…increase the risk of stroke and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the…

…death. The risk profile differs between diagnostic angiography and PCI, and is strongly influenced by the clinical setting, vascular access route, anticoagulation, renal function, age…

…as greater than 85%, particularly when one or more of the following are present: Severe symptoms despite guideline directed antianginal treatment. Typical angina or dyspnoea…

…another. A low blood pressure may be due to low flow, low vascular tone or both, and the appropriate action differs fundamentally between these cases…

…Congestive Heart Failure Hypertension Age = 75 years Diabetes Mellitus Stroke/TIA/TE Vascular disease Age 65 74 years Sex category (female) Calculate Score CHA2DS2…

…and pathophysiology Atherosclerosis is a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction, immune cell recruitment, extracellular matrix remodelling…

…calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces…

…Induces arteriolar vasodilation without effects on venous circulation. The reduction in systemic vascular resistance (SVR) is rapid and may cause reflex sympathetic stimulation, including tachycardia…

…channel blocker (CCB). Nicardipine inhibits the influx of extracellular calcium in the myocardial and peripheral vascular smooth muscle cell membranes, thus inhibiting the contraction of…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…It forms part of multisite artery disease, defined as atherosclerosis affecting at least two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease…

…Inflammation contributes to atherothrombosis through activation of innate immune pathways, cytokine signalling and recruitment of inflammatory cells to vascular lesions. The interleukin 1β pathway…

…vascular autoregulation during a rapid or severe rise in BP. This may produce acute injury in the brain, retina, heart, aorta, kidneys, or other vascular…

…pharmacodynamic mechanisms. These drugs are broadly utilised to augment myocardial contractility, manipulate systemic and pulmonary vascular resistance, and restore adequate end organ perfusion. Dobutamine is…

…left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures…

…from pulmonary vascular disease, left sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms…

…characterized by the gradual accumulation of inert cholesterol debris, modern vascular biology has redefined atherosclerosis as a dynamic, immune mediated fibroproliferative response to endothelial injury …

…mild to moderate Secondary prevention, walking exercise ≤ 0.40 Severe ischaemia Urgent vascular surgical assessment Exercise ABI. With a normal or borderline resting ABI but…

…cardiac arrest. Repeated blood gases, for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients…

…level Measure in both arms at the first visit; a difference 15 mmHg suggests vascular disease, and the arm with the higher reading is used…

…Inotropes increase myocardial contractility. There are several synthetic and endogenous agents with inotropic and vasopressor effects, and they often need to be combined in order…

…surgeon. Dislocation of a native hip (as opposed to a prosthesis) — a high risk of avascular necrosis of the femoral head and of vascular injury…

…contaminated wounds where a long time has passed since the injury (see below). Be particularly cautious with impaired healing: peripheral vascular disease, diabetes with neuropathy…

…calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces…

…Hemodynamic determinants of MAP Hemodynamically, MAP is influenced by cardiac output (CO) and systemic vascular resistance (SVR), as described by the relationship: MAP = (CO…

…Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with higher perioperative risk…

…facility with vascular expertise. The initial evaluation should establish: The time of symptom onset and the rate of progression The location and severity of pain…

Cardiology Emergency medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and…

…disease, or peripheral artery disease. Secondary prevention concerns patients with established vascular disease, in whom aspirin has a substantially more favourable benefit–risk profile. Aspirin…

…therapy 18% Fixed dose combination with ezetimibe 38% Pooled analyses across different background therapies 17%–25% In patients with atherosclerotic vascular disease or familial hypercholesterolaemia…

…interaction between these acquired risks and age related cardiovascular remodeling contributes to the high incidence and prevalence of coronary and vascular disease in older adults…

…atherosclerotic plaque, and the severity and distribution of coronary stenosis. Modern cardiac CT can acquire a three dimensional cardiac dataset within approximately 5–15 seconds…

…myocardial wall stress and subendocardial ischemia. Neurohormonal activation and vascular and renal abnormalities contribute to sodium and water retention. The interaction between cardiac and renal…

…hyperplasia following vessel wall injury. PCI and stent implantation produce local vascular injury and initiate a sustained inflammatory and reparative response. Proliferation and accumulation of…

…sinus rate. Its principal therapeutic distinction from beta blockers is that it lowers heart rate without directly reducing myocardial contractility or altering vascular tone. Accordingly…

…in approximately one in five individuals. Pathophysiology Lp(a) is associated with several interrelated pathological processes: accelerated atherogenesis; vascular inflammation; progression of calcific aortic stenosis…

…Endothelial dysfunction, increased vascular stiffness, impaired coronary circulation, vascular calcification and myocardial fibrosis further accelerate cardiovascular and renal injury. Adipokine imbalance contributes to insulin resistance…

…inflammatory cytokines, and vasoconstricting mediators, producing abnormal vascular responses and potentially increasing the future risk of obstructive coronary disease. ANOCA/INOCA is heterogeneous. Potential mechanisms…

…As mentioned above, posterior myocardial infarction may be accompanied by inferior infarction if the occlusion affects both vascular territories. This will result in ST segment…

…Although the kidney is a major target—where MR activation promotes sodium transport—MRs are also present in cardiac myocytes, vascular smooth muscle, endothelial cells…

…not universal, however. Delayed recognition may permit vascular remodelling and renal impairment to develop, leaving persistent hypertension despite correction of the initiating disorder. Earlier diagnosis…

…premature mortality compared with continued smoking. Cessation also improves vascular health and may reduce cardiovascular risk within several years, although risk may remain higher than…

…particularly important. The precise initiating mechanism is incompletely defined. Several associations have been described: Female sex, particularly in patients aged approximately 40–50 years. Hormonal…

…contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow, structural and functional impairments sustain vascular obstruction…

…older age, vascular disease and renal dysfunction. The commonly used CHA2DS2 VASc score incorporates the following variables: Risk factor Points Congestive heart failure 1 Hypertension…

…Nevertheless, the risk of arrhythmia and sudden cardiac death is most often determined by the presence and severity of underlying cardiovascular disease. Conduction disease and…

…flow limitation. The mechanisms are incompletely defined. Proposed contributors include hypercontractility or hypersensitivity of coronary vascular smooth muscle to vasoconstrictor stimuli, including adrenergic agonists, leukotrienes…

…is slightly simplified. In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications…

…calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces…

Echocardiography Structure and contractile function of myocardial fibers The left ventricular wall can be subdivided into several layers. These layers are similar to those seen…

…exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering…

…to visualize clearly with trans thoracic echocardiography. Causes of right ventricular hypertrophy Lung disease (with increased pulmonary vascular resistance), congenital heart disease (transposition of the…

…to ischemia/infarction in the conduction system, one must be familiar with the vascular supply to these components. Figure 1 presents all relevant parts of…

…from sudden cardiac arrest (SCA). Cardiovascular collapse : Sudden cessation of tissue perfusion as a result of cardiac or vascular condition. May reverse spontaneously (e.g…

…compartments Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue…

…acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window…

…arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate for a central cause. Acute…

…Ask specifically about: Neurological symptoms: confusion, visual loss, focal neurological signs, seizures, severe or sudden headache. Chest pain, back pain, dyspnoea, orthopnoea and new sweating…

…under vascular surgical supervision Diabetes with neuropathy Reduced compression, closer monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe…

…patient. An unstable pelvic fracture with circulatory compromise. A ruptured aortic aneurysm or another major vascular bleed. Perioperative bleeding that rapidly fills the suction, the…