…time due to the advent of more efficacious agents with wider therapeutic to toxic windows, and its routine use in adult patients is generally discouraged…

…5–3.5 Some centres use 2.0–3.0 with a modern bileaflet prosthesis and no risk factors Mechanical mitral valve 2.5–3…

…A2 promotes vasoconstriction and platelet aggregation. Because aspirin affects only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that…

…receive both lifestyle and antihypertensive drug therapy. For grade 1 hypertension, pharmacological treatment has demonstrated cardiovascular benefit, although in younger individuals with low short term…

…barriers associated with more frequent injectable therapy, although the clinical importance of improved adherence remains dependent on sustained follow up and administration. Clinical indications and…

…less durable relief of angina in some patients and a greater likelihood of repeat PCI. Multivessel disease in ACS is associated with an adverse prognosis…

…and combinations are frequently required. The central therapeutic aim is symptom control rather than modification of long term cardiovascular outcomes. With the important exception of…

…C may paradoxically be associated with increased risk, and HDL C should therefore be interpreted as a risk assessment variable rather than a therapeutic objective…

…symptoms despite the exhaustion of conventional therapeutic options. It is defined by symptoms lasting more than 3 months and attributable to established reversible myocardial ischaemia…

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

…in patients with established atherosclerotic cardiovascular disease (ASCVD), chronic coronary syndrome (CCS), peripheral artery disease (PAD), and acute coronary syndromes (ACS). Its principal therapeutic objective…

…patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow to the infarct zone, thereby limiting infarct size and…

…central therapeutic objective is prevention of thromboembolic complications, particularly stroke. In untreated AF, stroke risk is increased approximately five fold, and AF is associated with…

…need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic considerations, with recommendations aligned with current guidelines from both…

…before cleaning the skin. 2. Clean and let it dry. Do not palpate the puncture site again with an unsterile hand. 3. Insert the needle…

…intracranial hypertension. Therapeutic drainage in idiopathic intracranial hypertension and in assessment before shunt surgery. Contraindications Clinical signs of herniation — deep unconsciousness with unreactive pupils, an…

…at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and makes it visible even when it lies…

…sterile attire for therapeutic drainage with an indwelling catheter. Lidocaine 10 mg/mL, 5–10 mL, 25 G for the skin wheal and 21 G…

…forward with the arms on a table for diagnostic and therapeutic aspiration; for drain insertion the supine position is used with the arm abducted and…

…hours is 1000 mL. Adverse effects Headache. Nausea. Fever. Atrial fibrillation. Worsening of heart failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine…

…Adverse effects Tachycardia. Headache. Flushing. Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration…

…2031 7. The TIMI risk score for unstable angina/non ST elevation MI: A method for prognostication and therapeutic decision making E M Antman, M…

…2031 7. The TIMI risk score for unstable angina/non ST elevation MI: A method for prognostication and therapeutic decision making E M Antman, M…

…coronary perfusion, particularly in patients with coronary disease. Excessive systolic reduction may be associated with falls, syncope, renal deterioration, functional decline, and cognitive impairment. Heart…

…HFrEF is commonly associated with structural and functional ventricular abnormalities and progressive neurohormonal activation. The therapeutic rationale for disease modifying treatment is to reduce mortality…

…or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD…

…decisions regarding revascularization and, in selected patients, identifying microvascular or vasomotor coronary disorders. The investigation should be undertaken when its diagnostic or therapeutic consequences are…

…Long term efficacy data remain limited, and the possibility that chronic If channel blockade could increase sympathetic activity, with adverse remodelling or pro arrhythmic c

…therapeutic inhibition. Gain of function PCSK9 mutations are associated with familial hypercholesterolaemia (FH) and premature coronary heart disease, whereas loss of function variants are associated…

…molecular, and acquired factors may interact in its development. PAH may be idiopathic, heritable, drug associated, or associated with conditions such as systemic sclerosis, HIV…

…Patients with acute coronary syndrome should be offered cessation support during hospitalization. Depression and adverse environmental exposures are associated with continued or resumed smoking after…

…ECLS) emerges as the sole therapeutic alternative for such situations. Presently, this treatment is confined to well equipped centers and is generally reserved for meticulously…

…Adverse effects Tachycardia. Headache. Flushing. Edema. Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration…

…for conducting the test. All personnel must be appropriately trained and the laboratory must be equipped with defibrillators and other emergency instruments. Personnel conducting the…

…when the shock is delivered, and that the thromboembolic risk has been dealt with before the atria begin to contract again. An unsynchronised shock that…

…J. (2015). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal , 36(41…

…J. (2015). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal, 36(41…

…Use with caution in patients on low dose acetylsalicylic acid for cardioprotection. Pharmacokinetic interactions Methotrexate: NSAIDs inhibit tubular secretion of methotrexate, increasing plasma levels and…

…characteristics and preferences when making therapeutic decisions. References 1. Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin associated…

…with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care. Despite their proven morbidity and mortality benefits, their use is limited by specific adverse…

…arrhythmia indications, and potential adverse effects, consideration should be given to initiating therapy with the patient hospitalized and monitored for at least several days. Intravenous…

…failure and ischaemic heart disease. Ageing is associated with progressive increases in systolic blood pressure (SBP), while diastolic blood pressure (DBP) rises less steeply and…

…and blood transfusion with radial access. Radial access has also been associated with lower overall major adverse cardiac events and mortality in pooled analyses of…

…driven atherothrombosis, while interruption of antiplatelet therapy after recent stenting is associated with increased risk of major adverse cardiovascular events (MACE) and stent thrombosis. Premature…

…disease can lead to right ventricular strain and dysfunction, which is associated with poor outcomes. Preserving right ventricular function is therefore an important therapeutic objective…

…Patients with manifest clinical disease are at high risk of progression and generally require all appropriate evidence based measures, including drug treatment and therapeutic lifestyle…

…clinical entity typically associated with drug induced long QT syndrome (DI LQTS) [1]. The condition arises in the setting of both modifiable and nonmodifiable risk…

…Endocrinology & metabolism Definition and Pathophysiology Type 2 diabetes mellitus (T2DM) is a major cardiovascular risk condition. It is associated with a two to four fold…

…in reperfusion therapy. Advanced ECG interpretation, combined with clinical assessment and imaging modalities, has been shown to improve the identification of these patients. Although current…

…renal insufficiency, therapeutic interventions with tamoxifen or lithium, thiazide administration, and over supplementation of calcium and vitamin D. ECG in hypercalcemia Typical ECG changes: Shortened…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

…heart rate) and also slows conduction over the atrioventricular (AV) node. The most classical ECG finding is generalized ST segment depressions with curved ST segment…

…to evaluate ventricular and valvular function. Levosimendan drug is generally well tolerated. Severe adverse effects are less common. Levosimendan may be administered simultaneously with milrinone…

…PMVT): Characterized by a continuously changing QRS morphology and axis, indicating a dynamic sequence of ventricular activation. PMVT is frequently associated with acute myocardial ischemia…