| CONCEPTS |
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| concepts/HCM-Genetics-and-Phenotypes |
Genetics and phenocopies in HCM. A sarcomeric variant is found in 40-60%, MYBPC3 (~45%) and MYH7 (~35%) dominating against at least eight causal genes; ClinGen is definitive for MYBPC3, MYH7, TNNI3, TNNC1, TPM1, FHOD3, CSRP3, ACTC1 and ALPK3 but disputes CALR3, MYH6, CASQ2, DSP (HCM-specific), VCL, KCNQ1 and ANKRD1, so legacy panels may return false positives. Bi-allelic MYBPC3 truncation is fatal in infancy and compound variants cause 14% of childhood-onset disease; the South Asian 25-bp intron 32 deletion sits in 4% of the population with 6.99-fold HF risk, and regional founders run from Iceland 58% to centre-east France 8.4%. A polygenic score gives OR 2.34/SD independent of rare-variant status, and HCM and DCM alleles run in opposite directions at the same loci. Genocopies are under 5% of adults but up to 25% of children; mitochondrial HCM is invisible to standard panels because neither mtDNA nor nuclear-encoded mitochondrial genes are tested, making gene-elusive results ambiguous |
hypertrophic-cardiomyopathy, genetics, sarcomere, polygenic-risk, phenocopies |
2026-10-30 |
| concepts/HCM-Diagnosis-and-Risk |
Diagnosis and sudden death risk in HCM. Diagnostic thresholds are phenotypic - adult maximum wall thickness >=15 mm or >=13 mm in a first-degree relative, paediatric z-score >2 - with CMR at baseline (Class I) showing LGE in ~65%; a normal resting gradient does not exclude obstruction without provocation. Invasive assessment when non-invasive data are inconclusive, provoking with Valsalva then post-PVC then isoproterenol, with the technique itself deferred to LVOTO. SCD is 0.5-1%/yr and 8-10% at five years in childhood, VF being the commonest terminal rhythm; prophylactic ICDs cut disease-related mortality more than tenfold. ESC 2022 grades an ICD at >=6% Class I while ESC 2023 grades the same threshold IIa; AHA 2024 treats the calculator as one element of shared decision-making. The Maron registry gives 15.6% device-terminated VF among 527 patients with a marker and a primary-prevention device, against 0.3% sudden death without markers or devices |
hypertrophic-cardiomyopathy, diagnosis, cardiac-mri, sudden-cardiac-death, risk-stratification |
2026-10-30 |
| concepts/HCM-Mechanism |
How a sarcomeric variant becomes hypertrophy, fibrosis and ventricular arrhythmia, and why the two phenotypes respond differently to therapy. Increased myofilament calcium sensitivity is the final common pathway. The cMyBP-C layer: eight Ig and three Fn3 domains with an N-terminal C0 and an M-motif carrying Ser273/282/302, Ser282 the hierarchical switch; the protein brakes crossbridges by tethering myosin S1 to S2, and phosphorylation by PKA releases that brake, so reduced protein impairs diastolic relaxation before hypertrophy appears. Truncating MYBPC3 variants act by haploinsufficiency through NMD, UPS and autophagy rather than a toxic fragment; missense variants may instead poison the sarcomere, which decides whether gene replacement or silencing is the right therapy. Arrhythmia arises from ion channel remodelling, increased calcium sensitivity and SR calcium overload generating EADs and DADs; INaL upregulation is demonstrable in preclinical carriers before hypertrophy, driving sodium then calcium overload and APD prolongation. Nonobstructive symptoms come from diastolic dysfunction, ischaemia and microvascular disease, which myosin inhibition does not correct |
hypertrophic-cardiomyopathy, sarcomere, ion-channels, calcium-handling, arrhythmogenesis |
2026-10-30 |
| concepts/HCM-Management |
Management of HCM by physiological stage. LVOTO is defined at >=30 mmHg and treated at >=50, is dynamic and volume-dependent, so nitrates, PDE5 inhibitors, digoxin and inotropes are avoided; the ladder runs beta-blocker, calcium channel blocker, disopyramide, then myosin inhibitor, with AHA placing mavacamten at Class I step 3 and ESC at IIa step 4. SEQUOIA-HCM gave +1.7 ml/kg/min and all ten secondary endpoints; MAPLE-HCM had aficamten beating metoprolol on every objective endpoint while metoprolol moved nothing. ODYSSEY-HCM was negative in nonobstructive disease despite a 59% NT-proBNP fall and LVEF <50% in 21.5%, leaving that phenotype without approved therapy. SHaRe (n=10,225) reports 0.4% 30-day mortality and more repeat reduction after ablation; AF is anticoagulated irrespective of CHA2DS2-VASc and genotype-positive patients need more ablation procedures; mavacamten is contraindicated in pregnancy, moving myectomy pre-conception; universal exercise restriction is no longer indicated; perioperative hypotension is treated with vasopressors, not inotropes |
hypertrophic-cardiomyopathy, lvot-obstruction, cardiac-myosin-inhibitors, septal-reduction, atrial-fibrillation |
2026-10-30 |
| concepts/Factor-XI-Inhibition |
The anticoagulant class built to uncouple thrombosis from haemostasis, and the trial that ended its first wave. Factor XI acts in the amplification phase, so inherited deficiency causes less thrombosis without spontaneous bleeding; abelacimab (monoclonal antibody, binds factor XI and XIa, 99% free-factor-XI suppression, monthly subcutaneous) cut major or CRNM bleeding 62–69% versus rivaroxaban in AZALEA–TIMI 71 (n=1,287, phase 2b, stopped early for benefit, never powered for stroke), with ischaemic strokes numerically higher (HR 2.06, 0.70–6.02). Asundexian (oral factor XIa inhibitor, 92–94% activity suppression) cut major bleeding 68% versus apixaban in OCEANIC-AF but caused 3.79-fold more strokes or systemic emboli (1.3% vs 0.4%), and the composite of stroke, systemic embolism or major bleeding favoured apixaban (HR 1.61) — the bleeding hypothesis held and the efficacy hypothesis failed. Three explanations compete: mechanism (factor XI vs XIa), potency (>99% suppression required), and an apixaban arm that beat its own historical event rate. LILAC–TIMI 76 tests abelacimab against placebo in patients unsuitable for anticoagulation. No agent is approved |
atrial-fibrillation, anticoagulation, factor-xi-inhibition, stroke-prevention, bleeding |
2026-10-29 |
| concepts/Patent-Foramen-Ovale |
Hub for the patent-foramen-ovale cluster; three spokes on detection, selection and non-stroke indications. A tunnel in ~25% of adults, causally involved in ~10% of ischaemic strokes under 60 — so about half of the PFOs found after an embolic stroke of undetermined source are incidental, and the clinical task is causal inference rather than detection. RoPE gives the attributable fraction (23% PFO prevalence at RoPE <3, meaning the PFO almost certainly did not cause the stroke; 77% at RoPE 9–10, ~90% attributable) and PASCAL adds anatomy. Closure plus antiplatelet therapy is strongly recommended at 18–60 on high-quality evidence (annualised stroke 0.47% vs 1.09%, adjusted HR 0.41), but the effect is confined to the causal categories: HR 0.10 in PASCAL probable, 1.14 in unlikely, 2-year ARR 2.1% overall (NNT 47) rising to 5.5% (NNT 14–18) with a large shunt plus aneurysm. Harm lands where benefit does not — post-45-day AF rises 4.41% in unlikely, 0.65% in probable. No closure-versus-DOAC trial exists. Neither guideline can recommend anything under 18 or over 60 |
patent-foramen-ovale, cryptogenic-stroke, embolic-stroke-of-undetermined-source, pfo-closure, paradoxical-embolism, rope-score, pascal-classification |
2026-10-27 |
| concepts/PFO-Detection-and-Anatomy |
Detecting a right-to-left shunt when there is no gold standard — contrast TOE, the conventional reference, has only 89% sensitivity against autopsy, surgery or catheterisation, so ESO 2024 issues no evidence-based recommendation on diagnosis at all. c-TCD is the best rule-out (0.96 sensitivity, 0.90 specificity, AUC 0.96) but cannot localise the shunt or see the septum; c-TTE is specific (0.99) and insensitive (0.71, AUC 0.71) — a fair screen and a bad rule-out; c-TOE is the only test that measures anatomy, limited by Valsalva under sedation. Large-shunt definitions differ by modality (>20 bubbles within 3 cardiac cycles at TOE, >10 HITS at TCD) and none is calibrated to outcome. High-risk anatomy — atrial septal aneurysm ≥10 mm, hypermobility, PFO size — is present in 38.9% of cryptogenic-stroke patients with a PFO (DEFENSE-PFO) and is multiplicative with RoPE. MRI and single-phase CT are inferior. Residual shunt 0–19% with no standard for finding or acting on it |
patent-foramen-ovale, echocardiography, transcranial-doppler, atrial-septal-aneurysm, right-to-left-shunt, diagnosis |
2026-10-27 |
| concepts/PFO-Closure-Selection |
Who to close, as a Bayesian decision: recurrence on medical therapy ~1/100 patient-years, pooled 6-RCT treatment effect HR 0.41, and heterogeneity that makes the average meaningless. RoPE scores six clinical variables (age, vascular risk factors, cortical infarct) to estimate whether the PFO is pathogenic — not recurrence risk; PASCAL adds large shunt and atrial septal aneurysm, giving HR 1.14 (unlikely), 0.38 (possible), 0.10 (probable) and identical 2.1% two-year ARR for possible and probable. Both features together: 5.9% versus 0.4% recurrence, ARR 5.5%, NNT 14. Closure cuts PFO-associated recurrence by 76% (HR 0.24) but all ischaemic recurrence by 59%, and disability-worsening stroke never reached significance (HR 0.59, P=.14) — the outcome patients care about most is the one not shown. The three negative trials and the four positive ones differ in design — follow-up, comparator, anatomical selection, device — not biology. Guidelines disagree on whether anatomy gates the recommendation (SCAI: no; ESO: yes). No closure-versus-DOAC trial. After the device, stroke risk is still 6.3× the general population and tracks vascular risk factors |
patent-foramen-ovale, pfo-closure, rope-score, pascal-classification, cryptogenic-stroke, heterogeneity-of-treatment-effect |
2026-10-27 |
| concepts/PFO-Non-Stroke-Indications |
The scenarios the trials excluded: migraine, decompression illness in divers, platypnea-orthodeoxia, thrombophilia, isolated atrial septal aneurysm, systemic embolism, TIA, DVT, and AF with prior stroke. SCAI 2022 recommends for closure in only two (platypnea-orthodeoxia, on a 14.21-point rise in oxygen saturation; systemic embolism, on three patients) and against in six, every one conditional and all but migraine very low certainty. Migraine is the paradox: MIST, PRIMA and PREMIUM all failed their primary endpoints, yet a post-hoc pooled analysis showed −3.1 vs −1.9 migraine days and cessation in 9% vs 0.7% — so SCAI recommends against routine closure while writing a remark that licenses it. DCI risk is ~5× higher with a PFO but recurrent DCI falls only to RR 0.31 (0.08–1.13) with closure, and the alternative offered is behavioural. DVT found in 7–27% of PFO-stroke workups |
patent-foramen-ovale, migraine, decompression-illness, platypnea-orthodeoxia, thrombophilia, atrial-septal-aneurysm, systemic-embolism |
2026-10-27 |
| concepts/Pregnancy-in-Genetic-Cardiomyopathy |
Pregnancy in the genetic cardiomyopathies, and the structural problem that neither CARPREG II nor mWHO accepts genotype as an input — a normal-function LMNA carrier scores class I despite 90–95% penetrance by 60. Five phenotypes with their thresholds: DCM is the highest risk (MACE 39%, mortality to 7%, pre-pregnancy LVEF <50% the strongest predictor; mWHO III at LVEF 30–45%, IV at <30%); PPCM carries DCM genes in ~15% and TTNtvs in >10%, is tested in 11% of patients and has no agreed definition of recovery; ACM is uneventful for most but has postpartum VA HR 13.74 and needs secondary-prevention ICD before conception; HCM has 0.2% mortality but myosin inhibitors are contraindicated, so myectomy moves pre-conception, with phenylephrine and assisted second stage intrapartum; GP/PN has 10% significant complications and 34% PKP2 progression, and is decided on phenotype. PGT-M needs multiple positive relatives for linkage and is never for a VUS. GDMT conversion is a procedure. Aspirin from 12 weeks is recommended and unstudied in the group that now makes up most referrals |
pregnancy, genetic-cardiomyopathy, cardio-obstetrics, peripartum-cardiomyopathy, hypertrophic-cardiomyopathy, dilated-cardiomyopathy, arrhythmogenic-cardiomyopathy, preimplantation-genetic-testing, mWHO-classification |
2026-10-26 |
| concepts/LV-Hypertrabeculation |
LV hypertrabeculation (formerly noncompaction) as a phenotypic trait, not a cardiomyopathy — the ESC position against the AHA's. Present in 30.5% of genotyped DCM by fractal dimension (29.7% by Petersen, κ 0.638) and prognostic of nothing: embolism HR 1.50, MVA 0.93, advanced HF 0.82 after adjustment. Unadjusted it looks protective because hypertrabeculated ventricles are younger with higher LVEF and less LGE. Do not anticoagulate for it — 3.2% embolic events overall, 2.8% in sinus rhythm with LVEF ≤40% (HR 1.89, 0.66–5.46), with AF (HR 3.26) carrying the risk and 57% of events occurring in AF. Prevalence inverts prognosis: MYH7 71%, MYBPC3 55%, TTN 38%, genotype-negative 33%, cytoskeleton 7%, nuclear envelope 5% — the genotypes that cause arrhythmic death do not produce the trait, and cohorts selected by imaging for it are enriched for favourable genotypes. Real predictors are nuclear envelope genotype (HR 4.4), LGE (3.1) and LVEF |
