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…

…on the extent of microvascular obstruction and the territory supplied by the treated vessel. Possible manifestations include: Persistent or recurrent myocardial ischemia Deterioration in ventricular…

…and a high probability of unstable angina (UA), and patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent…

…venous outflow and persistent right sided congestion may be important mechanisms. Diuretics relieve the hemodynamic consequences of congestion by producing a negative sodium and water…

…and fibrin formation. Within a stented segment, thrombus may also develop because of disturbed flow, residual dissection, inadequate stent expansion, incomplete apposition, or persistent disease…

…vasovagal syncope is reported to occur in over 40% of females and 30% of males due to a lack of effective reflex response to posture…

…as dyspnoea and fatigue, as well as a greater prevalence of MVA. Symptoms may be persistent or episodic and may not follow a classical pattern…

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

…or without ECG abnormalities and with or without an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion or…

…dL), and at least a 50% reduction from baseline. For a patient who experiences a recurrent atherothrombotic event while receiving maximally tolerated statin therapy, an…

…Patients with persistent or recurrent chest pain require repeat blood sampling even when an accelerated algorithm has already been initiated. Evaluation and Physical Examination Patients…

…ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that remains uncontrolled despite optimal therapy Acute type A dissection has a particularly rapid early mortality…

…a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options. It is defined by symptoms lasting more than 3 months and…

Cardiology Pharmacology & dosing Definition and pathophysiology Heart failure is a clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s…

…and closely adherent to the endocardial surface. Protruding or mobile: extending into the ventricular cavity, sometimes with independently mobile components. Although a mural thrombus is…

…A nondiagnostic tracing therefore does not exclude acute infarction, particularly when the clinical presentation is compatible with acute coronary syndrome. Recurrent or persistent symptoms should…

…of <12 h duration and persistent ST segment elevations. I A Primary PCI is recommended over fibrinolysis within indicated timeframes. I A If timely primary…

…when ischemic cardiomyopathy is associated with recurrent MI, ventricular arrhythmias, or a large burden of hibernating myocardium. Evaluation and physical examination The assessment should establish…

…opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI criteria and occlusion…

…atrial thrombus. A markedly enlarged left atrium, marked hyperthyroidism or an untreated underlying cause make recurrence all but certain and argue against elective cardioversion. Anticoagulation…

…syndrome and in marked renal failure. Duration of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence…

…response. The ECG in ectopic atrial rhythm and atrial tachycardia A regular rhythm with P waves that differ in contour from sinus P waves. If…

…plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other…

…membrane cannot be inspected and the examination is needed for the diagnosis. Before audiometry or the fitting of a hearing aid. Recurrent otitis externa in…

…in this setting. The duration of therapy requires an individualized balance between: Ischaemic risk, including recurrent myocardial infarction and stent thrombosis. Bleeding risk, particularly major…

…a symptomatic or large pneumothorax, recurrent malignant effusion (often combined with pleurodesis), and in chest trauma and postoperatively. Emergency needle decompression: a clinical suspicion of…

…sinus arrhythmia may also be observed as a consequence of drug toxicity, such as digitalis excess. Biomarkers and Laboratory Findings The source material does not…

…optimal or maximally tolerated guideline directed therapy, or when recurrent cardiovascular events occur despite such treatment. The trials did not establish a mortality benefit. Consequently…

…greatest relatively soon after implantation and declines over time. Evolution of Coronary Stent Platforms Bare metal stents BMS consist of a metallic scaffold without an…

…High Lp(a) is independently associated with first and recurrent atherosclerotic cardiovascular disease events. The strongest observed associations are with myocardial infarction and aortic valve…

…of approximately 30–40% and in death of approximately 35–45%. In chronic coronary syndrome, cessation has been associated with a 36% reduction in premature…

…packing — and each step presupposes that the previous one has been done properly. Indications Ongoing epistaxis that has not stopped spontaneously. Recurrent bleeding from a…

…a tourniquet . Without a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence…

…Addition of a PCSK9 inhibitor when the target remains unmet despite maximally tolerated statin therapy and ezetimibe. For patients with a recurrent atherothrombotic event while…

…in the reperfusion era. Clinical presentation and symptoms A new episode of hypotension, recurrent chest pain, pulmonary congestion, a new cardiac murmur, or jugular venous…

…thrombus formation, recurrent coronary occlusion, and stent thrombosis. Aspirin inhibits the cyclooxygenase 1 pathway, whereas P2Y12 receptor antagonists inhibit a separate platelet activation pathway. The…

…ACS complicated by cardiogenic shock. In NSTE ACS, a strategy involving coronary angiography and subsequent revascularization may be undertaken early, delayed, or selectively after initial…

…smoking, abdominal obesity, and diabetes. Behavioural factors also make a substantial contribution to all cause mortality, while low educational attainment contributes materially to overall risk…

…Limit recurrent myocardial infarction, cardiovascular morbidity, and mortality The modern concept of rehabilitation has evolved from early post infarction physical activity programmes into a structured…

…should incorporate the estimated risk, risk enhancing factors and a clinician–patient discussion regarding the expected net benefit of therapy. Lifestyle modification is appropriate across…

… and A reduction of at least 50% from baseline. In patients who experience a recurrent atherothrombotic or cardiovascular event within 2 years while receiving maximally…

…miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known instability and a low energy mechanism, and a neurovascularly…

…orthodromic AVRT and atrial tachycardia. Suspected atrial flutter with a rapid, regular ventricular rhythm in which the flutter waves are concealed. A recurrent unclear wide…

…ascites, as recurrent treatment. Contraindications There are in practice no absolute contraindications; suspected spontaneous bacterial peritonitis carries more weight than a deranged coagulation profile . Avoid…

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

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

…of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead to consideration to perform early angiography.

…ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia) can also cause this cardiomyopathy. The duration of the tachyarrhythmia appears to be a stronger risk factor…

…the absolute majority. The CCU may be suitable for stable (hemodynamically and respiratory) and fully conscious patients who experienced a brief cardiac arrest. Post resuscitation…

…patients with life threatening ventricular tachyarrhythmias and atrial fibrillation (AF). It is also effective in preventing the recurrence of a wide variety of supraventricular tachycardias…

…arrow), with subsequent asystole. ECG 10 . Recurrence of supraventricular complexes (red arrows). ECG 11 . Relapse of VF and new shock. ECG 12 . Sinus rhythm. ECG…

…the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics. 5…

…low risk of recurrence. Atrial fibrillation in other circumstances (particularly those listed above) is usually a progressive disease. Complications of atrial fibrillation and available treatments…

…and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and a higher risk of…

…and prepare step 2 at the same time By about 10 to 20 minutes at the latest Give a full loading dose of an intravenous…

…ischaemia. A focused history should establish: Quality of the discomfort. Location and radiation. Onset and temporal pattern. Duration and recurrence. Provoking and relieving factors. Associated…

…to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a history of…

…tachycardia. ECG 3 . Spontaneous termination of the ventricular tachycardia. ECG 4 . Recurrence and spontaneous termination of ventricular tachycardia. ECG 5 . Polymorphic ventricular tachycardia, self terminating…

…and also speeds up the ECG interpretation. Press the Download button to download the pocket guide. Download Become a member and unlock all chapters and…

…as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g × 3 IV Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and…