…dyspnoea, and the presence of risk factors or previously identified coronary calcification. Age and sex remain important determinants of the expected prevalence of obstructive CAD…

…myocardial oxygen requirements, principally through increased heart rate and contractility. In the presence of a flow limiting coronary stenosis, supply cannot increase adequately. Ischaemia begins…

…epicardial vasomotor abnormalities or structural and functional microvascular disease. Thus, the presence of non obstructive epicardial arteries does not exclude a coronary cause of symptoms…

…without acute elevations in cardiac troponin concentrations. Based on the presenting electrocardiogram (ECG) and the presence of troponin elevation, ACS are classified into unstable angina…

…of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of ≥50%, accompanied by objective evidence of structural and/or functional…

…an anatomical or functional dysfunction in the right bundle branch, such that the electrical impulse is blocked. Figure 1 illustrates the components of the ventricular…

…R wave in V5 and V6. Secondary ST T changes occur invariably in the presence of LBBB. The following ECG criteria and characteristics are used…

…prognosis. Pathophysiology The defining physiological abnormality is heart failure occurring with mildly impaired LV systolic function. The syndrome remains fundamentally one of impaired cardiac performance…

…progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant…

…this combination is associated with a worse prognosis. VA may occur in the presence of obstructive coronary artery disease (CAD), in non obstructive coronary arteries…

…on lesion location, severity, length, the presence of multilevel disease and collateral circulation. Flow limitation may be clinically silent, manifest as exertional symptoms, or progress…

…physical signs for LMCAD. Diagnostic Assessment Coronary angiography Invasive coronary angiography defines: The presence and severity of left main stenosis Ostial, shaft or distal bifurcation…

…HFrEF. Clinical evaluation should define: The severity of symptoms and functional limitation. Evidence of congestion or fluid retention. The presence of precipitating or aggravating conditions…

…metabolic imaging. Contribute to assessment of cardiac inflammation, infective endocarditis, and cardiac amyloidosis using appropriate radiopharmaceuticals. Functional perfusion imaging primarily identifies haemodynamically important disease. Non…

…duration and progression of symptoms should be documented carefully. Longer standing and more severe pain or functional loss reduce the likelihood of successful limb salvage…

…76). Lack of Clinical Variables : The original SYNTAX Score focuses solely on anatomical factors, ignoring clinical variables such as age, diabetes, and renal function, which…

…presence or absence of haemodynamic instability or cardiogenic shock. The likelihood of an identifiable IRA. The extent and complexity of coexisting coronary disease. Renal function…

…The severity and functional impact of angina or anginal equivalent symptoms. The response to GDMT. The extent of myocardial ischaemia. The presence of viable myocardium…

…with oxygen demands. Depending on several factors– including the severity of the stenosis/occlusion, microvascular function, myocardial oxygen extraction, presence of collateral circulation, etc –ischemia…

…Notably, 31.2% of patients discharged with intact neurological function were observed to lack a pupillary reflex upon their initial presentation. An absent pupillary reflex…

…device function. The clinical consequences depend on the device, the patient's dependence on pacing, the presence of CRT, the type and location of surgery…

…rate, the behavior of the pacemaker in the presence and absence of intrinsic cardiac activity, Modern pacemakers are packed with algorithms that optimize the function…

…The absence of symptoms indicates that the bradycardia is compensated by an increase in stroke volume. Symptomatic bradycardia may present with chronic or acute symptoms…

…compared with chest pain and dyspnea, a poor predictor of cardiovascular and all cause mortality. However, leg fatigue must be registered. 2. Exercise performance (functional

…be ignored. The most common situation is when assessing aortic stenosis in the presence of a narrowing of the LVOT (left ventricular outflow tract). Such…

…reveal pneumothorax (highlighted by a lack of lung tissue) and its impact on cardiac function. Clinically, patients may present with: Absent breath sounds on the…

…or a very strong clinical suspicion. 3. Give intravenous calcium in the presence of hyperkalaemic ECG changes or arrhythmia. 4. Shift potassium into the cells…

…itself leads to impaired right ventricular function, especially if the load becomes prolonged. However, most often the cause of the load is the primary problem…

…acute phase protein — a normal ferritin does not exclude iron deficiency in the presence of inflammation Transferrin saturation 15–50 % < 15 % indicates iron deficiency…

