…Presentation and Symptoms The clinical spectrum of ISR is broad: Many patients remain asymptomatic. The most common symptomatic presentation is CCS, usually with recurrent angina…

…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…

…Hypoperfusion with persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative care Right ventricular failure is characterized by increased right atrial and…

…conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation, aggregation, and fibrin formation. Within a stented segment…

…long QT, and bundle branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is…

…establish a benign diagnosis. ANOCA/INOCA is associated with recurrent symptoms, impaired quality of life, repeated hospital presentations and angiography, and increased short and long…

…inhibitor should begin with a comprehensive history and physical examination. Clinicians should inquire about historical clues suggesting alternative etiologies, such as a sensation of postnasal…

…Clinical Presentation and Symptoms The clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac…

…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…

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

…coronary ostial compromise Focal neurological deficits or non haemorrhagic stroke Renal, mesenteric or lower limb ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that…

…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…

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

…heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise after MI, mechanical complications…

…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…

…is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment elevations. I A Primary PCI is recommended over…

…or a previous myocardial infarction (MI) is absent. Heart failure (HF) symptoms may result from several overlapping processes: Recurrent or extensive MI with necrosis and…

…indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic…

…Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent atrial fibrillation where…

…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…

…III antiarrhythmic agents may be considered. Catheter ablation should be considered in patients with a high risk of recurrence. Electrical cardioversion is generally ineffective in…

…with increasing frequency or severity; angina that awakens the patient from sleep. Patients receiving modified antiplatelet therapy require clinical surveillance for both recurrent ischemia and…

…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…

…The clinical rationale for DAPT is particularly strong after ACS and coronary stent implantation. ACS is associated with a high risk of platelet driven atherothrombosis…

…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…

…Long term pharmacological management of chronic sinus bradycardia with a pacemaker is usually not necessary unless sinus rates are too slow to meet physiologic needs…

…The interleukin 1β pathway, with downstream effects involving interleukin 6 and C reactive protein, has been a major therapeutic target. This concept is clinically…

…more likely with: Small reference vessel diameter A small post procedural lumen Substantial residual stenosis Long lesions Diabetes mellitus Untreated edge dissection Components and mechanisms…

…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…

…premature death, recurrent infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the five year…

…that has not stopped spontaneously. Recurrent bleeding from a visible vessel on the septum (cautery). Continued bleeding despite compression and cautery (packing). Contraindications Cautery: Type…

…procedure painful. Test with a needle tip before you start. Apply the tourniquet only after the block has taken effect, and note the time. It…

…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…

…coronary intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI is associated with approximately a 25% reduction in recurrent infarction…

…and ischaemia related ventricular failure as potential causes of shock. Patients with moderate to severe chronic kidney disease have a higher burden of comorbidity and…

…mass index, cholesterol and glucose levels, together with a low salt, low cholesterol diet, regular physical activity, avoidance of smoking, and adequate sleep. The process…

…inadequate emotional support is associated with recurrent cardiac events. One possible mechanism is poorer adherence to prescribed treatment. Rehabilitation programmes that incorporate psychosocial care and…

…40–75 years without diabetes and with LDL C between 70 and 189 mg/dL, 10 year risk of a first hard ASCVD event—fatal…

… 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…

…sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient with known ascites…

…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.

…cause of left ventricular dysfunction among patients with atrial fibrillation and other supraventricular tachyarrhythmias. Moreover, ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia) can also…

…develop as a result of stunning. The systemic response to reperfusion and ischemia causes a state similar to SIRS (systemic inflammatory response syndrome) with risk…

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

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

…ulcers; everything else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation…

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

…Patients with AF in the setting of ACS have more comorbidities and a higher risk of complications than patients without AF; both short and long…

…intraosseous access if intravenous access cannot be obtained quickly and parenteral treatment is needed. Prepare airway equipment and contact anaesthesia early with a prolonged seizure…

…threatening diagnoses rapidly, and select a safe disposition and diagnostic strategy. Only a minority of patients presenting with acute chest pain ultimately have ACS; reported…

…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…

…perform systematic interpretation may actually be detrimental. We have therefore compiled a pocket guide with a universal interpretation algorithm. These 22 pages includes all you…

…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…