left-ventricular-hypertrabeculation, dilated-cardiomyopathy, cardiac-magnetic-resonance, anticoagulation, thromboembolism, genotype-phenotype, MYH7, TTN, LMNA |
2026-10-26 |
| concepts/Gene-Therapy-in-Arrhythmia |
Hub for the gene-therapy-in-arrhythmia cluster; six spokes on modality. Three modalities — replacement (haploinsufficiency: PKP2, CASQ2, TMEM43), silencing (gain/dominant-negative: RYR2, CALM, PLN, KCNH2), editing (recurrent point mutations) — with suppression-replacement as the hybrid. The ~4.5 kb AAV ceiling, not biology, decides which genes can be replaced. Five trials now running: three PKP2-ARVC Phase I, AAV8-CASQ2 in RYR2-CPVT1 (adults then ages 7–17), subcutaneous siRNA against PLN p.R14del. Partial correction suffices for arrhythmia (~30–50%) but not for structural repair (>70%), which is why channelopathies are the beachhead and why the PKP2 trials may be enrolling too late. Safety is now the binding constraint: four AAV deaths in 2025. Thirteen-row state-of-play table from CPVT to post-MI VT and AF |
gene-therapy, arrhythmia, channelopathies, AAV, gene-editing, gene-silencing, inherited-arrhythmia, precision-medicine |
2026-10-26 |
| concepts/Gene-Therapy-Transduction-Threshold |
How much of the myocardium a gene therapy must correct before the arrhythmia stops — the question that decides whether a vector works, independent of dose. Source–sink buffering means 70–80 contiguous cells must depolarise together to fire in 1-D, ~7,000–8,000 in 2-D, ~700,000–800,000 in 3-D, so ~30–50% stabiliser cells (30–40% in 2-D/3-D) suffice to abolish triggered activity; animals agree (CPVT 40–66%, CASQ2 p.D307H >33%, LQT3 20%, LQT1 30%, SQT1 47%). But the same heterogeneity raises APD dispersion and can create reentry, clustering and fibrosis raise the threshold again, and structural repair still needs >70% — which makes early intervention the binding constraint rather than vector efficiency. |
gene-therapy, AAV, arrhythmia, channelopathies, cardiac-electrophysiology, source-sink, mosaicism |
2026-10-26 |
| concepts/Atrial-Standstill |
Complete atrial electrical and mechanical silence from diffuse atrial myocardial disease — inexcitability proven by failed atrial capture at 10 mA/2 ms, not by absent P waves alone; routinely mistaken for AF with a slow ventricular response. Three convergent pathways: SCN5A ± GJA5 exit block (EHRAS I, unconfirmed), homozygous NPPA interstitial fibrosis (II), EMD/LMNA fibro-fatty replacement (III). TE 22–54% and CHA2DS2-VASc under-predicts by an order of magnitude, so anticoagulate every etiology at diagnosis regardless of score. VVI in complete standstill, EAM-guided DDD cuts RV pacing 100%→4–19% in partial, atrial leads fail within 3–8 years. ICD decided by gene: EMD pacemaker (ICD 3.3%) versus LMNA ICD (60%). Preserved LVEF in NPPA is a trap — mortality 38%. |
atrial-standstill, atrial-cardiomyopathy, bradycardia, SCN5A, NPPA, EMD, LMNA, thromboembolism, permanent-pacing |
2026-10-26 |
| concepts/Chronic-Kidney-Disease |
CKD definition and CGA staging (G5 = kidney failure); eGFR + uACR screening in all CVD; KFRE and referral triggers; bidirectional cardiorenal risk (45-fold kidney failure after incident HF); four-pillar cardiorenal stack with trial thresholds (ACEi/ARB, SGLT2i, finerenone, semaglutide) and the acceptable <30% eGFR dip; SCORE2 with CKD Add-On; cardiac troponin in CKD (cTnT 70% vs 24%, six-fold eGFR gradient); eGFR slope as surrogate; hyperkalaemia; non-diabetic CKD |
chronic-kidney-disease, nephroprotection, RAS-inhibitors, SGLT2-inhibitors, mineralocorticoid-receptor-antagonist, GLP-1-receptor-agonists |
2026-10-25 |
| concepts/ECLS-in-PH |
VA-ECMO and PA-LA approach for refractory RV failure in PH; bridge to transplant the only established indication; awake ECMO preferred; RVAD contraindicated in PAH; ECMO watershed phenomenon; 94% bridged to Tx; 78% hospital discharge |
extracorporeal-membrane-oxygenation, right-ventricular-failure, pulmonary-hypertension, lung-transplantation, mechanical-circulatory-support |
2026-05-31 |
| concepts/Lung-Transplantation-PAH |
Referral (ESC/ERS intermediate/high or REVEAL >7); listing (high risk or REVEAL ≥10); bilateral Tx procedure of choice; no RV dysfunction precludes Tx; perioperative + prolonged postoperative ECMO prevents early LV graft dysfunction; 1-year survival >90%; RV recovers universally post-Tx |
lung-transplantation, pulmonary-hypertension, right-ventricular-failure, extracorporeal-membrane-oxygenation, intensive-care |
2026-05-31 |
| concepts/Paroxysmal-AV-Block |
PAVB: sudden complete AV block with asystole; TD-PAVB (atrial rate acceleration → repetitive concealed conduction in diseased His-Purkinje with postrepolarization refractoriness) vs PD-PAVB (pause → source-sink mismatch ± phase 4 depolarization); His bundle most common site (7/10 EPS cases); "phase 3/4 block" are misnomers; Mobitz II closely associated |
paroxysmal-AV-block, His-Purkinje-system, tachycardia-dependent-block, concealed-conduction, atrioventricular-block |
2026-05-30 |
| concepts/NOAC-AF-Management |
NOAC use in AF: EHRA VHD Type 1/2 eligibility; pharmacokinetics and dose-reduction criteria; CKD (ESC 2026 renal bands I A / IIa B1 / IIa C) and Child-Pugh dosing; weight extremes; P-gp and CYP3A4 interactions; drug-level interpretation; follow-up and adherence; cardioversion; post-stroke initiation; missed and doubled doses; bleeding reversal; switching between anticoagulants; factor XI inhibition (abelacimab and asundexian reduce bleeding but are not DOAC alternatives); SINGLE-AF dose distribution at intermediate risk |
atrial-fibrillation, anticoagulation, noac, stroke-prevention, pharmacokinetics |
2026-10-30 |
| concepts/NOAC-Perioperative |
Perioperative NOAC management: no LMWH bridging; timing tables (dabigatran CrCl-dependent: 24–96h; FXa inhibitors 24–48h); dental surgery no-stop; device implantation last-dose-morning-before; neuraxial ≥3–5 days; AF ablation uninterrupted or 12h before (ACT 300–350s); urgent surgery tiers (immediate/urgent/expedite) with reversal agent decision tree |
anticoagulation, noac, perioperative, surgery, bridging |
2026-05-30 |
| concepts/HCM-AI-ECG-Scar |
XplainScar: explainable ML model for LV scar detection/localization in HCM from 12-lead ECG; F1=89% external validation; unsupervised clustering + SCARF + SHAP; basal scar → Q wave/intrinsicoid QRS in aVR; apical scar → T wave inversion V2–V6; cannot quantify scar; prospective validation pending |
hypertrophic-cardiomyopathy, artificial-intelligence, ECG, LV-scar, explainability |
2026-05-30 |
| concepts/Fascicular-Blocks |
LAH (LAFB) and LPH (LPFB): anatomy (posterior division dual blood supply — LAD + PDA, most protected); LAH ECG (AQRS −45° to −90°; S III > S II; CCW VCG loop = pathognomonic); LPH ECG (AQRS +100° to +180°; S1Q3; rS in I/aVL; CW VCG loop); 7 MI masking/simulation patterns; masquerading RBBB (LAH conceals RBBB S waves); RBBB+LPH = near-trifascicular: 80–87% acute MI mortality, 42% AV block; LAH epidemiology (2.77% healthy population; 62% in <40yr; CAD 41% in hospital patients); Lev vs Lenègre disease |
left-anterior-hemiblock, fascicular-block, intraventricular-conduction-delay, myocardial-infarction-masking, electrocardiography |
2026-05-30 |
| concepts/RBBB |
RBBB clinical overview: 2–3% prevalence, strongly age/sex-dependent (1% age 50 → 18% age 80 men); thin long RV bundle (LAD supply); initial 30–40 ms normal → MI co-diagnosis preserved; rSR' most common V1 pattern; Brugada = pseudo-RBBB (no wide S in I/V6; Chiale maneuver unmasks concealed Brugada in true RBBB); CRT generally no benefit except RBBB+LAFB or prolonged PR; isolated RBBB benign; RBBB+CVD = independent mortality predictor |
right-bundle-branch-block, ECG-criteria, ventricular-conduction-delay, Brugada-syndrome, bifascicular-block |
2026-05-30 |
| entities/Vectorcardiography |
Frank lead system (gold standard, 7 electrodes); Kors regression (~98%) and IDT (~97.2%) best ECG→VCG transforms; quasi-orthogonal NOT reliable; QRS-T spatial angle most analyzed parameter; QRS area outperforms QRS duration and LBBB morphology for CRT response; VCG superior for LQTS (86% vs 69%), MI (98% vs 73%), atrial enlargement; mid-end QRS loop delay pathognomonic of true LBBB; IDT contraindicated for AF f-wave analysis |
vectorcardiography, ECG-derived-VCG, Frank-lead-system, QRS-T-angle, cardiac-signal-processing |
2026-05-30 |
| concepts/LBBB-Criteria |
Conventional AHA criteria (QRS ≥120 ms) vs Strauss strict criteria (≥140/130 ms men/women + mid-QRS notching/slurring ≥2 leads); ~1/3 of conventional LBBB = pseudo-LBBB (LVH+LAFB); concordant LBBB (~28–32%, milder disease, LVEF ~51%, better prognosis) vs discordant LBBB (~68–70%, lower LVEF ~36%, worse prognosis, greater CRT benefit); VCG mid-end QRS loop conduction delay pathognomonic of true LBBB; gender differences (women exhibit LBBB at shorter QRSd); ~30% CRT non-responder rate linked to false LBBB diagnosis |
left-bundle-branch-block, ECG-criteria, cardiac-resynchronization-therapy, vectorcardiography, ventricular-conduction-delay |
2026-05-30 |
| concepts/Atrial-Septal-Defect |
Most common CHD diagnosed in adulthood (25–30% of new diagnoses); 4 subtypes (secundum 80%/primum 15%/sinus venosus 5%/coronary sinus); proactive closure normalises prognosis; PVR <5 WU safe / ≥5 WU contraindicated; cardiac erosion — atrial septal malalignment novel risk factor; PCWP monitoring in elderly (abandon if rise >10 mmHg or >20 mmHg absolute); ASD closure does NOT reliably reduce AF; ~1/3 >60yr and ~1/2 >70yr have AF; PVI before closure for symptomatic paroxysmal/persistent AF (age <75, LA <50 mm); ASD closure beneficial even in permanent AF; Eisenmenger contraindication; COstatus transpulmonary ultrasound dilution for Qp/Qs in critically ill paediatric patients; Qp:Qs is a relative ratio — absolute flow burden varies widely at identical Qp:Qs; exercise-induced shunt dynamics contradictory across 3 studies (no clear guideline on exercise restriction); late-onset post-closure PAH risk factors: delayed repair >40yr, BMPR2 variants, microvascular disease. Adds ablation after percutaneous closure: transseptal puncture 100% successful, 77.7% freedom from AF, 4.7% inadvertent epicardial puncture. |
atrial-septal-defect, adult-congenital-heart-disease, congenital-heart-disease, pulmonary-arterial-hypertension, arrhythmia-management |
2026-10-29 |
| concepts/Intracardiac-Shunts |
Qp/Qs ratio classification (<1.0 R→L / 1.0–1.5 small / 1.5–2.0 moderate / ≥2.0 large L→R); Qp/Qs is a relative index — absolute flow differs widely at identical ratios (7.2 vs 10.8 L/min at Qp:Qs 1.8 with CO 4 vs 6 L/min); echocardiography detects but cannot quantify Qp/Qs; oximetric shunt equation (invasive gold standard); perivascular flow probes (coronary flow excluded → Qs underestimate); COstatus ultrasound dilution sensitivity 95.7%/specificity 97.6% for shunt detection but underestimates Qp/Qs magnitude in moderate/small shunts; PVFP vs OSE percentage error 58.8% — no true gold standard |
intracardiac-shunt, congenital-heart-disease, pediatric-hemodynamics, cardiac-output, hemodynamic-monitoring |
2026-05-28 |
| concepts/Cardiac-Output-Measurement |
5 method classes: Fick (direct O₂ = gold standard, CO₂ rebreathing ±35–49%), indicator dilution (PAC TD gold standard — revival in cardiac ICUs; CCOM every 20s; 9 error sources; TCPTD/PiCCO + GEDV/EVLW; LiDCO; COstatus shunt detection), pulse contour (PiCCO ±32%, LiDCO ±24%, Vigileo ±41%, Modelflow ±17%), CCE/TTE ±25% (acceptable; proposed future reference), bioreactance (NICOM: poor in cardiogenic shock), esCCO/USCOM 42.7%/CO₂ rebreathing (all unacceptable in critically ill); Critchley-Critchley ±28% criterion; no method surpasses 3-synchronized-injection TD. Thiele/Bartels/Gan 2015 review supplies all ten governing equations (Fick, Stewart–Hamilton, Swan thermodilution, Doppler, CO₂ Fick, rebreathing derivation, PiCCO integral, Moens–Korteweg) |
cardiac-output, hemodynamic-monitoring, thermodilution, pulmonary-artery-catheter, critical-care-echocardiography, critical-care, pulse-contour-analysis |
2026-10-16 |
| concepts/Pulmonary-Artery-Pulsatility-Index |
PAPi = PAPP/RAP; NOT a direct RV function measure — composite of SV, pulmonary arterial capacitance (PAC), and RAP; PAWP reduces PAC and raises PAPi independently of RV function; population-specific cutoffs non-interchangeable (≤0.9 RV MI / <1.85 LVAD / <3.65 advanced HF / ≥1.0 VA-ECMO wean); PAPi NOT associated with 30-day mortality in SHOCK trial; post-LVAD PAC normalisation reduces PAPi sensitivity |
cardiogenic-shock, hemodynamic-monitoring, right-ventricular-failure, mechanical-circulatory-support, pulmonary-arterial-capacitance |
2026-05-25 |
| entities/Levosimendan |
