…and progressive ASCVD; CAD and aortic stenosis may occur before the age of 20 years, with death often occurring before age 30. Clinical presentation and…

…and may be the first clinically important manifestation of an otherwise unrecognized inflammatory disease. Epidemiology and disease specific patterns Patients with inflammatory rheumatic disease have…

…patients with diabetes should be assessed for: ASCVD Severe target organ damage (TOD) HF AF CKD Other clinically relevant cardiovascular disease, including PAD Conversely, patients…

…In contrast, patients with confirmed hypertension generally require BP lowering treatment without additional risk stratification for that treatment decision. Population to which SCORE2 and SCORE2…

…Their clinical importance arises from the causal role of low density lipoprotein cholesterol (LDL C) and other apoB containing lipoproteins in atherosclerotic cardiovascular disease (ASCVD…

…Clinical indications and treatment goals Established atherosclerotic cardiovascular disease Patients with established ASCVD are at very high cardiovascular risk and require intensive LDL C lowering…

…to individuals without established atherosclerotic cardiovascular disease (ASCVD), coronary artery disease, cerebrovascular disease, or peripheral artery disease. Secondary prevention concerns patients with established vascular disease…

…countries as an adjunct to diet and maximally tolerated statin therapy in patients with heterozygous familial hypercholesterolaemia or ASCVD who require further LDL C lowering…

…patients whose LDL C remains above the recommended goal despite maximally tolerated statin therapy, generally with ezetimibe where appropriate. Established clinical atherosclerotic cardiovascular disease (ASCVD…

…may be clinically important in individuals at high or very high risk. Prolonged exposure to lower LDL C concentrations is associated with lower ASCVD risk…

ECG Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms…

…stimulators, and other electronic equipment may also interfere with device function. The clinical consequences depend on the device, the patient's dependence on pacing, the…

…population and diagnostic criteria. MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients presenting with myocardial…

…make the diagnosis more likely. HFpEF and HFmrEF together account for approximately half of patients with symptomatic HF. The distinction is clinically useful but not…

…than the risk among patients with Brugada syndrome. It follows that Brugada syndrome is a likely diagnosis in patients presenting with these symptoms and typical…

…Consequently, current guidelines recommend a 3 generation family history and consideration of genetic testing for all patients with non ischemic HFrEF. Toxic and infiltrative causes…

…Patients with HFmrEF may represent individuals whose LVEF has improved from below 40% or has declined from at least 50%. This distinction is clinically important…

Cardiology Definition and terminology Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by the cardinal symptoms and signs of heart…

…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…

…of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients with acute coronary syndromes. Importantly…

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

…this period. Cascade testing of parents, siblings, and children can identify relatives with high Lp(a) and increased risk of premature cardiovascular disease. Units and…

…clinical presentation is not sufficiently specific to identify the underlying mechanism. Microvascular, vasospastic, and obstructive angina may produce overlapping symptom patterns. Patients may present with…

…Clinical evidence for cardiovascular benefit CLEAR Outcomes CLEAR Outcomes was a randomized, double blind, placebo controlled study of 13,970 patients at high cardiovascular risk…

…representation of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably exclude clinically important differences…

…according to the clinical setting. Values obtained in the emergency department for acute dyspnoea should not be transferred directly to patients with less acute outpatient…

…oxidative stress. Metabolic dysfunction associated fatty liver disease affects approximately 10% of non obese individuals and up to 65% of patients with metabolic syndrome. A…

…several distinct clinical scenarios: Suspected Pulmonary Hypertension: In patients presenting with symptoms like unexplained dyspnea on exertion, assessing the axis is a valuable diagnostic step…

…myocardial necrosis [4]. Clinical Implications and Prognosis Mechanical and Diagnostic Impact LBBB causes extensive reorganization of left ventricular activation [2]. This leads to abnormal LV…

…and thoracic diagnoses must be considered. The immediate clinical categories include: Non cardiac diagnosis Chronic stable angina Possible ACS Definite ACS In patients with ST…

…use of validated risk models to estimate the risk of acute myocardial infarction, 30 day and 1 year mortality in patients with NSTE ACS. TIMI…

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

…an important contrast. Patients with manifest clinical disease are at high risk of progression and generally require all appropriate evidence based measures, including drug treatment…

…The HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation…

…requirement for antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity…

…recurrent infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of…

…associated with poorer survival. Patients with unstable angina pectoris with low risk (according to TIMI score or similar) may undergo stress testing when their clinical…

Cardiology Clinical medicine Definition and Pathophysiology An abdominal aortic aneurysm (AAA) is diagnosed when the abdominal aortic diameter exceeds 3 cm. Most AAAs are located…

…synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use…

…and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age alone…

…patients with diabetes. The haemodynamic consequences depend on lesion location, severity, length, the presence of multilevel disease and collateral circulation. Flow limitation may be clinically…

…Exercise Intensity Intensity may be prescribed using several complementary approaches. Heart rate based methods For patients with cardiovascular disease, dynamic aerobic exercise may be prescrib

…diuretic appropriate for kidney function. In patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m², an adequately up titrated loop…

…recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD Characteristics suggesting that good…

…of patients with previous myocardial infarction, the Mediterranean intervention involved greater consumption of fruits, vegetables, legumes, bread and an alpha linolenic acid rich margarine, with…

…responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients. Pathophysiological basis Exercise progressively increases myocardial oxygen demand through increases in heart rate…

…is broad: Many patients remain asymptomatic. The most common symptomatic presentation is CCS, usually with recurrent angina. Approximately one fifth of clinically recognized ISR presentations…

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

…the patient is clinically unstable, identify life threatening diagnoses rapidly, and select a safe disposition and diagnostic strategy. Only a minority of patients presenting with…

Arrhythmias and arrhythmology Critical care Definition and pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and…

…objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic…

…However, in cases of rapid AVNRT or in patients with underlying structural heart disease, the arrhythmia may result in symptoms indicative of reduced cardiac output…

…It includes patients with recent changes in symptoms or clinical signs, with or without diagnostic electrocardiographic abnormalities and with or without an acute rise in…

…of profession, must be able to diagnose ventricular tachycardia. Causes of ventricular tachycardia Patients with ventricular tachycardia almost invariably have significant underlying heart disease. The…

…bleeding risk assessment tools exist for patients with AF, including HAS BLED, HEMORR2HAGES, and ORBIT scores. Each incorporates various clinical parameters to stratify bleeding risk…

…result on management. ICA with available coronary pressure assessment is recommended in patients with a very high clinical likelihood of obstructive CAD, defined in the…

…guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal correlation…

…clinical guidelines, it aligns with their emphasis on early angiography in high risk patients regardless of ECG findings. Thush, it serves as a valuable diagnostic…

…The clinical spectrum includes patients with a confirmed NSTEMI, patients with a working diagnosis of NSTE ACS and a high probability of unstable angina (UA…

…can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal…