…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…

…to distinguish Type 2 MI from acute and chronic myocardial injury. Myocardial injury is characterised by myocyte necrosis and troponin elevation due to mechanisms other…

…however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia…

…to have complete LMCA occlusion, likely because most such occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic…

…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…

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

…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…

…to left heart disease Group 3: PH due to chronic lung disease, hypoxia, or sleep disordered breathing Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) and…

…Large thrombotic burdens increase procedural risk because thrombus can fragment, embolize to other coronary branches or vascular beds, propagate through gaps between stent struts, and…

…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…

…atherosclerosis is the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation…

…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…

…no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal jugular vein is the first choice in most situations…

…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…

…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…

…swelling. A vein suspected of thrombosis or previously thrombophlebitic. Intraosseous access (absolute, for the bone in question): A fracture of the bone to be punctured…

…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 venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent distal to the obstruction…

…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…

…segments; assessment of stent expansion and apposition; recognition of edge dissection, tissue prolapse, thrombus, or other acute complications; investigation of restenosis and stent thrombosis. Intravascular…

…artery dissection (SCAD) Standard angiography may fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal…

…underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic blood interact to initiate and extend thrombosis…

…obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities. Diabetes is associated with inflammation, thrombosis and accelerated atherosclerosis. In…

…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…

…praecordium to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position also works and…

…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…

…within the neointima. It may be accompanied by necrotic core formation and calcification. Neoatherosclerosis can contribute to both ISR and stent thrombosis. Optical coherence tomography…

…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…

…supply and demand. The universal classification distinguishes infarction according to its mechanism: Type 1 myocardial infarction: acute atherosclerotic plaque disruption or erosion with coronary thrombosis…

…stent or scaffold thrombosis Type 4c MI caused by restenosis Type 5 MI associated with coronary artery bypass grafting (CABG) Types 4b and 4c fulfil…

…severe hypotension, or high degree AV block. Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing…

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…

…2 to 24 hours After failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis…

…exceeding those seen with native vessel PCI. Mechanisms The principal mechanism is distal embolization of atheromatous and thrombotic material. Plaque or thrombus may be dislodged…

…caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood. Platelets adhere, become activated, and aggregate…

…often leads to a mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders…

…previous thrombotic microangiopathy. Antidepressants can affect the blood pressure in several ways. Monoamine oxidase inhibitors can cause a hypertensive crisis through interactions, while venlafaxine and…

…administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for…

…Lesions causing only mild obstruction may rupture, thrombose and occlude. Many acute myocardial infarctions arise from lesions that previously obstructed less than 50% of the…

…to a complex fibroatheroma. Smooth muscle cells (SMCs) migrate from the tunica media into the intima, driven by platelet derived growth factor (PDGF) and other…

…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…