…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…

…considerably. Symptoms of systemic venous congestion include: Peripheral edema Rapid weight gain Increasing abdominal girth Early satiety Bendopnea Abdominal ascites Older patients may present atypically…

…or CABG, daily or weekly angina remains present in approximately 2%–24% of patients with CAD. The pathophysiology of refractory angina is heterogeneous. In obstructive…

…factors—high LDL cholesterol, cigarette smoking, hypertension and diabetes mellitus—disturb endothelial function and favour the accumulation of fat, smooth muscle cells, fibroblasts and extracellular…

…neurological deficits. Neurological involvement Hypertensive encephalopathy may present with somnolence, lethargy, tonic–clonic seizures, cortical blindness, and, in advanced cases, loss of consciousness. Focal neurological…

…leads [7]. These stricter parameters correlate more closely with abnormal LV mechanical function and the potential benefit of resynchronization pacemaker therapy [7]. R Wave Peak…

…where a fractional excretion of urea below 35 % is a better alternative. Follow up At an eGFR below 60, or in the presence of albuminuria…

…to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with…

…Ongoing or newly recognized LV systolic dysfunction. A patient may also present because of complications of the underlying infarction or LV remodeling, including heart failure…

…conduction. Clinical Presentation and Symptoms Patients with atrial flutter typically present with symptoms related to high ventricular rates and the loss of the atrial kick…

…Reduced cellular uptake and clearance of LDL leads to increased circulating LDL C. The principal genetic mechanisms involve: Loss of function variants in the LDL…

…Several underlying conditions increase a patient's sensitivity to digitalis related arrhythmias. The clinician must evaluate for the presence of worsening renal function, advanced age…

…sided precordial leads when RVI is suspected in the setting of an inferior infarction. The presence of right sided ST segment elevation supports the diagnosis…

…pattern does not determine the anticoagulation indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic cardiomyopathy. Heart failure…

…further reducing myocardial workload. 1 The pharmacokinetic profile of levosimendan is modulated by the presence of an active metabolite, which exerts sustained hemodynamic effects for…

…causes immense strain on the ventricular myocardium, simultaneously as the cause of the arrhythmia already affects cellular function. This results in electrical instability which explains…

…chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations arising from structural or functional abnormalities of the coronary arteries or coronary microcirculation…

…Demonstration of reduced CFR and/or inducible microvascular spasm. The microvascular circulation cannot be directly visualized in vivo in humans. Consequently, diagnosis depends on functional…

…by itself, establish the presence or haemodynamic significance of a specific stenosis. Clinical Role and Indications CAC scoring is principally a risk stratification tool for…

…NSTEMI than in those presenting with STEMI. Approximately one third of patients with MINOCA may present with STEMI. Pathophysiology and causes MINOCA encompasses several distinct…

…systolic function is depressed or preserved Whether hypotension is present Whether an accessory pathway is suspected, particularly before administration of digoxin The duration of the…

…major determinants of subsequent LV deterioration and long term survival. Viable, stunned, and hibernating myocardium Viable dysfunctional myocardium is myocardial tissue whose contractile function improves…

…4). Figure 1 . 12 lead ECG (presented according to Cabrera), recorded at 63 years of age, demonstrates concave upward ST segment depression in leads I…

…It is particularly useful when the clinical question is whether CAD is present and when an anatomical examination is preferred over an initial functional test…

…potential culprit lesion is present. Clinical Indications Suspected Chronic Coronary Syndrome The decision to perform ICA is based on the clinical likelihood of obstructive CAD…

…present. • Can be given as a bolus. • Effective if bradycardia is caused by beta blockers. Dopamine Dopamine receptor agonist, α and β agonist Infusion of…

Info Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…

Cardiology Antiarrhythmic drugs and management of ventricular tachycardia, ventricular fibrillation This manual presents recommendations for the management of ventricular tachyarrhythmias (VT, VF). It is primarily…

…reducing arrhythmic events, contingent upon the specific mutation present. For patients at elevated risk—such as those with a history of cardiac arrest, recurrent syncope…

…is referred to as a syncytium , which implies that the entire network of cells functions as one unit. If one cell in the syncytium is…

…increases), both of which lead to regurgitation. Table 1 presents the most common causes of mitral regurgitation. Table 1. Causes of mitral regurgitation Degeneration, prolapse…