…hyperplasia following vessel wall injury. PCI and stent implantation produce local vascular injury and initiate a sustained inflammatory and reparative response. Proliferation and accumulation of…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Refractory angina is a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options…

…the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction). 1 Initial diagnosis of STEMI…

…PCI of an occluded infarct related artery is not recommended when presentation is more than 48 hours after symptom onset in the absence of persistent…

…from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when typical ischaemic symptoms occur without persistent ST segment elevation, accompanied…

…presentation depends on the extent of microvascular obstruction and the territory supplied by the treated vessel. Possible manifestations include: Persistent or recurrent myocardial ischemia Deterioration…

…elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment elevation…

…working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic symptoms. The immediate pathophysiological objective is restoration of blood…

…clinical patterns of AF—paroxysmal, persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes…

…implantation Bradyarrhythmia is the main indication for the implantation of a pacemaker. When considering a permanent pacemaker for bradyarrhythmia, it is important to distinguish persistent…

…abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has formed…

…NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8. Document the ceiling of care and the decision…

…level of consciousness. Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent…

…persistent, concave upward ST segment depression in leads I, II, aVL, aVF, and V2 through V6. These ECG changes were stable over a period of…

…5% to 30% of patients taking these agents. The cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in the…

…of lipid storage. Its biology includes: accumulation and modification of lipids within the intima; recruitment of innate and adaptive inflammatory leukocytes; oxidative stress and persistent…

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

…acute troponin elevation without evidence of ischaemia represents acute myocardial injury rather than MI. Persistent elevation without a significant dynamic change is consistent with chronic…

Cardiology Pharmacology & dosing Definition and pharmacological basis Ivabradine is a selective inhibitor of the If, or “funny,” current in sinoatrial node pacemaker cells. This current…

…high probability of unstable angina (UA), and patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST segment…

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

…impairment to develop, leaving persistent hypertension despite correction of the initiating disorder. Earlier diagnosis is associated with a greater likelihood of cure. When to investigate…

…because of disturbed flow, residual dissection, inadequate stent expansion, incomplete apposition, or persistent disease at the inflow or outflow edges. The contemporary incidence of stent…

…protocols. Note that while cardioversion restores sinus rhythm in up to 95% of patients, long term maintenance (particularly in persistent AF) remains the greater challenge.

…a genetic mutation in the RYR1 receptor, resulting in persistent muscle contraction upon administration of halogenated anesthetic agents. As an idiosyncratic response to substances such…

…but only if the examiner is trained. Brief attacks triggered by the position of the head relative to gravity: perform Dix Hallpike and, if needed…

…of raised intracranial pressure or impending herniation Moderately severe symptoms New confusion Severe headache Persistent nausea Moderately reduced consciousness Marked gait instability The specificity of…

…ischaemia. Motor dysfunction ranges from weakness to paralysis and is a particularly important marker of threatened limb viability. Paralysis generally indicates severe and persistent ischaemia…

…initiation and after each adjustment. Persistent symptoms despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization. Revascularization may be selected…

…is associated with persistent disease activity, rheumatoid factor and anti cyclic citrullinated peptide antibodies. RA is also accompanied by a higher prevalence of conventional cardiovascular…

…may influence treatment selection and tolerability. Whether the patient has persistent or progressive disease suggestive of an advanced phenotype. Particular attention should be paid to…

…may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to…

…plus ezetimibe. Consider bempedoic acid in selected patients, particularly those with statin intolerance or persistent failure to reach goal. For statin intolerant patients, ezetimibe may…

…are elevated. The syndrome is therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary syndrome, revascularisation is particularly indicated when functionally significant disease produces persistent…

…Persistent apical akinesis or dyskinesis. LV aneurysm formation. LVEF below 40%. Ongoing or newly recognized LV systolic dysfunction. A patient may also present because of…

…as well as a greater prevalence of MVA. Symptoms may be persistent or episodic and may not follow a classical pattern of stable exertional angina…

…that are taken up by myocardial tissue. The distribution of retained tracer provides tomographic information about relative regional perfusion. Imaging is generally performed at rest…

…promote atherosclerosis. The principal anatomical distributions are: Abdominal aorta and iliac arteries, involved in approximately 30% of symptomatic patients. Femoral and popliteal arteries, involved in…

…is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At…

…laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis…

…low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to guide therapy. Diagnostics Electrocardiography…

…has declined. Clinical Presentation and Symptoms The clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present…

…Suggestion of gastrointestinal hemorrhage Persistent bradycardia (< 40 beats/min) Undiagnosed systolic murmur Carotid sinus massage should be considered in patients with symptoms suggestive of…

…e.g via a persistent foramen ovale (PFO), which enables blood flow from the right to the left atrium. Echocardiography is of importance for cardioembolic…

…and arrhythmias caused by digoxin were discussed previously. Below follows a rather detailed declaration of ECG changes, arrhythmias and conduction defects that occur due to…

…is competition between these latent pacemakers, the one with the fastest intrinsic rate of depolarization will be the pacemaker, which means that it usually is…

…inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and a consequent excess risk of premature atherosclerotic cardiovascular…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes…

…those individuals genuinely at risk of arrest. This predictive problem has proven persistently resistant to resolution. Known predictors of cardiac arrest The only risk biomarker…

…50%. A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when interpreting a current LVEF of 41–49%…

…Brief coronary occlusion or relatively prolonged moderate ischemia may produce post ischemic stunning. In the absence of infarction, contractile recovery can occur rapidly after reperfusion…

…as compared with atrial fibrillation, atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial…

…form of atrial tachycardia may occur due to embryological remnants within the atrial myocardium. These residual tissues, persisting from cardiac embryogenesis, are capable of exhibiting…

…motion is persisted in; and, that on stopping, the distress immediately abates, or altogether subsides; have . . . formed a constituent part of the character of Angina…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness or after prolonged very high intake More than 90 percent of withdrawal…

…with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and initial fluid treatment Adrenaline…