…sodium loading. It is the most common form of secondary hypertension. Aldosterone acts principally through the mineralocorticoid receptor (MR). After entering target cells, it binds…

…dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated, distinguishing it from classic allergic reactions…

…Indeed, any cell type in the ventricles may cause ventricular arrhythmias. Definitions and ECG criteria for ventricular rhythm and idioventricular rhythm Ventricular rhythm exists if…

…wave. Because of the long duration of the plateau phase most contractile cells are in this phase at the same time (more or less). Moreover…

…to their indication. Do not routinely stop aspirin given as secondary prevention 8 Contact the endoscopist and the consultant on call early. In cirrhosis or…

…to a mismatch between the expansion of contractile cells as compared with conduction cells. Therefore it is very common to observe secondary ST T changes…

…may require expertise and technologies unavailable in primary care. Before investigating secondary causes, pseudo resistance must be excluded. This includes: Poor adherence to antihypertensive treatment…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological basis Secondary prevention after myocardial infarction (MI) encompasses long term interventions intended to reduce recurrent infarction…

Procedurer The ankle brachial index is the cheapest and most accessible method of objectively demonstrating peripheral arterial disease, and it is needed more often than…

…patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long term corticosteroid treatment cannot increase their own cortisol production. Situation Action : : Fever…

…and infarction Definition and Purpose Cardiac rehabilitation is a comprehensive, multidisciplinary secondary prevention intervention for patients with cardiovascular disease, including those recovering from myocardial infarction…

…ECG, normal variants & pathological variants Sinus tachycardia is the most common tachyarrhythmia (tachycardia). Sinus tachycardia is the result of an increased rate of depolarization (i…

…of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and secondary prevention is…

…that increase blood pressure; or An undiagnosed secondary cause of hypertension. White coat hypertension must be excluded with out of office measurements. Objective assessment of…

…which individuals are most likely to benefit from preventive drug therapy. Secondary prevention Although outside the principal scope of primary prevention, secondary prevention provides an…

…predictors in prediction models. Targeting risk factors has been very successful in the primary and secondary prevention of atherosclerotic cardiovascular disease, both at the population…

…or downsloping ST segment. Indeed, North American and European guidelines assert that the ST segment must be either downsloping or horizontal. Otherwise, ischemia is unlikely…

…the test must never delay treatment. Indications Suspected primary adrenal insufficiency (Addison's disease): fatigue, weight loss, hyperpigmentation, hyponatraemia, hyperkalaemia, postural symptoms. Suspected secondary adrenal…

…t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated without unnecessary pauses [1]. The aims are…

…rather than isolated nutrients considered independently. For cardiometabolic health, the most favourable patterns generally contain more minimally processed, fibre rich and bioactive foods, including fruits…

…significantly complicates the electrocardiographic diagnosis of MI because the resulting secondary ST T changes can either mask or mimic the signs of ischemia or infarction …

…threatening ventricular arrhythmias and therefore QT duration must always be assessed. QT prolongation may be congenital (due to genetic mutations) or acquired (secondary to medications…

…tumors. Most of all cardiac tumors are secondary, and the primary cardiac tumors, generally, are benign. Primary and secondary cardiac tumors • Primary cardiac tumors , which…

…cardiomyopathy Takotsubo cardiomyopathy Tachycardia induced cardiomyopathy Non compaction cardiomyopathy Peripartum cardiomyopathy Cardiomyopathy secondary to valvular heart disease Long term prognosis varies markedly across these conditions…

…sign of hyperkalemia is the pointed T waves. This is most pronounced in the precordial (chest) leads. Pointed T waves are tall and narrow at…

…ventricular depolarization and repolarization, which result in secondary ST T changes. Such ST T changes may mimic (simulate) or mask ischemia. Simulation of ischemia manifests…

…only communication between the atria and the ventricles. The atrial impulse must pass through the atrioventricular node, which delays the impulse due to its slow…

