…without a clear trigger: consider vestibular migraine, Ménière's disease, TIA and arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does not apply…

…Experimental angiogenic or regenerative strategies. The syndrome is clinically important not only because of persistent symptoms, but also because quality of life is often poor…

…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…

…instructions are not provided in the source material. Delayed help seeking is associated with older age, female sex, Black race, lower socioeconomic or uninsured status…

…assessment. The clinical burden of AF does not reliably predict stroke risk. Infrequent episodes observed during office based assessments may coexist with asymptomatic episodes. Consequently…

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

…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…

…and anticoagulation status: Tachyarrhythmia with haemodynamic compromise: hypotension, shock, pulmonary oedema, myocardial ischaemia or a falling level of consciousness. Unstable monomorphic VT with a pulse…

…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…

…does not imply inevitable clinical disruption. Fewer than 5% of thin capped fibroatheromas have been identified as the source of an acute myocardial infarction during…

…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…

…Troponin results should not be interpreted in isolation because myocardial injury is also encountered in non ACS cardiopulmonary disease. Patients with persistent or recurrent chest…

…begins with assessment and management of reversible causes. Because the prognosis is described as benign, treatment is directed primarily at symptom relief and may not…

…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…

…Cure is not universal, however. Delayed recognition may permit vascular remodelling and renal impairment to develop, leaving persistent hypertension despite correction of the initiating disorder…

…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…

…devices. Electrode position (anterior posterior vs. antero lateral) does not affect success, but active compression of the pads lowers defibrillation thresholds and improves success, and…

…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…

…immediate treatment with hypertonic sodium chloride, whether the hyponatraemia is acute or chronic. The aim is to relieve the cerebral oedema quickly, not to normalise…

…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…

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

…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…

…does not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or…

…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…

…the LDL C target is not achieved with the maximum tolerated statin dose. This recommendation carries Class I status with Level B evidence in the…

…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…

…with or without extension into the arch or descending aorta. Stanford type B: does not involve the ascending aorta and includes dissections involving the arch…

…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…

…associated with lower five year survival than a more distal lesion. Revascularisation improves myocardial blood flow and angina related health status but does not reverse…

…does not provide a detailed catalogue of specific embolic syndromes. Clinical suspicion should be heightened after: Anterior STEMI. A large or transmural infarction. Persistent apical…

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…

…Non obstructive coronary atherosclerosis not associated with demonstrable ischaemia may therefore remain undetected unless CT based coronary calcium assessment or another anatomical technique is added…

…patients who do not exert themselves sufficiently to provoke symptoms. Intermittent claudication Intermittent claudication is exertional discomfort in a limb muscle that improves with rest…

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

…that does not respond to medication Visual disturbance Persistent severe epigastric pain Pulmonary oedema Thrombocytopenia, with platelets <100 × 10⁹/L Renal insufficiency, with creatinine 1…

…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…

…The atrioventricular node does not possess automaticity, but cells surrounding it do. These cells are capable of generating an escape rhythm with a rate of…

…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…

…viable myocardium with demonstrable ischaemia. However, randomized evidence has not shown a reduction in mortality or myocardial infarction with routine CTO PCI compared with medical…

…after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes. Standby pacing — pads applied but the device not switched on…

…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…

…a previous myocardial infarction (MI) is absent. Heart failure (HF) symptoms may result from several overlapping processes: Recurrent or extensive MI with necrosis and scar…

…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…

…Do not wait for troponin. If clinical suspicion persists despite an initially non diagnostic ECG, the ECG must be repeated, particularly with ongoing or recurrent…

…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…