% of patients with pulmonary embolism or…

…probability of obstructive CAD, testing may generate false positive results and unnecessary downstream procedures. In patients with a high probability, testing may add little diagnostic…

…presentation and symptoms A CTO may be asymptomatic and identified during angiography performed for another indication. When clinically significant, it may present with chronic angina…

…24% of patients with CAD. The pathophysiology of refractory angina is heterogeneous. In obstructive CAD, symptoms may result from extensive or diffuse epicardial disease, chronic…

…Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by the subendothelial accumulation of apolipoprotein B…

…a patient's sensitivity to digitalis related arrhythmias. The clinician must evaluate for the presence of worsening renal function, advanced age, hypokalemia, chronic lung disease…

…of ischaemia. Maximal exercise capacity, expressed by exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular disease…

…patients with a very high clinical likelihood of obstructive CAD, defined in the source material as greater than 85%, particularly when one or more of…

…to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary…

…symptoms are particularly important because of the increased risk of cerebrovascular complications. Seizures in a patient with preeclampsia indicate eclampsia. Postpartum disease is clinically important…

…of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease…

…is required. Patients with suggestive symptoms, signs or a medical history indicating possible secondary hypertension should undergo appropriate screening for an underlying secondary cause. Evaluation…

…perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis. ANOCA/INOCA is associated with recurrent symptoms…

…a patient with chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic heart disease…

…in patients with structurally normal hearts [2] . Epidemiologically, BrS is responsible for up to 20% of sudden cardiac deaths in patients without structural heart disease…

…quality of life. Approximately half of all patients with heart failure die suddenly, as a result of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation). Early diagnosis…

…that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients with a very high probability of endocarditis…

…angina pectoris. The location of the pain beneath the xiphoid and epigastrium, combined with patient denial, often leads to a mistaken impression of indigestion. STEMI…

…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…

…course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG criteria. Acute myocardial infarction: a diagnosis…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

…A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when interpreting a current LVEF of 41–49%. Diagnostic…

…spectrum of non ST elevation acute coronary syndrome (NSTE ACS). The clinical spectrum includes patients with a confirmed NSTEMI, patients with a working diagnosis of…

…start immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute…

…with obstructive atherosclerotic disease. Patients with MINOCA tend to be younger and more often female than patients with atherosclerotic mediated myocardial infarction. A history of…

…management of patients with acute STEMI. Although ECG changes in acute STEMI have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction), a…