Quadruple-mechanism inodilator (TnC calcium sensitisation + vascular KATP vasodilation + mitochondrial KATP/mPTP/cytochrome-C cardioprotection + endothelial NO via p38 MAPK; PDE3 only supratherapeutic); OR-1896 t½ ≈70–80h → ≥1 week pharmacodynamic effect; ONLY inotrope with zero myocardial O₂ cost; AF risk (increased vs dobutamine/placebo); VT discordant (REVIVE vs SURVIVE) but real-world ICD/VT unchanged (LEVO-D); LIDO 180-day HR 0.57; enoximone CS/AMI survival 69% vs 37%; VA-ECMO weaning mixed; PPCM/takotsubo preferred; cardiac surgery LCOS reduction; septic shock positive meta-analyses; LEVO-D registry (n=403 destination therapy): HF hosp 77.9%→38.7%; 43.7% responders; LEVO-D score AUC 0.71; no strategy or dose superiority; ESC 2021 palliative/bridge to transplant/LVAD |
calcium-sensitizer, inotropes, advanced-heart-failure, destination-therapy, cardiogenic-shock |
2026-05-26 |
| concepts/IABP |
IABP device mechanics (8-9.5Fr, helium, tip distal to left subclavian); 4 timing error patterns; coronary flow limited by autoregulation/stenosis; Benchmark Registry major complications 2.6%; NRMI-2 benefit with thrombolysis but not PCI; contraindications (AR, dissection, aneurysm, PVD); JCS/ESC/ACC guideline discordance |
intra-aortic-balloon-pump, cardiogenic-shock, mechanical-circulatory-support, hemodynamic-monitoring, acute-myocardial-infarction |
2026-05-25 |
| concepts/ECPELLA |
Combined VA-ECMO + Impella for cardiogenic shock; counteracts VA-ECMO retrograde afterload; Schrage 2020 HR 0.79 (observational); higher complication burden (bleeding/hemolysis/limb ischemia/RRT); three-step weaning (PAPi ≥1.0 for VA-ECMO; PAWP <20+CPO ≥0.6W for Impella); optimal PVA during recovery unresolved |
cardiogenic-shock, mechanical-circulatory-support, VA-ECMO, Impella, ECPELLA |
2026-05-25 |
| concepts/OTVA-ECG-Localization |
12-lead ECG localization of outflow tract VAs (RVOT 70–80%, LVOT 15–25%, LV summit 12%); ECG signatures for 11+ sites; 18 published algorithms — combined TZ+V2S/V3R best overall (Youden 0.77); V3R/V7 index best AUC (0.95); V3 transition and preferential conduction are key pitfalls; stepwise algorithm included |
outflow-tract-ventricular-arrhythmia, ECG-localization, catheter-ablation, PVC, ventricular-tachycardia |
2026-05-29 |
| concepts/Sudden-Cardiac-Death |
Epidemiology and mechanisms of SCD across the inherited cardiac diseases, channelopathies included. AHA 2017 US figures: 230,000-350,000 SCD/year and 356,500 OHCA/year; 10% overall OHCA survival (6% at home, 24% in-hospital); >=25% of SCD is the first cardiac event; ischaemic heart disease predominates but is declining; age-stratified risk. Mechanisms: automaticity, triggered activity and reentry |
ventricular-arrhythmia, sudden-cardiac-death, epidemiology, ICD-risk-stratification, guideline, channelopathies |
2026-05-23 |
| entities/ICD |
Implantable cardioverter-defibrillator. Trial base: MADIT-II (ischaemic, LVEF <=30%) HR 0.69 P=0.016; SCD-HeFT (LVEF <=35%, 52% ischaemic) HR 0.77 P=0.007; NYHA II HR 0.54 versus NYHA III HR 1.16 NS; DEFINITE (NICM LVEF <36%, n=458) all-cause HR 0.65 NS but SCD HR 0.20 P=0.006; DANISH (NICM) HR 0.87 NS, SCD HR 0.50 - together these set the <=35% threshold. AHA 2017 Class I primary prevention: ischaemic LVEF <=35% + NYHA II-III (>=40 d post-MI, >=90 d post-revascularisation); LVEF <=30% + NYHA I; NICM LVEF <=35% + NYHA II-III + >=3 months GDMT; secondary prevention after SCA or unstable VT; Lamin A/C with >=2 of 4 risk factors (IIa); value statements (primary prevention high value <$50K/QALY, secondary intermediate $64-100K/QALY). Programming (HRS 2015): prolonged detection 30/40 intervals, VF cutoff >=200 bpm, ATP first-line 188-250 bpm; dual-zone S-ICD; decision-tree omission safe for standard transvenous implants (SIMPLE n=2,500). POTCAST (NEJM 2025): potassium targeting reduces the composite of arrhythmia and death, HR 0.76, NNT 12.3 |
ICD, primary-prevention, secondary-prevention, sudden-cardiac-death, heart-failure, implantable-cardioverter-defibrillator, arrhythmia |
2026-05-23 |
| concepts/Electrical-Storm |
AHA 2017 definition: >=3 episodes of sustained VT, VF or appropriate ICD shocks within 24 h; acute management corrects reversible triggers then IV beta-blockers, IV amiodarone and deep sedation, with catheter ablation for drug-refractory cases. ESC 2022 supplies the step-by-step management algorithm |
ventricular-arrhythmia, ICD-risk-stratification, arrhythmia-management |
2026-05-23 |
| concepts/HCM-Risk-SCD |
HCM Risk-SCD and HCM Risk-Kids calculators, with ESC threshold-driven (>=6%) versus AHA decision-aid approaches. AHA/ACC 2017 risk factor table: established factors (SCA, sustained VT, FHx SCD-HCM, LV wall >=30 mm, unexplained syncope <6 months, NSVT, abnormal BP exercise response); potential modifiers (age <30, LGE-CMR, LVOTO); high-risk subsets (LV aneurysm, LVEF <50%) |
sudden-cardiac-death, HCM, risk-stratification, ICD-risk-stratification, guideline |
2026-05-23 |
| concepts/Sinus-Node-Dysfunction |
SND (sick sinus syndrome): age-dependent fibrosis → bradycardia/pause/tachy-brady syndrome; pacing requires symptom–bradycardia temporal correlation (no minimum HR/pause threshold); primary benefit QOL; atrial-based pacing over VVI; rate-responsive for chronotropic incompetence |
bradycardia, sinus-node-dysfunction, permanent-pacing, tachy-brady-syndrome, chronotropic-incompetence |
2026-05-23 |
| concepts/Atrioventricular-Block |
AV block classification (first-degree through third-degree), etiology (degenerative/Lyme/sarcoidosis/neuromuscular), site-based prognosis; Mobitz II/high-grade/third-degree → PPM regardless of symptoms; infranodal block does NOT respond to atropine; TAVR conduction disturbances; LVEF 36–50% + >40% ventricular pacing → CRT/His bundle pacing preferred |
atrioventricular-block, bradycardia, permanent-pacing, infranodal-block, cardiac-conduction-delay |
2026-05-23 |
| concepts/Permanent-Pacing-Indications |
Comprehensive 2018 ACC/AHA/HRS pacing indications: SND (symptom-required), AV block (Mobitz II/high-grade/complete → PPM regardless), neuromuscular disease (myotonic dystrophy/Kearns-Sayre), TAVR, acute MI, alternating BBB; LVEF 36–50% pacing mode selection; shared decision-making and pacemaker withdrawal rights |
permanent-pacing, bradycardia, sinus-node-dysfunction, atrioventricular-block, cardiac-conduction-delay |
2026-05-23 |
| concepts/Cardiac-Glycosides-in-HFrEF |
Digoxin/digitoxin in HFrEF: HF hospitalization HR=0.79 (benefit); all-cause mortality HR=0.98 (no benefit); digitoxin vs digoxin indirect comparison NS; DIGIT-HF 2025 only contemporary-GDMT trial; hospitalization benefit DIG-sensitive; TDM-guided dosing key; AHA/ACC COR IIb for symptom reduction |
cardiac-glycosides, heart-failure, HFrEF, digoxin, digitoxin |
2026-05-22 |
| entities/Cardiac-Glycosides |
Na⁺/K⁺-ATPase inhibitor drug class (digoxin + digitoxin); positive inotropy + vagotonic rate control; HFrEF COR IIb; HF hospitalization HR=0.79 (no mortality benefit); DIGIT-HF 2025 HR 0.82 composite; digoxin renal-cleared / digitoxin hepatic; Class III Harm in pre-excited AF; Fab antidote for toxicity |
cardiac-glycosides, digoxin, digitoxin, heart-failure, drug-toxicity |
2026-05-22 |
| concepts/Cardiac-Rehabilitation-HF |
Detail page for rehabilitation in heart failure: ESC 2026 adds I B1 for training within exercise-based CR, I B2 outside it, I B1 in LVAD and IIa B1 in decompensated HF, plus the HF contraindication list; Class 1A ACC/AHA; 10–30% participation worldwide; FITT prescription and HF-ACTION protocol; endurance plus resistance plus inspiratory muscle training as the HF template; MCT mainstay and HIIT not superior (SMARTEX-HF); 60-trial review improves function and HFH but not death; LVEF not a marker of benefit; HFpEF I B1 in Europe but no CMS coverage |
heart-failure, cardiac-rehabilitation, exercise-training, HFrEF, HFpEF |
2026-10-26 |
| concepts/SVT-Management |
AHA 2015 + ESC 2019 framework: vagal maneuvers (modified Valsalva 43% conversion) → adenosine → IV CCB/BB → cardioversion; catheter ablation first-line; Class III/Harm AV nodal blockers in pre-excited AF; PROCAMIO trial: procainamide superior to amiodarone in stable wide QRS; ESC vs AHA comparison table |
supraventricular-tachycardia, arrhythmia-management, catheter-ablation, antiarrhythmic-drugs, guidelines |
2026-05-21 |
| concepts/AVNRT |
Most common SVT (>60% female); dual AV nodal physiology; typical (slow-fast): pseudo-S inferior + pseudo-R' V1 (short RP); 50% minimally symptomatic improve spontaneously within 1–3 years; slow-pathway ablation 97% success, 2% recurrence, 0.3% complications (ESC 2019 Table 11); cryoablation lower AV block but higher recurrence |
supraventricular-tachycardia, AVNRT, catheter-ablation, arrhythmia-management |
2026-05-21 |
| concepts/AVRT-Accessory-Pathway |
Orthodromic AVRT (narrow; 90%) vs antidromic AVRT (wide; 5%); WPW SCD risk ~2.4/1000 person-years; pre-excited AF: amiodarone Class III/B (ESC) + Class III/Harm (AHA); EPS now Class I/B for athletes/high-risk occupations (ESC 2019); intermittent pre-excitation downgraded as imperfect low-risk marker |
supraventricular-tachycardia, accessory-pathway, AVRT, wolff-parkinson-white, pre-excitation |
2026-05-21 |
| concepts/Tachycardia-Induced-Cardiomyopathy |
TCM = reversible LV dysfunction from persistent tachycardia; any SVT can cause; focal AT commonest in <18 years; PJRT classic example; catheter ablation Class I/B; beta-blockers Class I/A if ablation fails; consider in any LVEF-reduced patient with HR >100 bpm; IST does NOT cause TCM |
tachycardiomyopathy, heart-failure, catheter-ablation, arrhythmia-management, cardiomyopathy |
2026-05-21 |
| concepts/AF-Stable-CAD-Antithrombotic |
Antithrombotic strategy in AF + stable CAD: OAC monotherapy vs dual therapy; AFIRE (rivaroxaban, non-standard dose, noninferior); EPIC-CAD (NEJM 2024; edoxaban; NACE HR 0.44; NNT 10.6; bleeding HR 0.34; ischemic events NS — underpowered); COR 2b/C-LD expected to be upgraded; East Asian population caveat |
atrial-fibrillation, coronary-artery-disease, edoxaban, antithrombotic-therapy, anticoagulation |
2026-05-20 |
| concepts/Venous-Thromboembolism-Anticoagulation |
COBRRA (NEJM 2026; n=2,760): apixaban vs rivaroxaban head-to-head — clinically relevant bleeding 3.3% vs 7.1% (RR 0.46; P<0.001); major bleeding 0.4% vs 2.4%; VTE recurrence equal (1.1% vs 1.0%); bleeding difference attributed to rivaroxaban's higher 21-day loading dose. HI-PRO (NEJM 2025; n=600): extended apixaban 2.5 mg BID vs placebo in provoked VTE + enduring risk factors — VTE recurrence 1.3% vs 10.0% (HR 0.13; P<0.001); major bleeding 0.3% vs 0%; CRNMB trend 4.8% vs 1.7% (NS); 10% placebo recurrence challenges the provoked/unprovoked binary. ESC 2019 (4th framework): abandons "unprovoked"/"idiopathic" for a three-tier recurrence taxonomy (low <3%/yr / intermediate 3–8%/yr incl. "no risk factor" / high >8%/yr for cancer, prior VTE, APS); indefinite VKA in APS; reduced-dose extended NOAC after 6 months |
venous-thromboembolism, noac, apixaban, rivaroxaban, extended-anticoagulation, provoked-VTE, bleeding-risk |
2026-10-15 |
| concepts/Aldosterone-Synthase-Inhibitors |
ASIs block CYP11B2 to reduce aldosterone production (vs MRAs which block the receptor); baxdrostat BaxHTN phase 3 (NEJM 2025; n=794): −8.7/−9.8 mmHg placebo-corrected office SBP at 12 weeks (P<0.001); lorundrostat ADVANCE-HTN phase 2b (NEJM 2025; n=285): −7.9/−6.5 mmHg placebo-adjusted 24h ambulatory SBP at 12 weeks (P<0.001); 50 mg optimal lorundrostat dose; MATE1 interaction → cystatin C preferred; no CV outcomes; no head-to-head vs spironolactone |
resistant-hypertension, aldosterone-synthase-inhibitor, baxdrostat, hypertension, renin-angiotensin-aldosterone-system |
2026-05-20 |
| concepts/Angiography-Based-Coronary-Physiology |
FAST III (NEJM 2026; n=2,235; NI P=0.004): vFFR (3D-QCA, no wire, no adenosine) noninferior to pressure-wire FFR for death/MI/revasc at 1yr (7.5% vs 7.5%); vFFR detects more functionally significant lesions (40.9% vs 31.3%) → higher revasc rate (45% vs 36%); procedure −5 min shorter; complication rate lower (3.7% vs 6.0%); FAVOR III Europe (QFR) showed higher MACE than FFR — not all angiography-based indices equivalent |
angiography-based-physiology, fractional-flow-reserve, coronary-physiology, intermediate-coronary-lesions, pci-guidance |
2026-05-20 |
| concepts/Blood-Pressure-Target-T2DM |
BPROAD (NEJM 2025; n=12,821; HR 0.79; P<0.001): intensive SBP <120 vs standard <140 mmHg in T2DM; 21% CV event reduction; stroke primary driver; albuminuria HR 0.87; resolves ACCORD null result; ESC 2024 Class I SBP 120–129 mmHg in T2DM (most aggressive guideline target, now BPROAD-corroborated); hyperkalemia/hypotension monitoring required |
type-2-diabetes, hypertension, blood-pressure-control, cardiovascular-outcomes-trial, randomized-controlled-trial |
2026-05-20 |
| concepts/Hypertension-HMOD |
ESC 2024 HMOD framework: structural/functional target organ damage (heart/kidney/arteries/eye/brain) from sustained elevated BP; HMOD positive at elevated BP (120–139 mmHg) triggers treatment without SCORE2; renal HMOD (eGFR <60 or ACR ≥30 mg/g); cardiac HMOD (ECG LVH: Sokolow-Lyon/Cornell/RaVL; echo LVH: sex-specific LV mass/height²·⁷ thresholds; hs-cTnT/NT-proBNP); vascular HMOD (PWV >10 m/s; plaque >1.5 mm; CAC >100); retinal HMOD Class I at BP >180/110 |
hypertension, hmod, left-ventricular-hypertrophy, chronic-kidney-disease, cardiovascular-risk |
2026-05-20 |
| concepts/HF-COPD-Comorbidity |
