Coronary blood flow mainly occurs during diastole. When the heart is contracting, the intramuscular blood vessels are compressed and blood flow is at its lowest. During diastole, the myocardium relaxes, allowing blood flow to resume. Any increase in the heart rate reduces diastolic time more than systolic time, thus reducing coronary artery perfusion time. In patients with pre-existing disease (such as coronary artery disease or aortic stenosis), tachycardia may lead to reduced myocardial perfusion. The greater the stretch of the ventricle during diastole, the greater the force of contraction, and therefore the greater the stroke volume General principles: treatment should be initiated for patients with stage 1 hypertension, under the age of 80, with end organ damage, cardiovascular or renal disease or diabetes. All patients with stage 2 hypertension should be offered treatment. Encourage patients to modify specific lifestyle factors, such as preventing obesity, stopping smoking, and adopting a low salt diet.

The left anterior descending (LAD) artery, also known as the ‘widowmaker’, because occlusion of this vessel can lead to rapid death NICE does not recommend the use of stress ECG testing, because of the relatively higher false positive and negative rate – but note that other guidelines (e.g. ESC) do still recommend it as a viable alternative Medicine in a Minute is a brand new full-colour text covering the fundamentals of undergraduate medicine in one book. The book is edited and written by two of the authors behind the bestselling Cardiology in a Heartbeat and features several common design elements and features. Enables assessment of ventricular function, wall motion abnormalities and valvular or structural abnormalities

Determining probability (NICE 2010, CG95)

Note that in clinical practice both types of heart failure often occur simultaneously, which is termed congestive cardiac failure. Investigations The joint ESC/ACCF/AHA/WHF task force published the following recommendations for the diagnosis of acute MI in 2012. Associated with acute mitral regurgitation and inferior infarctions in particular; life-threatening complication Definition: the term acute coronary syndrome (ACS) refers to a group of conditions that result from a sudden and unpredictable disruption in coronary blood flow. ACS exists on a continuum, from myocardial ischaemia (unstable angina) to the development of myocardial infarction and necrosis (NSTEMI or STEMI; see Fig. 1.9). Clinically, these conditions are classified according to changes in the electrocardiogram and biochemical markers of myocardial necrosis.

GTN: may be given via the sublingual or buccal route – if minimal to no response, an IV infusion may be considered; note that GTN should be avoided if systolic BP <90mmHgGlyceryl trinitrate (GTN) should be used as and when necessary, repeating a second time after 5 minutes if the pain persists; call an ambulance if the pain persists 5 minutes after a second dose Ratio of total cholesterol to HDL cholesterol is the best predictor of CVD risk, while LDL cholesterol helps guide goals of lipid therapy After immediate management, further therapy depends on the type of ACS, STEMI or NSTEMI/UA and the clinical condition of the patient. Indications include previous ventricular fibrillation/ventricular tachycardia and a reduced ejection fraction Ultrasound allows the physician to visualise the heart and assess its function; may be in two or three dimensions

Medicine in a Minute is a student-friendly, concise text that you will want close to hand throughout your studies. Myocardial wall motion is used as a surrogate marker for perfusion, because ultrasound cannot visualise blood flow in the arteries Digoxin inhibits the sodium-potassium pump and is a negative chronotrope and positive inotrope. Patients on digoxin should be monitored for complications (see Section 1.14.1). Atherosclerosis The dosage of these drugs is usually set by the doctor according to the patient's needs or age (e.g., hypotensive drugs). In this case, you also don't have to worry about medical dosage calculations!

1.2 Acute coronary syndrome

The sinoatrial (SA) nodal branch, which supplies the sinoatrial node, the dominant pacemaker of the heart

Offer patients anticoagulation (fondaparinux 2.5mg SC is recommended for 8 days or until discharge) without early angiography and proceed to post-acute management Pathophysiology: the pathophysiological process that takes place in heart failure involves a complex interplay of many factors. As cardiac output begins to decline, compensatory mechanisms (both mechanical and neurohumoral in nature) are activated in an attempt to sustain adequate tissue perfusion. These may initially be beneficial, but will lead to worsening heart failure over time as their ability to compensate declines. Consider IV glycoprotein IIb/IIIa inhibitors and anticoagulation (bivalirudin or unfractionated heparin recommended) LV aneurysm typically develops after 4–5 weeks, presenting with LV failure, VT and systemic emboli. ECG shows persistent ST elevation. Treat with anticoagulation and/or excision.I’ve got finals coming up in a few months and feel with this book I will be well prepared! It’s well worth the money. The cardiac cycle can be divided into two distinct phases: systole (contraction) and diastole (relaxation). Medicine in a Minute is a student-friendly, concise text that you will want close to hand throughout your studies. The aortic and pulmonary valves, which are similar in structure, are each composed of three cusps, and are also known as semilunar valves Coronary circulation Refers to the degree of stretch applied to a resting muscle at the end of diastole; this increased resting muscle length augments the strength of the subsequent muscle contraction