…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…

…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)…

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

…NSTEMI and UA may be similar. NSTEMI is diagnosed when typical ischaemic symptoms occur without persistent ST segment elevation, accompanied by a rise and subsequent…

…Possible manifestations include: Persistent or recurrent myocardial ischemia Deterioration in ventricular function Hemodynamic instability Periprocedural myocardial infarction Cardiogenic shock Cardiac arrest The severity may be…

…presentations Pain is not universal. Painless STEMI is more frequent in people with diabetes and becomes more common with advancing age. Presentations without pain may…

…patients. More than 48 hours after onset: routine PCI of an occluded infarct related artery is not recommended in stable, asymptomatic patients without severe ischaemia…

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

…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…

…formed. Ultrasound settles the question when the clinical picture is unclear. Cellulitis without a pus cavity must not be incised — there, antibiotics are the treatment…

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

…risk is greatest after, not during, the cardioversion itself. Duration reliably under 48 hours: cardioversion has traditionally been possible without prior anticoagulation. The 2024 ESC…

…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…

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

…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…

…ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific marker of myocardial infarction (MI). MI requires both: Acute myocardial injury, demonstrated…

…sinus rate. Its principal therapeutic distinction from beta blockers is that it lowers heart rate without directly reducing myocardial contractility or altering vascular tone. Accordingly…

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

…source material does not describe a distinctive symptom profile for resistant hypertension. In clinical practice, the condition is identified primarily through persistently elevated blood pressure…

…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…

Myocardial ischemia and infarction Definition and pathophysiology Stent thrombosis is thrombotic occlusion arising within a coronary stent or at its margins after percutaneous coronary intervention…

…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…

…hyponatraemia is acute or chronic. The aim is to relieve the cerebral oedema quickly, not to normalise the plasma sodium. Chronic or minimally symptomatic hyponatraemia…

…weakness to paralysis and is a particularly important marker of threatened limb viability. Paralysis generally indicates severe and persistent ischaemia. The limb may be cold…

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

…It may include: Accelerated atherosclerosis and premature myocardial infarction Coronary microvascular dysfunction Myocarditis and pericarditis Coronary or large vessel arteritis Pulmonary arterial vasculopathy and pulmonary…

…not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without…

…min/1.73 m², cardiovascular mortality risk may be as much as three times higher than in individuals without comparable renal impairment. The cardiovascular burden…

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

…account for approximately half of patients with symptomatic HF. The distinction is clinically useful but not absolute. Ejection fraction is a continuous variable and echocardiographic…

…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…

Myocardial ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form…

…than a more distal lesion. Revascularisation improves myocardial blood flow and angina related health status but does not reverse coronary atherosclerosis. Long term benefit therefore…

…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…

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

Cardiology Myocardial ischemia and infarction Definition and Clinical Purpose Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) or positron emission tomography (PET…

…Clinical assessment should include functional status and walking capacity, because these may reveal “masked” PAD in patients who do not exert themselves sufficiently to provoke…

…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…

…hypertension, defined as blood pressure ≥160/110 mmHg Headache that does not respond to medication Visual disturbance Persistent severe epigastric pain Pulmonary oedema Thrombocytopenia, with…

…the setting of an inferior infarction. The presence of right sided ST segment elevation supports the diagnosis, although the source material does not provide sensitivity…

…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…

…with adenosine sensitive syncope, a subtype of reflex syncope that manifests without a prodrome and usually features a nonrevealing cardiac workup. Evaluation and Physical Examination…

…or TIA. The purpose of performing an ultrasound is to scrutinize potential cardiac sources of emboli and to evaluate the carotid and cerebral arteries. Ultrasound…

…Propafenone is usually not the first line therapy in this patient category. Prophylaxis and treatment of symptomatic paroxysmal supraventricular tachyarrhythmia in patients without evidence of…

…Myocardial ischemia/infarction. Hyperkalemia. Treatment of sinoatrial arrest/pause Sinus arrest/pause due to increased vagal tone does not necessitate treatment but it might be…

…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…

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

…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…

…LVEF ≥50%. The ejection fraction classification is clinically useful but should not be regarded as a series of completely discrete diseases. Heart failure extends across…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

…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…

…or electrical heart disease. Less frequently, it may also present in individuals without identifiable cardiac disease. Contributing factors include pulmonary disorders, particularly obstructive pulmonary 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…

…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…

…Treatment of the alcohol use disorder and planned follow up , not merely detoxification. Benzodiazepines reduce the severity of withdrawal and the risk of seizures and…

…absence of urticaria must therefore not be used to exclude the diagnosis [1]. Isolated urticaria, localised angio oedema or itching without compromise of the airway…