…and favour the accumulation of fat, smooth muscle cells, fibroblasts and extracellular matrix beneath the endothelium. Plaques that are particularly prone to rupture characteristically contain:…

…high mortality when malperfusion or rupture develops; surgery or endovascular treatment is therefore generally favoured within 14 days of symptom onset in the source material…

…progressive, and cardiogenic shock may develop rapidly. Ventricular septal rupture VSR typically causes: Recurrent chest pain. Dyspnoea. Hypotension. Rapid development of biventricular failure. Pulmonary oedema…

…atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material. Superficial plaque…

…results in increased levels of circulating pro inflammatory cytokines that may cause plaque rupture (i.e the risk of atherosclerotic plaque rupture is increased during…

…of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes, occurring before…

…rupture or erosion Type 2 MI caused by oxygen supply–demand imbalance unrelated to acute atherothrombosis Type 3 Cardiac death with suspected acute ischaemia before…

…in mitral prolapse. Extensive myocardial infarction may lead to papillary muscle rupture. The risk of rupture is greater for the posteromedial papillary muscle, which only…

…physiological effect of a coronary lesion depends on more than its visual diameter reduction. Relevant determinants include: Lesion eccentricity Vessel tortuosity Calcification Plaque rupture or…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…occur when atherosclerotic plaques rupture or erode, leading to atherothrombosis and occlusion. This causes severe ischemia and the vast majority of patients experience angina pectoris…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…common cause of pericardial effusion is infections, such as viral, bacterial, and tuberculous infections. Post pericardiotomy syndrome. Acute transmural myocardial infarction. Rupture of the free…

…or rupture, resulting in myocardial infarction. Initial rhythm in traumatic cardiac arrest The initial rhythm in traumatic cardiac arrests comprises PEA in 60% of instances…

…pressure Marked respiratory variation in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute…

…circulation. It is possible to detect elevated levels of myocardial proteins in blood within 2 to 3 hours after the onset of myocardial infarction. Cardiac…

…laboratory abnormalities indicate end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis…

…accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral…

…one half of STEMI cases, a precipitating factor such as vigorous physical exercise, emotional stress, or a medical or surgical illness is present before the…

…A risk of rupture; use sparingly Prepatellar and olecranon bursitis The bursa Exclude septic bursitis first Injection is considered when 4–6 weeks of adequate…

…in fewer than 1% of AMI cases and is seen predominantly after larger infarctions and/or delayed reperfusion. Its typical onset is 1–2 weeks…

…include fixed coronary atherosclerosis without plaque rupture, coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation)…

…thoracotomy remains the primary therapeutic intervention. Ideally, it should be performed within 15 minutes of the onset of collapse. Pericardiocentesis , performed using a large needle…

…Rupture exposes highly thrombogenic subendothelial matrix components, notably tissue factor and collagen, to the circulating blood [3] . Plaque Erosion: Responsible for up to 30% of…

…aortic dissection. Symptom onset in PAU may indicate lesion expansion and involvement of the adventitia, requiring urgent imaging because of the risk of rupture. Type…

…but a substantially higher rupture risk; one guideline summary describes approximately a four fold greater risk. This difference informs the use of sex specific surveillance…

…short term prognosis, although early mortality is usually related to the extent of myocardial injury and its complications—shock, reinfarction, myocardial rupture, and ventricular tachyarrhythmia…

…Coronary mechanisms Coronary mechanisms include: Plaque rupture or plaque erosion with thrombosis, despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial…

…due to the risk of aggravating the infarction, as well as inducing ventricular arrhythmias. Unstable angina pectoris in the acute phase (before stabilization of symptoms) …

…rehabilitation, ablative or surgical interventions The test does not define the structure or composition of coronary atherosclerotic plaque, identify plaques at high risk of rupture…

…of the pericardium. Rapid accumulation may cause tamponade with a relatively small volume, whereas a slowly enlarging effusion may reach a much larger size before…

…measure of luminal obstruction. Calcified plaque is generally less likely to rupture than non calcified, lipid rich plaque. CAC nevertheless serves as a marker of…

…blood displacement. OCT is particularly useful for: characterizing the surface of atheroma; measuring fibrous cap thickness; distinguishing thrombus from plaque; evaluating occult plaque rupture; identifying…

…also have more contraindications and a greater risk of bleeding and myocardial rupture. Late presentation For patients presenting more than 12 hours after symptom onset…

…cardiogenic shock, right ventricular free wall rupture and cardiac tamponade. The most common of these are hypotension, low cardiac output and sensitivity to drugs that…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…anaesthesia. Placenta praevia or ruptured membranes in pregnancy — a speculum may be used, but not digital examination until the position of the placenta is known…

…or control of the bleeding in order to obtain a central venous catheter. 4. Take samples for blood grouping and cross matching before transfusion if…

…cells. The accumulation of these foam cells forms the earliest macroscopically visible lesion of atherosclerosis: the fatty streak [5] . Ruptured atherosclerotic lesion with atherotrombosis. Over…