Bidirectional HF-COPD pathophysiology: 70% of COPD+HF is HFpEF; hyperinflation → preload failure; pulmonary congestion → dynamic airway obstruction; NP unreliable in HFpEF+COPD; spirometry under euvolemic conditions; CPET VE intercept ≥2.6 L/min identifies COPD in HF; bisoprolol preferred in HFrEF+COPD (β1/β2 14:1; anti-inflammatory; FEV1 +0.46 L per Feng 2023 MA); β-blockers avoided in HFpEF+COPD; LAMA+ICS over LABA; BLOCK COPD (NEJM 2019): metoprolol without cardiac indication increased COPD hospitalisation (HR 1.91); active contradiction: bisoprolol MA (Feng 2023) shows HF-independent benefit — drug-class difference plausible but unconfirmed by RCT |
heart-failure, COPD, cardiopulmonary-interaction, HFpEF, beta-blockers |
2026-05-21 |
| concepts/Cardiopulmonary-Exercise-Testing |
CPET in HF: VE/VCO2 slope prognostic but non-discriminatory for COPD; VE intercept (VEint ≥2.6–4.07 L/min) identifies COPD as HF comorbidity across EF spectrum; recommended for stable dyspnoeic HF patients to confirm/exclude COPD; peak VO2 bounded by Fick equation; transplant threshold <12–14 mL/kg/min |
CPET, heart-failure, COPD, exercise-physiology, cardiopulmonary-interaction |
2026-05-28 |
| concepts/VO2max |
VO2max = (LVEDV−LVESV) × HR × a-v O2 diff — true parametric ceiling (Hawkins 2007 n=156: supramaximal work never exceeded VO2max); elite advantage = large cardiac output from LV EDV/compliance (not contractility or a-v O2); altitude VO2max −0.6%/100m via O2 transport (not motor recruitment); peripheral fatigue: Ca2+/Na-K pump/ROS → reduced central motor drive; Central Governor Model rebutted; ACE gene not confirmed; HF transplant threshold <12–14 mL/kg/min |
VO2max, exercise-physiology, cardiac-output, endurance-athletes, oxygen-transport |
2026-05-28 |
| concepts/Athletes-Heart |
Cardiac remodeling in elite endurance athletes: large LV EDV (not reduced ESV or higher contractility) from enhanced myocardial + pericardial compliance; Levine 1991 direct P-V curves; active diastolic suction from elevated equilibrium volume; pericardial constraint limits normal hearts (pericardiectomy → increased CO + VO2max in dogs/pigs); 1 year training achieves LV mass but not EDV/compliance of elite athletes; largest CO 42.3 L/min; largest SV 212 mL |
endurance-athletes, cardiac-remodeling, LV-compliance, cardiac-output, exercise-physiology |
2026-05-28 |
| concepts/Iron-Deficiency-in-HF |
IV iron in HFrEF/HFmrEF: ESC Class I (symptoms) + Class IIa (hospitalizations); FAIR-HF/CONFIRM-HF/EFFECT-HF positive for QoL; AFFIRM-AHF near-significant (acute HF, RR 0.79); HEART-FID (n=3,065 ambulatory) primary missed (win ratio 1.10; P=0.02 vs threshold 0.01); TSAT <20% emerging as preferred diagnostic criterion; SGLT2i era gap |
heart-failure, iron-deficiency, ferric-carboxymaltose, HFrEF, intravenous-iron |
2026-05-17 |
| concepts/NSTEMI-Elderly-Invasive-Strategy |
SENIOR-RITA (NEJM 2024; n=1,518; mean age 82; 32% frail; 4.1yr): invasive vs conservative in elderly NSTEMI — primary composite neutral (HR 0.94; P=0.53); nonfatal MI HR 0.75 (P<0.05); CV death HR 1.11 NS; time-varying benefit erodes by 5yr; radial access 89.3%; <1% complications; subsequent revasc 3.9% vs 13.7%; After Eighty positive at 18 months (contradicts); Kotanidis meta-analysis neutral; frailty not a contraindication to angiography |
nstemi, elderly-patients, invasive-strategy, frailty, coronary-artery-disease |
2026-05-18 |
| concepts/Fractional-Flow-Reserve |
FFR physiology (Pd/Pa at hyperemia; ≤0.80 threshold); validated in stable CAD; FULL REVASC (NEJM 2024; n=1,542; 4.8yr): FFR-guided complete revascularization NEUTRAL vs culprit-only (HR 0.93; P=0.53) + stent thrombosis HR 2.80; 40% of patients deferred all nonculprit lesions; diverges from angiography-guided COMPLETE (26% CV death/MI reduction) — FFR cannot detect vulnerable plaque; iFR equivalent in stable CAD; guideline: Class IIa AHA 2025 for intermediate STEMI lesions; FAST III (NEJM 2026): wire-free vFFR noninferior to FFR for intermediate lesions (7.5% vs 7.5%; P=0.004 NI); ALL-RISE (NEJM 2026): FFRangio noninferior to pressure-wire physiology (6.9% vs 7.1%; HR 0.98) with more lesions treated |
fractional-flow-reserve, coronary-physiology, complete-revascularization, acute-coronary-syndrome, coronary-artery-disease |
2026-05-20 |
| concepts/Multivessel-PCI-STEMI-Timing |
Immediate vs staged complete revascularization in STEMI with multivessel CAD; MULTISTARS AMI (NEJM 2023): immediate superior (8.5% vs 16.3%; RR 0.52; P<0.001); iMODERN (NEJM 2026): immediate iFR-guided NOT superior to deferred MRI-guided (HR 0.95; P=0.81); FULL REVASC (NEJM 2024): FFR-guided complete revascularization NEUTRAL (HR 0.93; P=0.53) vs angiography-guided COMPLETE (benefit); Class IIb/B-R AHA 2025 |
stemi, multivessel-pci, complete-revascularization, fractional-flow-reserve, pci-timing |
2026-05-20 |
| concepts/Instantaneous-Wave-Free-Ratio |
iFR: resting pressure-wire index (≤0.89 ischemic); no adenosine required; 2× higher lesion detection than cardiac stress MRI in STEMI (iMODERN); false-positive rate ~11% in STEMI due to elevated resting flow; validated equivalent to FFR in stable CAD (DEFINE-FLAIR, iFR-SWEDEHEART) |
ifr-guided-pci, coronary-physiology, fractional-flow-reserve, stemi, coronary-artery-disease |
2026-05-19 |
| concepts/Cardiac-Resynchronization-Therapy |
CRT-D vs ICD: COMPANION (HR 0.64 mortality), CARE-HF (CRT-P HR 0.64 mortality), MADIT-CRT (QRS ≥150ms HR 0.48; women HR 0.37), RAFT Long-Term (AF 0.80 at 14yr; curves converge >12yr); non-LBBB/AF benefit attenuated; conduction system pacing emerging alternative; CRT benefit on modern GDMT uncertain |
cardiac-resynchronization-therapy, heart-failure-reduced-EF, biventricular-pacing, QRS-duration, device-therapy |
2026-05-17 |
| concepts/ClinGen-Gene-Disease-Validity |
ClinGen 7-tier evidence framework (Definitive→Refuting) for gene-disease pairs; cardiovascular GCEPs; key disputed/refuting findings across HCM/BrS/ARVC/CPVT/LQTS/PAH; clinical actionability of classification |
clingen, gene-disease-validity, hereditary-cardiovascular-disease, variant-interpretation, genetics |
2026-05-09 |
| concepts/Atrial-Cardiomyopathy |
ESC/HFA 2025 diagnostic framework: electrical dysfunction (P-wave score ≥1) + mechanical dysfunction/enlargement/fibrosis; P-wave score 0–4; LAVi >40 ml/m², LASr <23%; atrial failure as end-stage; NLRP3/BMP10/epicardial adipose targets |
atrial-cardiomyopathy, atrial-fibrillation, heart-failure, atrial-fibrosis, electrocardiography |
2026-05-01 |
| concepts/Inter-Atrial-Block |
IAB defined by P-wave ≥120 ms; partial (bimodal, positive inferior leads) vs advanced (biphasic inferior leads = Bayes syndrome); P-wave score 1–2 (partial/advanced); partial IAB 2× AF risk; advanced IAB 4× AF risk; AHA 2009 LAA criteria: PTF-V1 >40 mm·ms / P duration ≥120 ms / terminal axis −30 to −90°; "intraatrial conduction delay" preferred over interatrial |
inter-atrial-block, atrial-cardiomyopathy, electrocardiography, atrial-fibrillation, stroke |
2026-05-16 |
| concepts/Atrial-Failure |
End-stage AtCM: persistent AF or HF with dyspnoea/fatigue attributable to atrial disease; progressive structural/electrophysiological/functional changes; manage per AF + HF guidelines |
atrial-cardiomyopathy, atrial-fibrillation, heart-failure |
2026-05-01 |
| concepts/Cancer-Associated-VTE |
Most common CV complication of malignancy; 7–8× VTE risk; Ottawa recurrence score; LMWH preferred over VKA; emerging DOAC evidence; API-CAT (NEJM 2025): reduced-dose apixaban 2.5 mg BID noninferior for VTE (2.1% vs 2.8%; SHR 0.76) AND superior for bleeding (12.1% vs 15.6%; SHR 0.75; P=0.03) vs full-dose 5.0 mg BID in extended-phase cancer VTE; first RCT to establish dose-reduced extended anticoagulation in cancer |
cancer-associated-VTE, venous-thromboembolism, anticoagulation, cardio-oncology, thrombosis |
2026-05-19 |
| concepts/Clonal-Hematopoiesis |
CH/CHIP: somatic HSC clonal expansion (DNMT3A/TET2/ASXL1/JAK2); 1.7–2× ASCVD risk; 25% HF risk; TET2→IL-1β/NLRP3; canakinumab/colchicine in TET2-CH; therapy-related CH amplifies cardiotoxicity; no proven CVD therapy |
clonal-hematopoiesis, cardiovascular-risk, inflammation, atherosclerosis, cardio-oncology |
2026-05-02 |
| concepts/CAM-in-Heart-Failure |
Complementary and alternative medicine in HF: omega-3 PUFA Class 2b AHA rec; CoQ10 uncertain; hawthorn harm in LVEF ≤35%; licorice/Vit E/grapefruit juice harm; yoga/tai chi recommended; drug-interaction catalog |
heart-failure, complementary-alternative-medicine, drug-interactions, nutraceuticals, guidelines |
2026-04-30 |
| concepts/AAV-Gene-Delivery |
AAV9 cardiac gene delivery platform; 4.7 kb packaging constraint; Danon (RP-A501): LVM −23%, troponin −84%, grade 4 TMA risk; Pompe (GC301): no anti-GAA antibodies, BBB penetration; DMD clinical fatalities (innate immune/AAV vector): 27-yr-old death + AAV-Cas12 minimal long-term rescue; LNP vs AAV strategic rule (LNP for liver targets) |
gene-therapy, viral-vectors, danon-disease, pompe-disease, lysosomal-storage-disorder |
2026-05-23 |
| concepts/Danon-Disease |
X-linked LAMP2 LOF → severe HCM + autophagic vacuoles; males die/transplant age 19–21yr; RP-A501 (rAAV9-LAMP2B) Phase 1: LVM −23%, troponin −84%, 7/7 alive at 4.5yr; grade 4 complement-mediated TMA; grade 3 steroid-induced myopathy; anti-LAMP2B antibodies without sequelae |
lysosomal-storage-disorder, hypertrophic-cardiomyopathy, gene-therapy, LAMP2, X-linked |
2026-05-18 |
| concepts/Pompe-Disease |
Lysosomal GAA deficiency; infantile-onset rarely survives >1yr untreated; ERT limitations (no CNS penetration, anti-rhGAA IgG, short half-life); GC301 (rAAV9-coGAA) first human trial: no anti-GAA immunity, BBB crossing, cardiac/psychomotor improvement in 3/4 patients |
lysosomal-storage-disorder, gene-therapy, acid-alpha-glucosidase, cardiomyopathy, enzyme-replacement-therapy |
2026-05-17 |
| concepts/Lipid-Gene-Therapy |
GET for lipid disorders using LNP/GalNAc hepatic delivery: PCSK9 base editing (VERVE-102/Heart-2 NEJM 2026 n=35: 1.0 mg/kg → PCSK9 −88%, LDL-C −62%, −78 mg/dL absolute, stable ≥18 months, no DLTs); ANGPTL3 editing (CTX310: LDL-C −49%, TG −55%); LPA/apolipoprotein(a) editing (CTX320 −94% Lp(a) NHP; VERVE-301 in development); APOC3 base editing for FCS; AGT editing for refractory hypertension (CTX340); primary prevention paradigm |
gene-therapy, lipid-lowering-therapy, PCSK9, familial-hypercholesterolemia, cardiovascular-genetics |
2026-05-27 |
| concepts/AF-Biological-Therapy |
Preclinical biological strategies for AF: gene transfer, miRNA, cell therapy; anti-miR-21 most replicated (4 labs); OR 0.15 AF inducibility, −6.7% fibrosis, +6.4 sinus rhythm days (meta-analysis 25 studies); 5 strategy classes; delivery/pre-AF design/single-target translational barriers; AAV durable delivery = path forward |
atrial-fibrillation, gene-therapy, microRNA, atrial-fibrosis, biological-therapy |
2026-05-15 |
| concepts/AF-CARE |
ESC 2024 structured AF management: Comorbidity, Avoid stroke, Rate/rhythm, Evaluation |
atrial-fibrillation, guidelines |
2026-04-12 |
| concepts/AF-Staging |
AHA 2023 four-stage AF classification (At Risk → Pre-AF → AF → Permanent) |
atrial-fibrillation, risk-stratification |
2026-04-12 |
| concepts/Subclinical-AF |
SCAF: CIED-detected asymptomatic AF; 2.4× stroke risk; dose-dependent episode duration — challenged by SOS AF (10,016 patients): no monotonic gradient across burden, lowest category nearly highest risk, no threshold at any cutoff 30 min–6 h; ARTESIA (2024): apixaban vs aspirin HR 0.63 stroke (37% RRR), disabling stroke HR 0.51 (49%), major bleeding HR 1.80 — net benefit favours OAC at CHA₂DS₂-VASc ~3.9; NOAH-AFNET 6 (2023): edoxaban vs placebo in AHREs — primary composite neutral (HR 0.81), safety harm (HR 1.31), major bleeding HR 2.10, stroke ~1%/yr (unexpectedly low = low arrhythmia burden); ARTESIA-NOAH discordance: different comparators + NOAH underpowered + diluted endpoint; AHA IIa ≥24h; ESC IIb any duration; SINGLE-AF (clinical AF at score 1/2, not SCAF): composite 0.5% vs 1.5%, HR 0.31 — bleeding risk, not stroke score, is the pivot across SINGLE-AF/ARTESIA/NOAH |
subclinical-atrial-fibrillation, atrial-fibrillation, stroke-prevention, anticoagulation, randomized-controlled-trial |
2026-10-16 |
| concepts/Poststroke-AF-Monitoring |
ACC 2024 ECDP three-population framework: (1) cardioembolic stroke → monitoring limited; (2) small/large-vessel stroke → 2–4 weeks, ICM for HF+LA enlargement (23.4% AF detection); (3) ESUS/cryptogenic → 2–4 weeks mandatory if OAC candidate, ICM in select cases; OAC threshold: AF ≥5 min + CHA₂DS₂-VASc ≥3; CHASE-LESS/AS5F best risk scores; CRYSTAL-AF 30% AF at 36 months; LOOP trial: no stroke reduction on ITT (HR 0.80; NS); consumer devices supplementary only |
atrial-fibrillation, stroke-prevention, cardiac-monitoring, anticoagulation, guidelines |
2026-05-25 |
| concepts/ACM-Diagnostic-Criteria |
Four generations of ACM criteria — 1994 Task Force, 2010 revised ITF, 2020 Padua, 2023 European Task Force; six categories split into RV and LV blocks; diagnosis requires a morpho-functional or structural criterion; rules for ARVC, biventricular and ALVC; CMR LGE patterns and why RV LGE went from major to minor; the ALVC genetic-requirement reversal; no prospective validation anywhere; 8 contradictions including the ESC 2023 NDLVC conflict |