…rate or decreasing blood pressure, making it a consideration for patients with low blood pressure secondary to a low cardiac output. Its primary clinical utility…

…the LDL receptor gene, LDLR, which account for most cases. Variants in APOB that impair apolipoprotein B binding to the LDL receptor. Gain of function…

…and deeper S waves in left sided leads. Left ventricular hypertrophy (LVH) The most common causes of left ventricular hypertrophy are aortic stenosis, aortic regurgitation…

…40% that has subsequently improved to 40% under guideline directed medical therapy (GDMT). These patients must be managed as having HFrEF, as their underlying pathophysiology…

…Hence, right ventricular hypertrophy must be pronounced in order to come to the expression on ECG. Moderate right ventricular hypertrophy may not alter the ECG…

…clinical assessment must determine whether immediate blood pressure lowering treatment is required. Patients with suggestive symptoms, signs or a medical history indicating possible secondary hypertension…

…output is inadequate, hypotension is present, or secondary arrhythmias result from the slow rate. In the setting of bradyarrhythmic or asystolic arrest, management priorities shift…

…chronotropy by elevating intracellular cyclic adenosine monophosphate (cAMP) and calcium, as well as through the direct activation of voltage sensitive calcium channels. At lower doses…

…progress [3]. The mean electrical axis is typically calculated for ventricular activation in the frontal plane using the hexaxial reference system. This system is constructed…

…outside the specialized conduction system. This slow propagation leads to a delayed and abnormal activation sequence of the right ventricle, resulting in a prolonged and…

…to hemodynamic collapse [4] . Sustained VT is a medical emergency that universally warrants acute intervention and long term secondary prevention strategies. By Morphology: Monomorphic VT …

…pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily. Principles of management Medical therapies do not alter disease progression. Diuretics…

…Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity…

…reduction of low density lipoprotein cholesterol (LDL C), the primary lipid target in contemporary secondary prevention. Statins inhibit hepatic 3 hydroxy 3 methylglutaryl coenzyme A…

…the sample was fasting or non fasting. The presence of ASCVD, peripheral arterial disease or aortic disease. Secondary causes, particularly diabetes, thyroid disease, kidney disease…

…not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical therapy and secondary prevention. Clinical Presentation and…

…underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and secondary prevention. PCI treats focal stenotic…

…cessation is therefore the preferred therapeutic endpoint. The cardiovascular benefits of cessation extend across primary and secondary prevention. Observational evidence indicates that cessation lowers the…

…multiple QT prolonging medications, and drug accumulation secondary to renal or hepatic impairment or the inhibition of cytochrome P450 metabolism [1]. Nonmodifiable risk factors encompass…

…abnormal 24 hour rhythm should prompt investigation for sleep apnoea, renal disease and secondary hypertension, and lead to one dose being moved to the evening…

…by very long chain acyl CoA synthetase 1. This activating enzyme is not expressed in skeletal muscle, a pharmacological feature that may limit muscle related…

…important inflammatory components. Inflammation contributes to atherothrombosis through activation of innate immune pathways, cytokine signalling and recruitment of inflammatory cells to vascular lesions. The interleukin…

…worse outcomes. Pulmonary hypertension secondary to left heart disease may occur because elevated left sided filling pressures are transmitted to the pulmonary circulation. Persistent pulmonary…

…or when LDL C is markedly elevated. Non HDL C and apoB are secondary targets or risk refining measures, particularly in patients with: Diabetes or…

…loss of independence. Identification of PAD also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention. Clinical assessment should…

…and Purkinje fibers. The conduction system allows for rapid spread of the depolarization to the contractile cells. Figure 3 illustrates the components of the conduction…

…renal replacement therapy. The study found no significant differences between the two treatment groups with respect to either the primary or secondary outcomes. Primary outcome…

…depolarization will consequently lead to abnormal repolarization. This explains the secondary ST T changes seen on premature ventricular complexes; the ST T vector will be…