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…

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

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

…electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest…

…limiting epicardial coronary stenosis. It is therefore a disorder of coronary microvascular perfusion rather than persistent obstruction of the treated epicardial segment. The phenomenon occurs…

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

…STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic…

…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…

…excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent atrial fibrillation where rhythm control is the aim. Atrial flutter…

…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…

…these agents. The cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in the throat. In recent years, the concept…

…lipids within the intima; recruitment of innate and adaptive inflammatory leukocytes; oxidative stress and persistent local inflammation; smooth muscle cell migration and proliferation; extracellular matrix…

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

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

…resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with an ACE inhibitor or ARNI, a beta blocker and a mineralocorticoid receptor…

…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…

…incomplete apposition, or persistent disease at the inflow or outflow edges. The contemporary incidence of stent thrombosis is approximately 1% during the first year after…

…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.

…body's capacity for heat elimination. Hyperthermia can induce an inflammatory state similar to the Systemic Inflammatory Response Syndrome (SIRS). Body temperatures surpassing 40°C (104°F…

…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…

…poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit the clinical picture…

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

…initiation and after each adjustment. Persistent symptoms despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization. Revascularization may be selected…

…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…

…may influence treatment selection and tolerability. Whether the patient has persistent or progressive disease suggestive of an advanced phenotype. Particular attention should be paid to…

…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…

…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…

…mesenteric or lower limb ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that remains uncontrolled despite optimal therapy Acute type A dissection has a…

…Stent malapposition Stent fracture or collapse Residual edge dissection Incomplete lesion preparation Persistent stenosis within the treated segment Mechanical factors are particularly important because correction…

…ischaemic burden. In chronic coronary syndrome, revascularisation is particularly indicated when functionally significant disease produces persistent, lifestyle limiting symptoms despite guideline directed medical treatment. Neither…

…syndromes. Clinical suspicion should be heightened after: Anterior STEMI. A large or transmural infarction. Persistent apical akinesis or dyskinesis. LV aneurysm formation. LVEF below 40%…

…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…

…generally performed at rest and during exercise or pharmacological stress, allowing comparison between myocardial blood flow states. MPI is used principally to: Diagnose and quantify…

…Improvement when the leg is placed in a dependent position. With advanced disease, rest pain may become persistent. Tissue loss, ulcers and gangrene may develop…

…is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At…

…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…

…low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to guide therapy. Diagnostics Electrocardiography…

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

…micturition, sneeze, swallow, and postprandial states. In some instances, patients may present with adenosine sensitive syncope, a subtype of reflex syncope that manifests without a…

…transported from the venous circulation to the arterial circulation, e.g via a persistent foramen ovale (PFO), which enables blood flow from the right to…

…left ventricular function. Persistent or non persistent ventricular tachycardia or frequent premature ventricular contractions that cause pronounced symptoms and other therapies have failed. Patients with…

…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…

…Definition and pathophysiology Familial hypercholesterolaemia (FH) is an inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes…

…most intractable challenges in clinical cardiology. Hundreds of thousands of arrhythmic deaths occur annually in the United States alone, yet no reliable model currently exists…

…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…

…By contrast, chronic hypoperfusion may result in hibernating myocardium: a persistently dysfunctional but potentially recoverable state. The chronically dysfunctional myocardium in ischemic cardiomyopathy is therefore…

…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…

…particularly obstructive pulmonary disease, the use of theophylline, and elevated catecholamine states. EAT typically has an abrupt onset, although a brief warm up phase lasting…

…meal; that thus excited, it is accompanied with a sensation, which threatens instant death if the motion is persisted in; and, that on stopping, the…

…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…

…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…