arrhythmogenic-cardiomyopathy, ARVC, ALVC, diagnostic-criteria, cardiac-magnetic-resonance |
2026-10-28 |
| concepts/ARVC-Task-Force-Criteria |
2010 Modified Task Force six-category scoring for ARVC diagnosis; now historical — superseded in specialist practice by Padua 2020 and the 2023 European Task Force criteria, though still cited by ESC 2023; what the later versions changed |
diagnostics, ARVC |
2026-10-28 |
| concepts/Arrhythmogenic-Cardiomyopathy |
ACM umbrella concept and class hub; competing definitions (HRS 2019 umbrella vs Padua/2023 scar-defined "scarring/arrhythmogenic cardiomyopathy" vs ESC 2023 rejection); three phenotypic variants with links to ARVC, biventricular ACM and ALVC; shared genetic architecture and age-related penetrance; final common pathway; diagnostic approach with the mandatory structural criterion; management principles and the phenotype/genotype-specific rule; 5 class-level contradictions |
arrhythmogenic-cardiomyopathy, sudden-cardiac-death, genotype-phenotype, gene-therapy |
2026-10-28 |
| concepts/Bidirectional-Ventricular-Tachycardia |
Beat-to-beat 180° QRS axis alternation; hallmark arrhythmia of CPVT |
arrhythmia, CPVT |
2026-04-11 |
| concepts/Biological-Pacemaker |
Gene therapy approaches to restore intrinsic cardiac automaticity (TBX18, HCN) |
gene-therapy, bradyarrhythmia |
2026-04-11 |
| concepts/CHA2DS2-VA |
ESC 2024 stroke risk score for AF; sex category removed vs CHA2DS2-VASc. SINGLE-AF (2026): first RCT at score 1 — composite 0.5% vs 1.5%, HR 0.31 (0.10–0.94); score 1 now has RCT evidence, score 0 still does not |
atrial-fibrillation, anticoagulation |
2026-10-15 |
| concepts/CRISPR-Cas9-in-Channelopathies |
CRISPR gene editing mechanisms (nuclease/base/prime/epigenome); LNP vs AAV delivery; first in-vivo RYR2 repair; nex-z in ATTR-CM (MAGNITUDE Phase 3 paused Oct 2025 hepatotoxicity); PCSK9/ANGPTL3 base editing clinical trials; DMD AAV clinical fatality |
gene-therapy, channelopathies, CRISPR-Cas9, attr-cardiomyopathy, lipid-lowering-therapy |
2026-05-23 |
| concepts/HCM-Calcium-Homeostasis |
SR Ca²⁺ overload and CaMKII-mediated triggered arrhythmia in HCM |
hypertrophic-cardiomyopathy, calcium-homeostasis |
2026-04-11 |
| concepts/Cardiac-Action-Potential |
Ion channel basis of phases 0–4; ischemia-induced partial depolarization shortens APD; hyperkalemia/hypokalemia effects; mutations cause specific channelopathies; regional/transmural APD heterogeneity underlies T-wave shape |
cardiac-electrophysiology, channelopathies, myocardial-ischemia |
2026-05-01 |
| concepts/Cardiac-Repolarization |
T-wave physiology; primary vs secondary ST-T classification; injury current mechanism in ischemia; regional IKs/IKr/INaL heterogeneity; EAD/R-from-T triggers; TdP focal-to-reentry; repolarization reserve; 176 QT-SNPs; AHA 2009 QT standards: linear regression preferred over Bazett; prolonged QT women ≥460 ms / men >450 ms; QT dispersion NOT recommended |
long-qt-syndrome, cardiac-repolarization, channelopathies, myocardial-ischemia |
2026-05-16 |
| concepts/ST-T-Changes |
Primary vs secondary ST-T changes; injury current mechanism; AHA 2009 sex/age J-point thresholds; coronary artery localization (LAD proximal/mid/distal; RCA vs LCx; left main 8-lead pattern; V3R/V4R RV infarction); Wellens syndrome; Sgarbossa criteria for LBBB (concordant high spec/low sens; discordant modified ratio); hyperkalemia sine-wave; T-wave quantitative descriptors; U wave norms; giant T-wave inversion entities (HCM/NSTEMI/ICH) |
electrocardiography, ST-T-changes, myocardial-ischemia, cardiac-electrophysiology, electrolyte-disturbances |
2026-05-16 |
| concepts/ECG-Ventricular-Hypertrophy |
LVH criteria (Sokolow-Lyon/Cornell/Romhilt-Estes/voltage-duration); sensitivity <50%, specificity 85–90%; no single superior criterion; confounders (age/sex/race/obesity diverge Sokolow-Lyon vs Cornell); "secondary ST-T abnormality" not "strain" (AHA 2009); LVH in LBBB cautious; RVH criteria (best in CHD; COPD pattern); biventricular hypertrophy low sensitivity; left/right atrial abnormality P-wave criteria (PTF-V1 >40 mm·ms; P II >2.5 mm) |
electrocardiography, left-ventricular-hypertrophy, cardiac-chamber-hypertrophy, ECG-standardization, atrial-abnormality |
2026-05-16 |
| concepts/Wellens-Syndrome |
Deeply inverted T waves (>0.5 mV) in V2–V4 + QT prolongation in pain-free state = critical proximal LAD stenosis warning; identical pattern from ICH; missed = high risk anterior STEMI; stress testing contraindicated |
myocardial-ischemia, ECG-diagnosis, LAD-occlusion, acute-coronary-syndrome, electrocardiography |
2026-05-16 |
| concepts/ECG-Lead-Standards |
AHA 2007 ECG recording standards: lead placement (V5 horizontal plane of V4; V1/V2 4th ICS; common misplacement consequences); Cabrera sequence (aVL→I→−aVR→II→aVF→III) highly recommended; global measurement preferred and systematically longer than single-lead; Mason-Likar NOT interchangeable for ST comparison; right-sided leads (V3R/V4R) in inferior STEMI; 40 Hz monitor invalidates amplitudes; "unipolar" terminology discouraged; computer ECG adjunct only |
electrocardiography, ECG-technology, ECG-standardization, digital-ECG, lead-placement |
2026-05-16 |
| concepts/ECG-Conduction-Disturbances |
AHA 2009 IVCD criteria: normal QRS duration (>110 ms abnormal adults); complete RBBB (rsr'/rsR'/rSR' in V1/V2; S > R in I/V6; QRS ≥120 ms); complete LBBB (8 criteria; negative concordance = abnormal — formal Sgarbossa basis); LAFB (axis −45° to −90°; qR aVL; R-peak ≥45 ms); LPFB; nonspecific IVCD; WPW; deprecated terms (bifascicular/trifascicular/Brugada pattern in auto algorithms) |
electrocardiography, bundle-branch-block, intraventricular-conduction, ECG-standardization, ventricular-preexcitation |
2026-05-16 |
| concepts/Sgarbossa-Criteria |
LBBB + AMI diagnosis: concordant STE/STD ≥1 mm (high specificity, low sensitivity); discordant STE ≥5 mm (very low spec/sens, superseded); modified criterion: STE:S ratio ≥0.25; applies to ventricular paced rhythms; AHA 2009 Part III LBBB criterion 7 is the multi-society formal basis for concordant criteria |
myocardial-ischemia, LBBB, ECG-diagnosis, acute-coronary-syndrome, electrocardiography |
2026-05-16 |
| concepts/Hyperacute-T-waves |
Tall, broad, symmetric T-waves in early OMI; HATW score first quantitative definition (T-wave magnitude + symmetry, ≥0.7 in 2 leads → 98.4% spec); T-wave amplitude alone insufficient; do not reliably evolve to STEMI criteria; requires automated software measurement |
occlusion-MI, ECG-diagnosis, LAD-occlusion, myocardial-ischemia, hyperacute-T-waves |
2026-05-03 |
| concepts/Polygenic-Risk-Score |
PRS for QT/LQTS/HCM/DCM/BrS arrhythmias + CAD: CAD top 5% PRS = 3-5× risk; intermediate-risk reclassification prevents 1 event/340 screened; young-adult PRS (30-40% vs 10% CAD by 70); high-PRS derives greater statin/PCSK9i benefit; lifestyle nearly counterbalances high PRS; genotype-negative LQTS has higher PRS; ancestry limitation |
polygenic-risk-score, coronary-artery-disease, long-qt-syndrome, cardiac-repolarization, genetics |
2026-05-16 |
| concepts/Cascade-Family-Screening |
Systematic cardiovascular and genetic evaluation of ACM and HCM families |
arrhythmogenic-cardiomyopathy, genetics |
2026-04-11 |
| concepts/Catheter-Ablation-AF |
Indications by scenario (ESC 2024 vs AHA 2023), technique and energy sources (PFA first, thermal alternatives), transseptal access after septal closure, procedural complications, lesion sets (antral PVI, posterior wall, non-PV triggers), periprocedural anticoagulation, surgical and hybrid ablation, outcomes beyond arrhythmia control (QOL, cognition, progression), genetic determinants; CASTLE-HTx (2023): ablation in end-stage HFrEF HR 0.24 primary composite (death/LVAD/urgent HTx), HR 0.29 mortality — landmark benefit in most advanced HF; AVANT GUARD (2026): first-line PFA beats AADs in persistent AF (56% vs 30%); OPTION (2025): LAAO superior for bleeding (HR 0.44) and NI for stroke/death vs NOAC post-ablation. |
atrial-fibrillation, catheter-ablation, heart-failure, end-stage-heart-failure |
2026-10-30 |
| concepts/Pulsed-Field-Ablation |
Redirect stub — PFA is split by application: see concepts/PFA-Atrial-Arrhythmias and concepts/Ventricular-PFA |
pulsed-field-ablation, electroporation, catheter-ablation |
2026-10-25 |
| concepts/HCM-Atrial-Myopathy |
Sarcomeric gene variants (MYBPC3/MYH7) drive primary LA fibrosis independent of LA pressure; progressive; predicts more ablation procedures |
hypertrophic-cardiomyopathy, atrial-fibrillation, atrial-myopathy, genetics |
2026-04-12 |
| concepts/Cardiogenetic-Centers |
Interdisciplinary arrhythmia/cardiomyopathy genetics centres; variant reclassification responsibility; panel strategy |
genetics, arrhythmia, channelopathy |
2026-04-12 |
| concepts/Variant-Reclassification |
>36% reclassification rate in cardiovascular genetics; channelopathies 38%; predominantly downgrading; notification gap |
genetics, channelopathy, cardiomyopathy |
2026-04-12 |
| concepts/Desmosome |
Cardiac intercalated disc adhesion complex; structural basis of ARVC pathogenesis |
arrhythmogenic-cardiomyopathy, ARVC |
2026-04-11 |
| concepts/Early-Onset-Atrial-Fibrillation |
AF before age 66; yield is selection-dependent — 10.1% P/LP in 1,293 unselected WGS patients, 20% in a prospective dedicated clinic (48/242) where the clinic made, rather than confirmed, the diagnosis in 42 of 48. TTN dominates (23 of 48 positives); 71% carry a cardiomyopathy variant; HFE, CPT2, TTR and LZTR1 appear incidentally as treatable non-arrhythmic disease. Predictors: prior cardiomyopathy OR 5.3, elevated T1 OR 4.0, infranodal conduction OR 3.3, LGE OR 2.4; negative: OSA OR 0.4, normal ECG OR 0.5. Family history of AF and HARMS2-AF do not discriminate. Ventricular penetrance 56% overall, 89% ACM versus 54% TTN-DCM. Management changed in 52%: 7 new ICDs, 2 PPM→ICD, anticoagulation in 7 with CHA₂DS₂-VA ≤1, Class I/III avoidance, ≤6 METs in desmosomal ACM. Gene-elusive overlap 9% |
atrial-fibrillation, early-onset-atrial-fibrillation, genetic-testing, cardiomyopathy, rare-variants, TTN |
2026-10-26 |
| concepts/Exercise-Restriction-in-ARVC |
Dose-dependent exercise-penetrance; gene-specific: harmful in PKP2/TMEM43/gene-elusive; NOT harmful in PLN-p.Arg14del (unique); DSP uncertain; gene-informed SDM per 2024 HRS |
ARVC, lifestyle, arrhythmogenic-cardiomyopathy, genotype-phenotype |
2026-05-05 |
| concepts/HCM-Exercise |
2024 paradigm shift: no universal exercise restriction for most HCM patients (AHA) |
hypertrophic-cardiomyopathy, lifestyle |
2026-04-11 |
| concepts/Final-Common-Pathway |
Hypothesis that cardiomyopathy subtypes converge on intercalated disc dysfunction |
arrhythmogenic-cardiomyopathy, ARVC |
2026-04-11 |
| concepts/Gene-Silencing-Therapy |
ASO/siRNA/shRNA strategies for cardiac gain-of-function or dominant-negative mutations |
gene-therapy, channelopathies |
2026-04-11 |
| concepts/Genetic-Testing-in-AF |
Panel testing in early-onset AF: yield rises from ~10% unselected to 20% in a referred precision-medicine clinic; ~60% of tested patients get only a VUS. Prospective pre-test odds measured for the first time — prior cardiomyopathy OR 5.3, elevated T1 OR 4.0, infranodal conduction OR 3.3, LGE OR 2.4; OSA OR 0.4 and a normal ECG OR 0.5 predict negative, while family history of AF and HARMS2-AF discriminate not at all, contradicting selection frameworks built on "no obvious risk factors". Management changes in 52% of genotype-positives: ICDs, GDMT, anticoagulation overriding CHA₂DS₂-VA, drug avoidance, exercise restriction. Gene-specific actions, ClinGen panel curation, cascade and genotype-guided pharmacotherapy |
genetic-testing, atrial-fibrillation, early-onset-atrial-fibrillation, rare-variants, cardiomyopathy |
2026-10-26 |
| concepts/Cardio-Oncology |
New clinical discipline integrating cardiology + oncology; MDT approach; care pathways by risk; HFA-ICOS stratification |
cardio-oncology, cardiovascular-toxicity, cancer |
2026-04-12 |
| concepts/Cancer-Therapy-Related-CV-Toxicity |
CTR-CVT clinical pathway: incidence by therapeutic class; HFA-ICOS; CTRCD grading; surveillance and AHA 2023 imaging tables; prevention; management incl. ICI myocarditis (abatacept+ruxolitinib 3.4% vs 60%); drug profiles by family; interaction and dosing thresholds |
cardio-oncology, cardiovascular-toxicity, heart-failure, cancer |
2026-10-29 |
| concepts/Radiation-Vasculopathy |
Spectrum of RT-induced vascular injury: premature CAD (linear dose-response, no safe threshold), carotid disease, axillary/aortic stenosis, autonomic dysfunction (4× higher HRR abnormality, 4× all-cause mortality in Hodgkin survivors); inferior PCI/CABG outcomes post-RT; surveillance: stress test 5–10 yr post-mediastinal RT |
radiation-vasculopathy, cardio-oncology, premature-CAD, radiation-therapy, vascular-toxicity |
2026-05-09 |
| concepts/PAH-Risk-Stratification |
3-strata at diagnosis; 4-strata at follow-up; low-risk haemodynamic targets; treat-to-target approach; vasoreactivity testing algorithm |
pulmonary-hypertension, pulmonary-arterial-hypertension, risk-stratification |
