…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)…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological rationale ST segment elevation myocardial infarction (STEMI) is a working diagnosis based on persistent ST segment…

…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…

…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…

…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…

…implantation of a pacemaker. When considering a permanent pacemaker for bradyarrhythmia, it is important to distinguish persistent, reversible and intermittent bradycardia. The pathophysiology and prognosis…

…with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has formed. Ultrasound settles the question when…

…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…

…can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can cause a stroke hours to weeks later. Everything else in the…

…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…

…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…

…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…

…patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk…

…function is impaired. Inadequate adherence to medication or dietary sodium restriction may therefore mimic pharmacological resistance or contribute directly to persistent hypertension. Resistant hypertension is…

…permit vascular remodelling and renal impairment to develop, leaving persistent hypertension despite correction of the initiating disorder. Earlier diagnosis is associated with a greater likelihood…

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…

…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…

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

…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…

Myocardial ischemia and infarction Pharmacology & dosing Definition and therapeutic objectives Antianginal therapy in chronic coronary syndrome (CCS) is directed primarily at reducing myocardial ischaemia and…

…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…

…LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical signs, and an LVEF below 40%…

…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…

…Inclisiran, with or without statin therapy Approximately 50% reduction The absolute reduction depends on the pretreatment LDL C concentration and the accompanying lipid lowering regimen…

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

…the intima. Intramural haematoma differs from classic dissection because haemorrhage occurs within the media without imaging evidence of an intimal tear or flap. AAS is…

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…

…disease produces persistent, lifestyle limiting symptoms despite guideline directed medical treatment. Neither CABG nor PCI should be performed when angina is present without anatomical or…

…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…

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…

…Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic claudication. In older adults…

…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…

…creatinine ratio ≥0.3. Preeclampsia may nevertheless be diagnosed without proteinuria when clinical symptoms or laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence…

…output in severe cases Cardiogenic shock in the most advanced presentations The symptoms of RVI commonly occur in the setting of an inferior myocardial infarction…

…rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI), in which myocardial ischaemia…

…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…

…therapy in this patient category. Prophylaxis and treatment of symptomatic paroxysmal supraventricular tachyarrhythmia in patients without evidence of structural heart disease. Propafenone is usually not…

…Asystole occurs if no escape rhythm awakes. It is uncommon that sinus arrest leads to persistent asystole; latent pacemakers virtually always awake and salvage the…

…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…

…AV block Mobitz type 2, newly discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or…

…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…

…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…

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…

…drug treatment and transport planning [1,5]. Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours: primary PCI should…

…hypoactivity, hallucinations and marked autonomic hyperactivity Up to 5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness…

…Isolated urticaria, localised angio oedema or itching without compromise of the airway, breathing or circulation is usually an allergic reaction but not in itself anaphylaxis…