…atherosclerotic plaque disruption (rupture or erosion). The dynamic thrombotic component can vary in burden and may lead to distal coronary embolization, resulting in myocyte necrosis…

…in 1858 by Virchow (the same Virchow who unraveled thrombosis). He used te term to describe a reduction of blood flow to tissues and organs…

…and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to…

…aortic stenosis – due to risk of syncope, ischemia, and arrhythmias Endocarditis – due to risk of embolization Deep venous thrombosis – due to risk of embolization Relative…

…maintenance dose of 10 mg is not recommended due to higher exposure to the active metabolite and increased bleeding risk compared to patients weighing ≥ 60…

…which is driven by plaque rupture and thrombosis. The mechanisms leading to Type 2 MI are diverse and can be broadly categorised by whether they…

…preferred due to the lower risk of thrombosis and evidence demonstrating long term durability (Filsoufi et al). Percutaneous interventions lack long term safety and efficacy…

…by the fact that there is no (or very little) turnover of myocardial cells and therefore myocardial troponins should not be detected in the blood…

…malignant arrhythmias, and rapid progression to cardiogenic shock. Ventricular fibrillation or asystole may occur early due to the massive ischemia. Complete LMCA occlusion is typically…

…rest to exercise. This response is age dependent and may rarely occur in healthy people older than 60 years. The abnormal slope does not itself…

…does not establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with stent thrombosis present…

…on an irregular surface. Petroleum jelly around the lesion to protect the surrounding skin. Eye protection and gloves for the operator. Explain before treatment that…

…and thrombosis interact to produce focal arterial lesions. Although epicardial coronary arteries are a major site of disease, atherosclerosis is systemic and may affect multiple…

…acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI…

…aspirin and an oral P2Y12 receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous…

…assessment should include functional status and walking capacity, because these may reveal “masked” PAD in patients who do not exert themselves sufficiently to provoke symptoms…

…with intervention on degenerated saphenous vein grafts, rotational atherectomy, and acute MI procedures. Distal embolization of atheromatous or thrombotic material is an important proposed mechanism…

…can also be sought anterior to the lateral malleolus. Calculation: for each leg, the highest of the dorsalis pedis and posterior tibial pressures is divided…

…Thrombolysis in stroke has its own thresholds in the patient on anticoagulants; see the acute stroke quick reference. Stopping the drug and forgetting to restart…

…does not interfere with ongoing CPR or airway management, no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal…

…Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with…

…compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive step is therefore not the choice…

…intraosseous flow requires pressure ; gravity is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the…

…Systemic thrombolysis is the first line treatment in high risk embolism, unless there is an absolute contraindication. The agent and dose are according to the…

…and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to…

…therapy The main objectives of antiplatelet treatment after MI are to: prevent recurrent MI; reduce ischaemic stroke and cardiovascular mortality; prevent stent thrombosis after PCI…

…Valvular disease APS and Behçet disease can cause both arterial and venous thrombosis. In SLE, renal artery involvement may contribute to difficult to control hypertension…

…to result from the cumulative influence of multiple modest dietary changes. Mediterranean type diets provide polyphenols from extra virgin olive oil, fruits, vegetables, nuts and…

…these techniques rests on their ability to characterize the anatomy responsible for a stenosis, define plaque morphology, identify occult lesions, and optimize percutaneous coronary intervention …

…may fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent…

…and less commonly to the abdomen, back, neck or lower jaw. Discomfort may extend superiorly as far as the occipital region but typically does not…

…and metabolic abnormalities. Diabetes is associated with inflammation, thrombosis and accelerated atherosclerosis. In CKD, additional mechanisms include vascular stiffness and accelerated medial calcification related to…

…high risk plaques may exist throughout the coronary tree, while inflammation and thrombotic susceptibility are often systemic rather than confined to a single lesion. Consequently…

…hypercoagulability, and pregnancy are common risk factors (see Risk factors below). A significant proportion of cases with pulmonary embolism require thrombolysis to dissolve the occlusion…

…hypo /hyperkalaemia and metabolic disturbance, hypothermia, tamponade, toxins, thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in…

…myocardial ischaemia or syncope — that has not responded to atropine: Complete heart block (third degree AV block) and second degree AV block Mobitz type 2…

…thrombosis, fever, acute starvation, and dieting. Clinicians should maintain a high index of suspicion for drug induced arrhythmias in patients receiving agents known to alter…

…risk of thrombosis related to the intravascular foreign body. First generation DES, particularly sirolimus and paclitaxel eluting devices, were associated with increased late and very…

…to both ISR and stent thrombosis. Optical coherence tomography (OCT) is currently the most suitable imaging modality for detecting neoatherosclerosis, although its resolution does not…

…sometimes with independently mobile components. Although a mural thrombus is attached to infarcted myocardium, superficial components may detach and embolize systemically. Observational data indicate approximately…

…rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction. Cardiac troponin identifies injury to myocardial…

…URL). It is considered acute when there is a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because…

…or deep vein thrombosis Acute myocarditis or pericarditis Acute aortic dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

…Intravenous thrombolysis within 4.5 hours improves functional outcome in properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to…

…treated similarly with respect to anti ischemic and anti thrombotic drugs. Management must, however, be individualized with respect to the delay to coronary angiography (PCI…

…to 24 hours After failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis, not…

…therapy may reduce embolization of thrombotic or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical…

…often to the abdomen, back, lower jaw, neck, or occipital region. It typically occurs at rest, lasts longer than ordinary angina, and does not reliably…

…costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in STEMI and suggests pericarditis instead. Pain is not uniformly present…

…drug, the target pressure and the rate of treatment are determined by the affected organ function, not by the blood pressure figure alone [2]. A…

…Thrombotic Thrombocytopenic Purpura (TTP): In very rare cases, TTP has been reported with ticagrelor treatment. TTP is characterized by thrombocytopenia and microangiopathic hemolytic anemia associated…

…anatomically severe lesion may not identify the patient most likely to benefit from intervention. Conversely, apparently mild lesions may rupture and precipitate myocardial infarction or…

…pro thrombotic milieu composed of extracellular cholesterol crystals, apoptotic and necrotic macrophage debris, and abundant tissue factor [9] . The transition from a stable plaque to…

…important to assess in patients treated with thrombolysis, because reperfusion may be inadequate and/or transient with thrombolysis therapy (PCI is superior to thrombolysis also…