…present, neurological examination, gait and truncal stability Acute balance syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke…

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…

…occur without persistent ST segment elevation, accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible…

…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…

…and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8…

…possible without prior anticoagulation. The 2024 ESC guidelines and several Swedish clinical knowledge support documents have tightened the threshold to 24 hours for patients with…

…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…

…Despite this prolonged course, its major complications—including myocardial infarction, unstable angina and stroke—may occur abruptly and without preceding warning. Initiation and progression of…

…state Principal management approach Congestion without hypoperfusion Intravenous loop diuretic therapy Congestion with hypoperfusion Loop diuretic therapy; consider inotropic support Persistent congestion despite initial therapy…

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

…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…

…elevation myocardial infarction (NSTEMI) is considered within the spectrum of non ST elevation acute coronary syndrome (NSTE ACS). The clinical spectrum includes patients with a…

…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…

…confusion Severe headache Persistent nausea Moderately reduced consciousness Marked gait instability The specificity of the symptoms is limited. In a patient with moderate symptoms the…

…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…

…guideline discussion. By contrast, the benefit of beta blockers in patients with CAD without previous MI and with normal LVEF is uncertain. Similarly, evidence for…

…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…

…or without physical signs, and an LVEF below 40%. Signs may be absent in early disease or after effective treatment. HFrEF is commonly associated with…

…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…

…artery was associated with lower five year survival than a more distal lesion. Revascularisation improves myocardial blood flow and angina related health status but does…

…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…

…and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic claudication…

…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…

…and infarction Definition and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without…

…that manifests without a prodrome and usually features a nonrevealing cardiac workup. Evaluation and Physical Examination The initial evaluation of a patient with suspected syncope…

…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…

…discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of…

…from the ECG, without echocardiography. They then stress tested the model against multiple outcome definitions and validated it, with no fine tuning, in geographically and…

…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…

…EAT) most commonly occurs in individuals with underlying structural or electrical heart disease. Less frequently, it may also present in individuals without identifiable cardiac disease…

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…