2026-04-13 |
| concepts/Pulmonary-Hypertension |
mPAP >20 mmHg (2022 ESC/ERS); 5-group classification; pre/post-capillary definitions; IpcPH vs CpcPH; exercise PH; PAWP 13-vs-15 mmHg uncertainty; PAH drug therapy (ERA+PDE5i Class I/B; sotatercept STELLAR/ZENITH/HYPERION); PDE5i Class III in HFpEF PH; genetics (BMPR2/CAV1/ATP13A3/EIF2AK4); ASD-PAH closure thresholds; RV failure, transplant and perioperative summaries; 14 sources. Group 2 PH-LHD: no approved pulmonary-vascular therapy; PADN-HF-PH (2026) halved clinical worsening (HR 0.49, P=0.006) but was open-label without sham control |
pulmonary-hypertension, classification, PAH, CTEPH, right-heart-failure, pulmonary-arterial-hypertension |
2026-10-25 |
| concepts/HFA-ICOS-Risk-Stratification |
Pre-treatment CV toxicity risk tool: Low/Moderate/High/VH across 6 treatment categories; anthracycline dose thresholds |
cardio-oncology, risk-stratification, cardiovascular-toxicity |
2026-04-12 |
| concepts/Genetic-Testing-in-Arrhythmias |
Genetic testing across the primary electrical diseases: ESC 2022 Class I for LQTS/BrS/SQTS/CPVT, EHRA classes at the edges (IIa adult-onset IVF, IIb BrS type 2/3 and SIDS, III ERS); ClinGen panels — SCN5A alone for BrS, KCNQ1/KCNH2/CALM1-3 for LQTS, RYR2/CASQ2/TECRL/TRDN for CPVT; yields 70–80% LQTS, 50–60% CPVT, 20–30% BrS, 20–25% SQTS; combined-panel real world 19.9% P/LP with 51.2% VUS-only; incidental CPVT-gene variants 8.8% vs 6.0% controls, 97.7% VUS; channelopathy reclassification 38%, mostly downgrades; genotype changes management only at the margins (mexiletine LQT3, quinidine SQTS/ERS, sodium-channel blockade in BrS); molecular autopsy, 42% cascade yield in relatives, and the access inequity of cardiogenetic centres |
genetic-testing, channelopathies, inherited-arrhythmias, sudden-cardiac-death, cascade-family-screening |
2026-10-28 |
| concepts/Genetic-Testing-in-Cardiomyopathy |
Systematic framework for multigene panel testing in HCM/DCM/ARVC/RCM; yields by phenotype; gene-specific management; VUS management; paediatric and incidental findings |
genetics, cardiomyopathy, genetic-testing, guideline |
2026-04-15 |
| concepts/Channelopathies |
The six inherited primary electrical diseases (LQTS, SQTS, Brugada, ERS, CPVT, IVF) as one class; gain- versus loss-of-function as the organising principle (SCN5A both directions); SCD in the young 1.3–3.2/100,000 with 40% structurally normal at autopsy; LQTS birth prevalence 1:2,534; BrS ancestry gradient 0.0–0.94% (Asian) to 0.0–0.02% (European); genetic architecture including BrS polygenicity and ClinGen limits on the 17 LQTS subtypes; Schwartz and Shanghai score thresholds; management principles with per-syndrome caveats, including that LCSD must section T1–T4; 13 contradictions |
channelopathies, genetics, inherited-arrhythmias, sudden-cardiac-death, cardiac-electrophysiology |
2026-10-28 |
| concepts/Epigenetics-Cardiac-Arrhythmia |
Epigenetic regulation of arrhythmia-susceptibility genes: miR-19b multi-channel regulation (LQTS/SQTS), circulating miRNA biomarkers, U1 snRNA/KCNH2 splicing therapy, SCN5A H558R promoter methylation (BrS modifier), KCNQ1OT1 imprinting, KChIP2/H3K4me3 histone regulation, SCN10A 3D enhancer–SCN5A promoter loop |
epigenetics, ventricular-arrhythmia, non-coding-RNA, DNA-methylation, channelopathies |
2026-05-09 |
| concepts/Sex-Differences-in-Channelopathies |
Sex-specific arrhythmic risk windows: males 4× higher risk age 10–12; females 11% vs 2% risk age 18–40; postpartum = highest-risk period; estrogen inhibits IKr (prolongs QT); testosterone shortens QT; BrS 8–10× male predominance via Ito augmentation; SQTS male predominance |
channelopathies, sex-differences, long-qt-syndrome, arrhythmia, hormonal-effects |
2026-05-09 |
| concepts/HCM-Ion-Channel-Remodeling |
Pre-structural INaL/ILTCC changes in HCM; detectable before hypertrophy |
hypertrophic-cardiomyopathy, arrhythmia |
2026-04-11 |
| concepts/Electrical-Remodeling |
Disease-driven ion channel changes in AF (↑IKACh constitutive, ↓ICaL, triangulated AP), HF (↑INaLate/CaMKII, ↑If, ↑NCX, ↓IKr/IKs/Ito/IK1), HCM, and MI; repolarization reserve concept |
cardiac-electrophysiology, arrhythmia-mechanisms, ion-channels, electrical-remodeling, channelopathies |
2026-04-30 |
| concepts/LVOTO |
Dynamic LV outflow obstruction from systolic anterior motion of the mitral valve; ~70% of HCM resting or provocable; ≥30 mmHg defines obstruction, ≥50 the usual treatment threshold, and 30–50 a data-free grey zone where invasive reduction may still be considered; Braunwald–Brockenborough sign versus fixed aortic stenosis; ESC-versus-AHA step table diverging only at step 3 (disopyramide→mavacamten IIa vs myosin inhibitor/disopyramide/SRT all Class 1), myosin inhibitors never with disopyramide; EXPLORER 37% vs 17%, SEQUOIA +1.7 ml/kg/min, MAPLE aficamten beats metoprolol on every objective endpoint while metoprolol moves the gradient −3.8 mmHg; ODYSSEY negative in non-obstructive HCM, so the benefit is obstruction-dependent |
cardiomyopathy, HCM, lvot-obstruction, mavacamten, cardiac-myosin-inhibitors |
2026-10-26 |
| concepts/Late-Gadolinium-Enhancement |
CMR fibrosis marker; LGE ≥15% LV mass elevates SCD risk 2.32× in HCM; HR 5.55 in DCM; transmural extent predicts viability recovery (>50% → <10% recovery); 23–44% post-STEMI ECGs non-diagnostic despite persistent LGE scar |
multimodality-imaging, cardiomyopathy, myocardial-viability, myocardial-infarction |
2026-05-01 |
| concepts/Left-Atrial-Strain |
LASr <23% threshold for mechanical atrial dysfunction (AtCM framework); more predictive of stroke/dementia risk than AF itself; better predictor of HFpEF outcomes than AF presence; LA booster strain <8%; LA emptying fraction <48%; CMR LGE ≥10–15% predicts ablation recurrence/stroke |
left-atrial-strain, atrial-cardiomyopathy, echocardiography, atrial-fibrillation, HFpEF |
2026-05-09 |
| concepts/Q-Wave-Remodeling |
Post-infarct Q-wave regression; pseudo-normalization confirmed by LGE-CMR; size (not transmurality) determines Q-wave presence; 6.2% LV mass cutoff; 44% non-diagnostic ECG at 5 years post-STEMI |
myocardial-infarction, electrocardiography, late-gadolinium-enhancement, stemi, cardiac-mri |
2026-05-01 |
| concepts/Myocardial-Viability |
Hibernation vs stunning; LGE-CMR transmural extent tiers (>50% → <10% recovery); STICH/PARR-2/REVIVED-BCIS2 show viability imaging does not discriminate revascularisation benefit; CABG vs PCI divergence; modality performance table |
myocardial-viability, ischemic-cardiomyopathy, cardiac-imaging, coronary-revascularization |
2026-05-11 |
| concepts/Left-Cardiac-Sympathetic-Denervation |
Thoracoscopic lower stellate ganglion removal for refractory LQTS and CPVT |
surgery, channelopathies |
2026-04-11 |
| concepts/Phenotypic-Approach-to-Cardiomyopathy |
ESC 2023 framework: identify morphological phenotype first, then aetiological diagnosis |
cardiomyopathy, diagnostics |
2026-04-11 |
| concepts/Septal-Reduction-Therapy |
Surgical myectomy and alcohol septal ablation for obstructive HCM |
cardiomyopathy, HCM |
2026-04-11 |
| concepts/Shanghai-Score-System |
Point-based probability score for Brugada syndrome and ERS diagnosis |
diagnostics, channelopathies |
2026-04-11 |
| concepts/Sports-Cardiology-SDM |
AHA/ACC 2025 SDM framework for competitive athletes with CVD; sports classification continuum; preparticipation evaluation; PKP2 vs non-PKP2 ACM distinction; LQTS/CPVT/BrS participation guidance |
sports-cardiology, shared-decision-making, sudden-cardiac-death, guidelines |
2026-04-25 |
| concepts/SupRep-Therapy |
Suppression-and-replacement gene therapy for LQTS; mutation-agnostic; validated in rabbits |
gene-therapy, channelopathies |
2026-04-11 |
| concepts/Torsades-de-Pointes |
Polymorphic VT in LQTS; EAD-mediated; sex hormone modulation of risk |
arrhythmia, channelopathies |
2026-04-11 |
| concepts/VA-Risk-Stratification-DCM |
Multi-parameter VA risk stratification in DCM; LGE + genotype + LVEF over LVEF alone; DANISH trial no all-cause mortality benefit (HR 0.87; SCD HR 0.50; age <68 HR 0.64); grade III diastolic dysfunction adds LVEF-independent arrhythmic risk (HR 3.52, pilot data) |
dilated-cardiomyopathy, ICD, diastolic-dysfunction, sudden-cardiac-death |
2026-05-14 |
| concepts/PVC-Induced-Cardiomyopathy |
Reversible LV dysfunction from frequent PVCs (burden >10–24%); ABC-VT risk score; wide QRS/epicardial origin/interpolated PVCs as risk factors; ablation normalises LVEF in 82%; Class I/IIa indications |
premature-ventricular-complexes, PVC-induced-cardiomyopathy, ventricular-arrhythmias, heart-failure, electrophysiology |
2026-05-01 |
| concepts/Pacing-Induced-Cardiomyopathy |
Right ventricular pacing causes a ≥10% LVEF fall to <50% in ~20% of patients; male sex (HR 2.15) and native QRS ≥115 ms (90% specific) predict it; risk begins at 20–39% pacing burden, below the 40% threshold; biventricular upgrade improves LVEF 32→44% |
pacing-induced-cardiomyopathy, right-ventricular-pacing, heart-failure, cardiac-pacing, biventricular-pacing |
2026-10-17 |
| concepts/PVC-Mapping-Ablation |
Comprehensive mapping/ablation guide: ECG localisation rules by site; activation/pace mapping/ECGI; RF/cryo/ethanol/PFA/stereotactic energy sources; site-by-site strategies (RVOT, LV summit, Purkinje, papillary muscles, intramural); 84% acute success, 2.4% complications |
premature-ventricular-complexes, catheter-ablation, ventricular-arrhythmias, electrophysiology, mapping |
2026-05-01 |
| concepts/iPSC-Derived-Cardiomyocytes |
Patient-specific cardiomyocyte models for channelopathy and HCM research and drug testing |
precision-medicine, channelopathies |
2026-04-11 |
| concepts/OSA-Arrhythmogenic-Substrate |
Dual mechanism: acute apnea-associated electrophysiological changes + long-term structural remodeling creating dynamic AF substrate in OSA |
obstructive-sleep-apnea, atrial-fibrillation, atrial-remodeling |
2026-04-18 |
| concepts/Valvular-Heart-Disease |
Overview of acquired VHD: aetiology, Heart Team model, imaging, associated conditions; A–D staging (ACC/AHA 2020); CHA2DS2-VASc for AF anticoagulation |
valvular-heart-disease, guideline |
2026-04-19 |
| concepts/PCI-Before-TAVI |
FFR-guided or angiographic PCI in TAVI candidates with concomitant stable CAD; NOTION-3 (NEJM 2024; n=455; FFR ≤0.80 or ≥90% stenosis; median age 82): MACE HR 0.71 (P=0.04); MI HR 0.54; urgent revasc HR 0.20; all-cause death HR 0.85 NS; bleeding HR 1.51; AKI HR 0.45; supersedes neutral ACTIVATION trial; ESC 2025 Class IIa B for ≥90% stenosis; optimal timing pre- vs peri- vs post-TAVI unresolved |
TAVI, aortic-stenosis, coronary-artery-disease, fractional-flow-reserve, randomized-controlled-trial |
2026-05-19 |
| concepts/TAVI |
Transcatheter aortic valve implantation; PARTNER 3 5yr: composite NS (22.8% vs 27.2%; P=0.07), valve thrombosis 2.5% vs 0.2%, AF 13.7% vs 42.4%; DEDICATE-DZHK6 (NEJM 2024; industry-independent; n=1,414; pragmatic device-choice): death/stroke HR 0.53 (5.4% vs 10.0%), all-cause death HR 0.43, AF HR 0.36, pacemaker HR 1.81; EARLY TAVR (NEJM 2025): asymptomatic AS primary composite HR 0.50 (P<0.001), death HR 0.93 NS, stroke HR 0.62 NS, 87% surveillance crossover; NOTION-3 PCI: MACE HR 0.71 (P=0.04); CEP (BHF PROTECT-TAVI 2025): routine CEP null — stroke 2.1% vs 2.2% (P=0.94) |
valvular-heart-disease, TAVI, aortic-stenosis |
2026-05-20 |
| concepts/Cerebral-Embolic-Protection-TAVI |
Sentinel CEP device (Boston Scientific) during TAVI: BHF PROTECT-TAVI (NEJM 2025; n=7,635; 33 UK centres; largest RCT; stopped for futility): stroke 2.1% CEP vs 2.2% control (P=0.94); disabling stroke 1.2% vs 1.4% (NS); serious adverse events 0.6% vs 0.3% (doubled); confirmed by PROTECTED TAVR (n=3,000); routine CEP not supported; DWI-MRI subclinical lesion reduction does not translate to clinical stroke prevention |
TAVI, cerebral-embolic-protection, stroke-prevention, aortic-stenosis, randomized-controlled-trial |
2026-05-20 |
| concepts/Aortic-Stenosis |
AS grading and ACC/AHA staging; low-flow low-gradient resolution; indications tabulated against ESC 2025 and ACC/AHA 2020; EARLY TAVR vs RECOVERY; mode of intervention and prosthesis age; invasive haemodynamics; perioperative AS |
valvular-heart-disease, aortic-stenosis, guideline |
2026-10-30 |
| concepts/Aortic-Regurgitation |
AR evaluation; surgical thresholds (LVESD, LVESDi, LVESVi, LVEF); VSARR preferred in young patients; new TAVI option for inoperable patients |
valvular-heart-disease, aortic-regurgitation |
2026-04-18 |
| concepts/Primary-Mitral-Regurgitation |
PMR evaluation; surgical indications including new asymptomatic criteria (3-of-4 rule); TEER for high-risk; minimally invasive surgery |
valvular-heart-disease, mitral-regurgitation |
2026-04-18 |
| concepts/Secondary-Mitral-Regurgitation |
Atrial vs ventricular SMR distinction; GDMT before intervention; TEER Class I A ESC 2025 for ventricular SMR; COAPT 5yr: HF hosp HR 0.53, mortality HR 0.72; RESHAPE-HF2: moderate-to-severe SMR all 3 primaries met (HF hosp RR 0.59; NNT 5.1); MATTERHORN (NEJM 2024): first TEER vs surgery RCT — noninferior efficacy (16.7% vs 22.5%; NI P<0.001); TEER dramatically safer (30-day safety 14.9% vs 54.8%); MR recurrence ≥3+ higher with TEER (8.9% vs 1.5%); evidence base spans EROA 0.20–0.40 cm² |
