Echocardiography is learned at the machine, not in a chair. What a book can do is shorten the interval between seeing something and knowing what it means — and make sure that when you do measure, you measure the thing that changes management. That is what this title is built around. Who it is written (more…)
Ten questions in the format the boards actually use, each followed by the reasoning for the correct option and for the distractors. Work through each one and commit to an answer before reading on — a question read passively teaches nothing. 1. Irregular narrow-complex tachycardia A 68-year-old man has palpitations and mild breathlessness. The ECG (more…)
Candidates rarely fail the DM or DNB cardiology examination for lack of effort. They fail because the effort was allocated badly: too long on the subjects they enjoy, question practice started too late, and no rehearsal of speaking the answer aloud. This is a six-month allocation that fixes those three things. On this page Four (more…)
No-reflow is the situation in which the epicardial vessel has been opened and the myocardium is still not perfused. It occurs in something between five and twenty per cent of primary angioplasty cases, it is an independent predictor of infarct size, heart failure and mortality, and the window in which it can be influenced is (more…)
Stent thrombosis is uncommon and catastrophic. It presents as ST elevation infarction in a patient who has recently had a stent, mortality is in the region of one in five, and the cause is almost always identifiable in retrospect. Knowing the categories is what makes it identifiable in advance. On this page Classification by timing (more…)
Dual antiplatelet therapy after percutaneous coronary intervention is no longer a fixed prescription. Duration is a judgement about which of two risks is greater in the patient in front of you, and the evidence has moved decisively towards shorter courses in patients whose bleeding risk is high. On this page The default durations The trials (more…)
A reference chart is only useful if you also know where each number stops being reliable. These are the values in routine use, with the qualification attached to each, following current ASE and EACVI chamber quantification guidance. On this page Left ventricle Left atrium Right heart Diastolic function Valve severity thresholds Where these numbers mislead (more…)
ST elevation is the pattern everyone is taught and the one that causes least difficulty. The infarcts that are missed are the ones whose ECG does not meet the elevation threshold, or whose elevation is in leads nobody recorded. This is an account of both. On this page The sequence of change Territory and culprit (more…)
Almost every ECG finding that gets missed was visible on the trace. It was missed because the reader went straight to the part of the ECG that matched their expectation and never systematically examined the rest. Interpretation becomes reliable when the reading order stops being decided by the trace and starts being decided in advance. (more…)