…subacute onset, continuous dizziness lasting hours to days, often with nausea, nystagmus, motion intolerance and difficulty walking Vestibular neuritis, cerebellar or brainstem infarction, haemorrhage, drug…

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 most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction)…

…elevation myocardial infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of…

…shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or vomiting. Persistent shortness of breath. Weakness, dizziness, light headedness…

…than persistent obstruction of the treated epicardial segment. The phenomenon occurs in approximately 2%–3% of PCI procedures overall. It is particularly associated with intervention…

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

…ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST…

…stroke risk is increased approximately five fold, and AF is associated with roughly one in five strokes. Thrombus formation is most commonly related to the…

…normal functioning AV node should not develop AV block when treated with beta blockers. Persisting bradycardia AV block AV block Definition Indication for pacing AV…

…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…

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

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

…of the ST segment. A male patient (Figure 1) presented at age 36 years with an ECG showing deep and persistent, concave upward ST segment…

…hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care. Despite their proven morbidity and mortality benefits…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction…

…Diuretic resistance or end stage renal failure Consider renal replacement therapy Hypoperfusion with persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative…

…in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific marker of myocardial infarction (MI…

…with symptomatic HFrEF. The guideline defined population includes: LVEF ≤35%; sinus rhythm; resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with…

…defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial…

…from: Inaccurate or inconsistent blood pressure measurement; White coat hypertension; Poor adherence or persistence with prescribed therapy; Inadequate dosing; An inappropriate diuretic for kidney function…

…persistent hypertension despite correction of the initiating disorder. Earlier diagnosis is associated with a greater likelihood of cure. When to investigate General indications Patients with…

…probable, and possible stent thrombosis for clinical research and outcome assessment. Predisposing factors Domain Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus…

…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…

…Severe symptoms require immediate treatment with hypertonic sodium chloride, whether the hyponatraemia is acute or chronic. The aim is to relieve the cerebral oedema quickly…

…ergotism, hypercoagulable states or iatrogenic vascular injury. Acute occlusion may also occur in an artery with established collateral circulation, particularly an occluded bypass graft; in…

…of long term cardiovascular outcomes. With the important exception of beta blockers in selected patients after acute myocardial infarction (MI), antianginal drugs have not been…

…directly attributable to CVD. Excess mortality becomes apparent approximately 7–10 years after diagnosis and is associated with persistent disease activity, rheumatoid factor and anti…

…Pharmacology & dosing Definition and pathophysiology Heart failure is a clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s requirements…

…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…

…to the pulmonary circulation. Persistent pulmonary vascular disease can lead to right ventricular strain and dysfunction, which is associated with poor outcomes. Preserving right ventricular…

…aorta: Stanford type A: involves the ascending aorta, with or without extension into the arch or descending aorta. Stanford type B: does not involve the…

…is CCS, usually with recurrent angina. Approximately one fifth of clinically recognized ISR presentations are ACS. ISR may occasionally be associated with myocardial infarction. The…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…embolic syndromes. Clinical suspicion should be heightened after: Anterior STEMI. A large or transmural infarction. Persistent apical akinesis or dyskinesis. LV aneurysm formation. LVEF below…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Angina with non obstructive coronary arteries (ANOCA) describes anginal symptoms in patients whose epicardial coronary arteries are…

…uptake that improves at rest indicates reversible hypoperfusion and is consistent with inducible ischaemia. A persistent defect on stress and rest images may represent scar…

…a dependent position. With advanced disease, rest pain may become persistent. Tissue loss, ulcers and gangrene may develop. In patients with CLTI, early recognition and…

…therefore does not exclude acute infarction, particularly when the clinical presentation is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG…

…growth factor ratio ≥40 is associated with increased risk of preeclampsia with severe features during the subsequent two weeks. Cerebral circulatory autoregulation is also disturbed…

…Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to…

…ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest, electrical or haemodynamic instability, or cardiogenic shock…

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

…3) dysarthria (4) pure sensory stroke (5) mixed sensorimotor stroke. Cardioembolic stroke Thromboembolism associated with cerebral atherosclerosis. Cryptogenic stroke : These cases have no known mechanism…

…with severe symptoms, provided that first line therapies have failed and the patient does not have structural heart disease or reduced left ventricular function. Persistent…

…cells surrounding it do. These cells are capable of generating an escape rhythm with a rate of 40 beats per minute. QRS complexes are normal…

…A personal history of premature CAD, cerebral vascular disease or peripheral vascular disease. A family history of premature myocardial infarction, vascular disease or marked hypercholesterolaemia…

…coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18…

…without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is…

…the deep learning model. Predicting sudden cardiac arrest Sudden cardiac death (SCD) remains one of the most intractable challenges in clinical cardiology. Hundreds of thousands…

…from a previous value of at least 50%. A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when…

…myocardium: a persistently dysfunctional but potentially recoverable state. The chronically dysfunctional myocardium in ischemic cardiomyopathy is therefore heterogeneous. Irreversibly scarred regions may alternate with viable…

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

…instead as an ectopic atrial rhythm (EAR) . Ectopic atrial tachycardia (EAT) most commonly occurs in individuals with underlying structural or electrical heart disease. Less frequently…

ECG Myocardial ischemia and infarction Coronary artery disease (ischemic heart disease) Coronary artery disease, which is synonymous with ischemic heart disease, is the most common…

…hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours: primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia…

…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…

…intravenous access, fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of…