valvular-heart-disease, mitral-regurgitation, heart-failure |
2026-05-19 |
| concepts/Mitral-Stenosis |
Rheumatic MS (PMC criteria); degenerative MS with MAC (TMVI emerging); VKA not DOACs if MVA ≤2.0 cm² with AF |
valvular-heart-disease, mitral-stenosis |
2026-04-18 |
| concepts/Tricuspid-Regurgitation |
TR aetiology (atrial vs ventricular secondary TR); anatomy (40% annular dilatation threshold; RCA <3mm; AV node 3-5mm from commissure); severe TR 1yr mortality 36–42%; HR 2.74 vs normal; 5-grade severity scale; TRILUMINATE Pivotal (NEJM 2023) TEER WR 1.48 — QoL-driven (KCCQ ≥15pts 49.7% vs 26.4%; PPM no increase; HF hosp paradox); TRISCEND II (NEJM 2025) TTVR WR 2.02 — TR ≤mild 95.2%; bleeding 15.4%; PPM 17.4%; RV reverse remodeling; TriClip + EVOQUE FDA-approved; ESC 2025 Class IIa A LBBP and TR: worsened by ≥1 grade in 32.6% of 89 patients over 19 months; lead entry ≤16.1 mm from the septal leaflet independently predictive; conflicts threefold with the LBBP registry's 11.1% |
valvular-heart-disease, tricuspid-regurgitation, transcatheter-interventions, right-heart-failure, echocardiography |
2026-10-17 |
| concepts/Heart-Valve-Centre |
Specialised centre requirements; volume-outcome evidence; regional Heart Valve Network model; Heart Team composition |
valvular-heart-disease, heart-team |
2026-04-18 |
| concepts/Structural-Valve-Deterioration |
Unified SVD definitions 2025: moderate SVD (PG increase ≥10 mmHg + absolute ≥20 mmHg); severe SVD (≥20 mmHg increase + absolute ≥40 mmHg) |
valvular-heart-disease, prosthetic-valves |
2026-04-18 |
| concepts/LQTS-Pregnancy-Management |
LQTS risk paradox: pregnancy protective, 9-month postpartum 2.7× risk; LQT2 highest risk; progesterone antiarrhythmic; beta-blockers Class I (nadolol preferred; propranolol/metoprolol if breastfeeding); three-tier delivery risk stratification; QTc >500ms postpartum → consider ICD/WCD; HRS 2023 primary current guideline |
long-qt-syndrome, pregnancy, arrhythmia-management, channelopathies |
2026-05-22 |
| concepts/LQTS-Genetics-and-Pathophysiology |
LQTS gene architecture (KCNQ1/KCNH2/SCN5A ~90%); ClinGen validity and disputed genes; syndromal/recessive forms; calmodulinopathy; modifier genes and PRS; ion-channel mechanisms; TdP final common pathway; repolarisation reserve; sex hormones and circadian variation |
long-qt-syndrome, genetics, electrophysiology, channelopathies |
2026-10-26 |
| concepts/Arrhythmia-in-Pregnancy |
HRS 2023 (163 recommendations; 8 societies): AF most common sustained arrhythmia; cardioversion safe/same energy; lead apron only 3% fetal radiation reduction; DOACs contraindicated; flecainide 1st-line fetal SVT; perimortem C-section target 5 min; IAS pregnancies 8× stillbirth risk |
pregnancy, arrhythmia, antiarrhythmic-drugs, fetal-arrhythmia, inherited-arrhythmia-syndrome |
2026-05-22 |
| concepts/Fetal-Arrhythmia |
Fetal arrhythmias in 1% of fetuses; flecainide 1st-line SVT (superior with hydrops); sotalol/digoxin for AFL; verapamil avoided (unexpected fetal death); IV magnesium 1st-line fetal VT; congenital heart block (anti-Ro/SSA); close-to-term delivery preferred over escalating pharmacotherapy |
fetal-arrhythmia, pregnancy, antiarrhythmic-drugs, cardio-obstetrics, fetal-SVT |
2026-05-22 |
| concepts/Precision-Medicine-LQTS |
Genotype-specific LQTS therapy from 1,304-patient Mayo Clinic cohort: 18 configurations in LQT3; propranolol over nadolol (INaLate); IPAP for LQT2; mexiletine off-label; intentional nontherapy in 18%; LCSD monotherapy in 5%; cardiac transplant in 4 LQT3 patients; 0.3% mortality over 20+ years |
long-qt-syndrome, precision-medicine, beta-blockers, antiarrhythmic-drugs, left-cardiac-sympathetic-denervation |
2026-05-09 |
| concepts/Drug-Induced-Arrhythmia |
AHA 2020 taxonomy of drug-induced arrhythmias: bradyarrhythmia, AF/AFL, AT, AVNRT, monomorphic VT, Brugada unmasking, TdP; CAST trial; repolarization reserve; IKr blockade; TdP risk factors and management |
drug-induced-arrhythmias, torsades-de-pointes, QT-prolongation, arrhythmia-management |
2026-04-19 |
| concepts/Antiarrhythmic-Drugs |
Vaughan Williams Classes I–IV overview; flecainide: PRR mechanism, CV efficacy 90%, CAST contraindication, RyR2 blockade in CPVT; dronedarone: ATHENA 24.2% RRR, ANDROMEDA mortality hazard in severe HF (HR 2.13), IK-Ach 100× more potent than amiodarone; genotype-specific pharmacology (mexiletine LQT3, amiodarone ineffective in SQTS1) |
antiarrhythmic-drugs, atrial-fibrillation, ventricular-arrhythmia, pharmacology, proarrhythmia |
2026-05-09 |
| concepts/Fabry-Cardiomyopathy |
AFD cardiac phenotype in full, the authority for cardiac questions now that the entity defers on them: HCM genocopy; HFpEF dominant (40%/91%); CMR 4-stage model from reduced T1 alone to systolic dysfunction; ERT paradox (augments LGE); zebra bodies; Lyso-Gb3/NT-proBNP/hs-cTn biomarkers; conduction disease with short PR as the earliest finding, 6% of young patients needing a bradyarrhythmia device, ICD or CRT-D preferred over pacemaker at LVEF <=35%, and LBBB distorting T1 mapping; amiodarone contraindicated, mavacamten and HCM Risk-SCD both prohibited |
fabry-cardiomyopathy, hypertrophic-cardiomyopathy, lysosomal-storage-disorder, cardiac-mri |
2026-10-30 |
| concepts/Titin-PTMs |
Three PTM types (acetylation/oxidation/phosphorylation) regulating titin spring stiffness; N2Bus vs PEVK opposing effects; cGMP-PKG therapeutic failures (RELAX, VITALITY, SOCRATES) |
titin, sarcomere, heart-failure, HFpEF, post-translational-modifications |
2026-04-19 |
| concepts/Titin-Isoform-Switch |
N2B vs N2BA isoform ratio and Frank-Starling regulation; RBM20 as master switch; isoform changes in HFrEF/HFpEF; RBM20 pathogenic variants → DCM; therapeutic targeting limitations |
titin, sarcomere, heart-failure, HFpEF, dilated-cardiomyopathy |
2026-04-19 |
| concepts/Sarcomere-Biology |
Cardiac sarcomere architecture: MYH7, MYBPC3, troponin complex, titin; crossbridge cycling; cMyBP-C as brake (C1-M-C2/myosin S2 binding); PKA phosphorylation switch; increased myofilament Ca²⁺ sensitivity = HCM final common pathway; HCM mutations (MYBPC3 40–50%, MYH7 25–40%); mavacamten mechanism; DCM vs HCM distinction |
sarcomere, hypertrophic-cardiomyopathy, MYBPC3, crossbridge-cycling, cardiomyopathy |
2026-05-09 |
| concepts/Haploinsufficiency |
Mechanism by which truncating mutations cause loss-of-function: NMD/UPS/autophagy degrade truncated protein → half-normal WT protein; canonical example MYBPC3 (>60% truncating); therapeutic implication: gene replacement/exon skipping restores WT, not gene silencing; contrast with dominant-negative missense mechanism; bi-allelic → neonatal CMP |
haploinsufficiency, genetics, MYBPC3, hypertrophic-cardiomyopathy, gene-therapy |
2026-05-09 |
| concepts/LV-Diastolic-Function |
2025 ASE algorithm: 2-step diastolic dysfunction definition; LAP estimation (e', E/e', TR velocity); LARS ≤18% primary variable; Grade 1/2/3 classification; diastolic exercise echo; special populations; grade III independently predicts arrhythmic death HR 3.52 (LVEF-independent, pilot data) |
echocardiography, diastolic-function, HFpEF, heart-failure |
2026-05-14 |
| concepts/Conduction-Disorders-in-Young-Adults |
CCDs in adults <50 years: acquired (Lyme/sarcoidosis/Chagas/autoimmune) and familial (SCN5A/LMNA/Fabry/neuromuscular/CHD-related); PM <50 → 3–4× risk; conduction system pacing preferred; ICD over PM in LMNA; genetic testing underused |
conduction-disorders, atrioventricular-block, genetics, cardiomyopathy, young-adults |
2026-05-02 |
| concepts/Conduction-System-Pacing |
CSP taxonomy (HBP/LBBP/LFP/LVSP/LBBAP/DSP); hemodynamics vs RVP/BVP; HOT-CRT/LOT-CRT outcomes; 7 published RCTs; PROTECT-HF (n=2,600) and Left vs Left (n=2,136) ongoing. Why LBBAP emerged as HBP's distal alternative: transseptal placement distal to the presumed block (simpler, lower/stable threshold, larger R-wave) at the cost of assuming the block lies in the left bundle — violated in ~36% of LBBB (intact Purkinje). LVSP as a distinct third entity (Rijks 2022): conduction-system-adjacent, not conduction-system pacing — captures left-sided septal myocardium near the Purkinje exit sites; LBB capture rates 60–90% mean 'LBBP' cohorts contain LVSP admixture, making published LVSP-vs-LBBP comparisons unreliable. MELOS primary source cited (2,533 pts/14 centres): success 92.4% brady vs 82.2% HF; capture types 69.5% fascicular / 21.5% LV septal / 9% proximal LBB; complications 11.7% (8.3% route-specific); learning curve plateau after 250 cases; no mortality or HF-event analysis. Lead type as a variable (De Pooter 2022, JCE; stylet-driven Solia S60, 353 pts/8 centres): success 94.6% and independent of centre volume (93–100%, p = .75; median 25 implants/centre) — the main argument CSP need not be confined to expert centres, though all operators were experienced electrophysiologists; only 73% achieved LBB capture (27% LVSP) under a composite "LBBP or LVSP" success definition, and LBB potential was seen in just 14%; perforation 2% and coronary fistula 1.4% ran above single-centre lumenless reports (attributed to including the learning curve); 12-month threshold stability rests on 67/353 pts (rated medium). Lead families are not interchangeable (Taddeucci 2024, J Clin Med, rated medium): lumenless 3830 = fixed isodiametric helix, stable but no locking stylet (extraction risk); SDL = sheath/stylet support plus pacing from the stylet during rotation, but helix retraction/deformation/fracture; no randomised comparison, and perforation figures (2% registry vs 10.2%/11.6% technical review) use different definitions. Capture cut-offs span 70–101 ms across 15 studies (Zhu 2022 systematic review), so within-patient comparison (ΔStim-LVAT, V6–V1, IDT−TCT) is preferred over fixed values. RBBP is a third right-sided target (19.6% of HBP-intended patients; ΔV6RWPT ≥10 ms standard; better sensing, no outcome difference; cannot correct LBBB). Long-term LBBP: 618 patients, thresholds 0.65→0.69 V at 2 years, LBBB QRS 167→124 ms, selective capture 74.4%→30.9%; vs RVP, narrower QRS but no clinical outcome difference; TR worsened in 32.6% and predicted by lead–annulus distance ≤16.1 mm |
conduction-system-pacing, cardiac-pacing, his-bundle-pacing, left-bundle-area-pacing, cardiac-resynchronization-therapy |
2026-10-17 |
| concepts/His-Bundle-Pacing |
HBP technique; hemodynamics (–56 ms QRS, +5 mmHg SBP vs RVP); HOPE-HF trial; fluoroless implantation; threshold rise 17%; back-up lead indications. His-SYNC: QRS not normalisable in almost half of LBBB — the failure that motivated LBBAP; further limits: His ~1–2 mm, unstable thresholds in 5–10%, small sensed R-wave, implantation damage. Fluoroscopic address (Jiang 2020): all 11 HB leads in partition 2 of the 9-partition method; lead-tip to NCC/RCC junction 1.9 ± 0.2 cm vs 3.8 ± 0.6 cm for LBB RBBP is a distinct distal right-sided target (potential–QRS <35 ms; ΔV6RWPT ≥10 ms; 19.6% of HBP-intended patients; better sensing, equivalent thresholds, no outcome difference; cannot correct LBBB) |
conduction-system-pacing, his-bundle-pacing, cardiac-pacing |
2026-10-17 |
| concepts/Left-Bundle-Branch-Area-Pacing |
LBBAP overview: transseptal pacing of the left septum; umbrella for LBBP/LFP/LVSP (MELOS 9% / 69.5% / 21.5%); more than one in five implants do not capture the LBB; HFH benefit vs BVP without a mortality benefit; the first RCT missed ITT non-inferiority; links to capture, implantation and outcomes pages. |
conduction-system-pacing, left-bundle-area-pacing, cardiac-pacing, cardiac-resynchronization-therapy |
2026-10-19 |
| concepts/LBBAP-Capture-Criteria |
How LBB capture is proved: output-dependent QRS transition (~26% available), V6RWPT, V6–V1, physiology-based rules, combined score, morphology, LBB potential and programmed deep septal stimulation; sensitivity is cohort-dependent and no criterion is validated in the majority. |
left-bundle-area-pacing, conduction-system-pacing, electrophysiology, ecg-criteria |
2026-10-19 |
| concepts/LBBAP-Implantation-Technique |
Stepwise transseptal implantation: anatomy, lumenless vs stylet-driven leads, entry-site methods (9-partition, contrast, ICE), septal crossing, real-time fixation-beat/COI/impedance monitoring, perforation recognition and programming. |
left-bundle-area-pacing, conduction-system-pacing, implantation-technique, cardiac-pacing |
2026-10-19 |
| concepts/LBBAP-Outcomes |
Clinical results of LBBAP: acute haemodynamics, HFH/mortality cohorts, LEFT-BUNDLE-CRT RCT, LBBP vs RVP, long-term lead performance, tricuspid regurgitation, complications, follow-up, LOT-CRT, LBBA defibrillation/ATP and scar substrate. |
left-bundle-area-pacing, cardiac-resynchronization-therapy, heart-failure, conduction-system-pacing |
2026-10-19 |
| concepts/Right-Bundle-Branch-Pacing |
RBBP as a distinct right-sided CSP modality (Jastrzębski 2023, n=326): potential–QRS <35 ms; ΔV6RWPT ≥10 ms diagnostic standard (paced > native by 17.8 vs 0.5 ms in HBP); six criteria; 19.6% of HBP-intended patients (12.2% at working output); vs HBP better sensing (5.6 vs 3.2 mV), equivalent thresholds, longer QRS/V6RWPT, no outcome difference; cannot correct LBBB; proposed for dual-branch pacing; criteria derived/tested in same cohort, no direct capture proof |
right-bundle-branch-pacing, conduction-system-pacing, his-bundle-pacing, cardiac-pacing, electrocardiography |
2026-10-17 |
| concepts/Constrictive-vs-Restrictive |
Haemodynamic and imaging differentiation of constrictive pericarditis vs restrictive cardiomyopathy; six-row comparison table (cause, mitral e′, annulus reversus, CMR, respiratory discordance); ventricular interaction mechanism and systolic area index; volume loading; severe RV failure as a mimic; tamponade x/y descent contrast; effusive-constrictive pericarditis; transient constriction resolves medically |
pericardial-disease, restrictive-cardiomyopathy, hemodynamics, cardiac-catheterization, right-heart-failure |
2026-10-30 |
| concepts/ANGPTL3-Inhibition |
ANGPTL3 hepatokine inhibits LPL (raises TG) + endothelial lipase (raises HDL-C); LOF variants → familial combined hypolipidemia + OR 0.59–0.66 CAD protection; evinacumab FDA/EMA-approved HoFH (−47% LDL-C, −55% TG; LDLR-independent); vupanorsen discontinued (TRANSLATE-TIMI 70 hepatotoxicity); ARO-ANG3 siRNA Phase 2b ongoing; BE3-Angptl3 murine base editing proof-of-concept |
angptl3, dyslipidemia, lipid-lowering-therapy, familial-hypercholesterolemia, atherosclerotic-cardiovascular-disease |
2026-05-23 |
| concepts/APOC3-Inhibition |
APOC3 as TG regulator (LPL inhibition + impaired TRL remnant clearance); genetic LOF validation; olezarsen (GalNAc-ASO) phase 3 −58–61 pp TG, remnant cholesterol −70%, ApoB −15%, LDL-C unchanged; plozasiran (siRNA) comparable class efficacy; GalNAc conjugation mitigates thrombocytopenia vs volanesorsen; safety: mild transaminase elevation, injection-site reactions, small HbA1c rise in diabetics; no CV outcomes data |
hypertriglyceridemia, antisense-oligonucleotide, apolipoprotein-C-III, lipid-lowering-therapy, cardiovascular-risk |
2026-05-21 |
| concepts/Hypertriglyceridemia-Management |
TG classification (150–499 moderate/≥500 severe/FCS); existing agents limited to 10–30% TG reduction; ESSENCE-TIMI 73b (NEJM 2025): olezarsen −58–61 pp TG; ~85–89% TG normalization at 6 months; remnant cholesterol −70%; no CV outcomes; regulatory: olezarsen FDA-approved FCS (COR 1 ACC/AHA); volanesorsen EMA-approved FCS (COR IIa B ESC); REDUCE-IT IPE COR 2b moderate HTG; no fibrate benefit on statin for ASCVD |
hypertriglyceridemia, antisense-oligonucleotide, apolipoprotein-C-III, lipid-lowering-therapy, cardiovascular-risk |
2026-05-21 |
| concepts/CETP-Inhibitors |
CETP inhibitor drug class: mechanism (HDL-C↑, LDL-C↓, Lp(a)↓); class history (torcetrapib harm → dalcetrapib/evacetrapib futility → anacetrapib partial success → obicetrapib); BROADWAY (NEJM 2025; n=2,530): obicetrapib −32.6 pp LDL-C on top of max LLT; Lp(a) −33.5%; safety comparable to placebo; BROOKLYN outcomes trial ongoing |
dyslipidemia, CETP-inhibitor, LDL-cholesterol, lipid-lowering-therapy, ASCVD |
2026-05-20 |
| concepts/Dyslipidemia |
Dyslipidemia overview hub: LDL-C/non-HDL-C goals by risk category (AHA 2026 + ESC 2025), CAC tiers, statin-ezetimibe-PCSK9i escalation in summary, lifestyle, hypertriglyceridaemia, Lp(a), emerging agents; Ez-PAVE first RCT of <55 vs <70 mg/dL (HR 0.67); ApoB codified as intensification marker without a numeric goal |
dyslipidemia, ldl-c, primary-prevention, ASCVD, guidelines, lipoprotein-a, triglycerides |
2026-10-25 |
| concepts/Dyslipidemia-Management |
Dyslipidemia treatment in practice: statin intensity and SAMS, ezetimibe -> PCSK9 mAb -> bempedoic acid/inclisiran order, secondary prevention in CCD and ACS (CCS/AHA sequential vs ESC 'strike early and strong'), special populations, STAREE at age >=70 |
dyslipidemia, ldl-c, statin, ezetimibe, pcsk9-inhibitor, bempedoic-acid, inclisiran, secondary-prevention, statin-intolerance |
2026-10-25 |
| concepts/Intracoronary-Imaging-Guided-PCI |
IVUS vs OCT vs angiography guidance for PCI; prior Asian RCTs positive (RENOVATE, ULTIMATE, IVUS-XPL); two large European RCTs neutral (IVUS-CHIP NEJM 2026: complex PCI N=2020 HR 1.25 NS; IVUS-OPTIMAL NEJM 2026: left main PCI N=806 HR 1.11 NS); challenges Class IA guideline recommendation; stent thrombosis lower with IVUS despite neutral primary outcomes |
ivus, oct, intracoronary-imaging, pci, complex-pci, left-main-pci |
2026-05-16 |
| concepts/ASCVD-Risk-Assessment |
PREVENT-ASCVD equations (replace PCE); CPR Framework (Calculate–Personalize–Reclassify); risk categories; CAC scoring tiers; risk enhancers including Lp(a) and reproductive markers; polygenic risk scores; SCORE2/SCORE2-OP (age ≥70) — the framework making older adults eligible on age alone, now tested by STAREE 2026 (nonfatal events reduced, disability-free survival and CV death unchanged) |
ASCVD, primary-prevention, risk-stratification, dyslipidemia, guidelines |
2026-10-15 |
| concepts/Lipoprotein-a |
Lp(a) biology; CardiogramPlus4D: LPA = most potent CAD genetic locus; universal measurement COR 1; risk table (1.4×–4×); residual risk HR 1.61 on statins (pooled 13,167 pts); ASTRONOMER CAVS progression data; statin effect contradiction (ESC: no effect vs Tsimikas: +11%); >50% reduction threshold hypothesis; management (risk factor optimisation → PCSK9 mAb → PCSK9i); emerging RNA therapies; thrombogenicity mechanisms (GPIIb/IIIa RGD; TF/TFPI; PAI-1; fibrin competition); endothelial dysfunction (Rho/ROCK; EPC impairment; FMD r=−0.33); decorin 2-part arterial wall binding |
dyslipidemia, ASCVD, lipoprotein-a, primary-prevention, risk-stratification |
2026-05-23 |
| concepts/Familial-Hypercholesterolemia |
HeFH (1:250–300); HoFH; genetic FH diagnosis confers 2-3× extra CAD risk at same LDL-C; LDL-C targets by ASCVD status (<100/<70/<55 mg/dL); other monogenic CAD forms (LDLRAP1/ABCG5-8/ABCC6/GUCY1A1/PDE5A/APOA5/SCARB1); genetic panel testing COR 2a; PREVENT equations contraindicated in FH; evinacumab for HoFH; cascade screening; inclisiran COR 2a add-on; VERVE-102 PCSK9 base editing Phase 1 |
dyslipidemia, ldl-c, genetics, primary-prevention, ASCVD, guidelines |
2026-05-27 |
| concepts/TTR-Stabilizer-Therapy |
TTR tetramer stabilizer drug class: tafamidis (entropic, ATTR-ACT HR 0.70 mortality, 70.5% 30-month survival) vs acoramidis (enthalpic T119M-mimicry, >90% stabilization, ATTRibute-CM win ratio 1.8, 80.7% 30-month survival); dose–response concept; no head-to-head; comparison with vutrisiran RNAi class |
attr-cardiomyopathy, TTR-stabilizer, acoramidis, heart-failure, amyloidosis |
2026-05-17 |
| concepts/Cardiac-Amyloidosis-Imaging |
Multimodality imaging in cardiac amyloidosis: scintigraphy grading (Grade 0–3), SPECT mandatory, PSIR LGE, ECV >0.40, cherry-on-top GLS, 5-5-5 TDI sign; addendum protocol updates |
cardiac-amyloidosis, multimodality-imaging, ATTR-amyloidosis, echocardiography, radionuclide-imaging |
2026-04-22 |
| concepts/DAPT-Strategies |
DAPT duration and de-escalation post-ACS and CCD; ticagrelor monotherapy COR 1/A; CCD-phase antiplatelet (PEGASUS, COMPASS, AFIRE); ARC-HBR criteria; triple therapy with OAC |
acute-coronary-syndrome, chronic-coronary-disease, antiplatelet-therapy, DAPT, bleeding-risk |
2026-04-22 |
| concepts/Balloon-Pulmonary-Angioplasty |
BPA for inoperable/residual CTEPH; ESC 2022 Class I; disease-level 1–4 classification; lesion subtypes (ring/web/subtotal/total/tortuous); Pd:Pa >0.80; safety trends 2013–2022; RACE and MR BPA trials |
balloon-pulmonary-angioplasty, CTEPH, pulmonary-hypertension, interventional-cardiology |
2026-04-28 |
| concepts/Acute-PE-Clinical-Categories |
AHA/ACC 2026 five-category PE classification (A–E); replaces massive/submassive/ESC 4-tier; integrates clinical scores, haemodynamics, biomarkers, RV imaging; respiratory modifier (R); management by category; CDL for Cat C3/D now RCT-supported (HI-PEITHO 2026, RR 0.39 vs anticoagulation alone). ESC 2019 predecessor now cited from primary source: four-tier criteria, the IIa caution that 34% of "low-risk" patients have RV dysfunction, and three structural non-equivalences (no Cat D, no asymptomatic category, Hestia not a classification criterion) |
pulmonary-embolism, risk-stratification, guidelines |
2026-10-15 |
| concepts/ACHD-AP-Classification |
ACHD anatomic (I–III) × physiologic (A–D) classification; Stage D now includes endocarditis/HF hospitalisation; Fontan/systemic-RV/truncus cannot be Stage A |
congenital-heart-disease, risk-stratification, guideline |
2026-04-21 |
| concepts/Tetralogy-of-Fallot |
Repaired TOF adult management; PVR criteria shift to RVESVi >80 mL/m²; SCD risk scores (PREVENTION-ACHD, Brompton, PACES); adjunctive VT ablation COR 2a |
congenital-heart-disease, tetralogy-of-fallot, sudden-cardiac-death, pulmonary-valve |
2026-04-21 |
| concepts/Fontan-Circulation |
Fontan adult management; annual liver surveillance + AFP COR 1; aspirin/anticoagulation all Fontan COR 1; rhythm control, pacing strategy, exercise, transplantation |
congenital-heart-disease, Fontan-circulation, single-ventricle, liver-disease, heart-failure |
2026-04-21 |
| concepts/Eisenmenger-Syndrome |
Eisenmenger: PAH monotherapy (ERA or PDE5i) COR 1; dual ERA+PDE5i COR 1; shunt closure COR 3:Harm; pregnancy COR 3:Harm; endocardial leads COR 3:Harm |
congenital-heart-disease, Eisenmenger-syndrome, pulmonary-arterial-hypertension, right-heart-failure |
2026-04-21 |
| concepts/Right-Ventricular-Failure |
RV failure pathophysiology (adaptive→maladaptive via neurohormonal, ischaemia, fibrosis, metabolic shift); classification by mechanism (preload: TR/shunts/AV fistulas; afterload: PE/chronic PH; contractility: RV MI/post-surgical/ARVC/sarcoidosis/LHF); diagnosis: TAPSE/TAPSE-PASP/FWS/CMR/RHC; treatment: preload (volume not universally helpful), afterload (PDE5i harmful in Group 2), contractility (dobutamine/milrinone/MCS; isolated RVAD contraindicated in severe PAH) |
right-ventricular-failure, pulmonary-hypertension, hemodynamics, right-heart-catheterization, right-ventricular-remodeling |
2026-05-17 |
| concepts/RV-PA-Coupling |
RV–PA coupling defined by Ees/Ea ratio (optimal 1.5–2.0; uncoupling <0.6–0.8); TAPSE/sPAP and CMR SV/ESV ratio as noninvasive surrogates; in PH: Ees rises to offset Ea until contractile reserve exhausted; single-beat methods under validation; adaptive vs maladaptive remodeling transition; sotatercept/FK506 as therapeutic targets. PADN for Group 2 PH (2026): coupling benefit inferred from echo, since no follow-up RHC was performed |
right-ventricular-failure, pulmonary-hypertension, RV-PA-coupling, hemodynamics |
2026-10-15 |
| concepts/Right-Heart-Catheterization |
Hub for the RHC cluster: the pressure–output framework behind PH classification and heart-failure phenotyping, what each measurement answers, safety, and the thresholds on which the guidelines disagree; routes to technique, interpretation and applications |
right-heart-catheterization, pulmonary-hypertension, heart-failure, invasive-hemodynamics |
2026-10-30 |
| concepts/RHC-Technique-and-Measurement |
RHC technique: access and zero reference (0.8 mmHg per cm); direct vs indirect Fick; thermodilution rules and its disputed accuracy in TR; PAWP timing, V-waves, over-wedging and wedge confirmation; shunt detection; volume-state artefacts; safety (1.1% adverse events, 0.055% mortality); 15-variable reference table with source discrepancies left visible |
right-heart-catheterization, invasive-hemodynamics, cardiac-output, pulmonary-hypertension |
2026-10-30 |
| concepts/RHC-Haemodynamic-Interpretation |
RHC interpretation: PAWP 13 mmHg normal vs 15 mmHg diagnostic; 12–18 zone of uncertainty; fluid challenge and passive leg raise (≥19 mmHg identifies occult post-capillary PH, ≤11 rules out); exercise HFpEF criteria (peak PAWP ≥25 supine, PAWP/CO slope >2); chronotropic incompetence and preload insufficiency; advanced indices; vasodilator challenge vs acute vasoreactivity testing |
right-heart-catheterization, pulmonary-hypertension, heart-failure, hfpef, invasive-hemodynamics |
2026-10-30 |
| concepts/RHC-Clinical-Applications |
RHC by context: PH confirmation and risk stratification; chronic and acute HF phenotypes; SCAI shock bands and HF-CS vs AMI-CS; valve indications; transplant thresholds (sPAP ≥50 + TPG ≥15 or PVR ≥3 triggers challenge) and post-transplant CAV; LVAD candidacy, ramp targets and explant criteria; portal vs congestion gradient; high-output HF; PA pressure monitoring; non-invasive PAWP candidates |
right-heart-catheterization, heart-failure, cardiogenic-shock, heart-transplantation, lvad, valvular-heart-disease |
2026-10-30 |
| concepts/Perioperative-Cardiovascular-Assessment |
2024 AHA stepwise perioperative framework, reaffirmed unchanged in 2026; risk indices, anticoagulation, DAPT timing and valve thresholds tabulated; RCRI/NSQIP/DASI; frailty; biomarkers; stress testing; MINS and the Fifth UDMI alignment; POAF; valvular, ACHD and LVAD populations; local handbook guidance distributed into the sections it qualifies |
perioperative-medicine, noncardiac-surgery, cardiovascular-risk, guideline, anticoagulation |
2026-10-30 |
| concepts/Heart-Healthy-Dietary-Patterns |
AHA 2026 9-feature framework: energy balance, vegetables/fruits, whole grains, healthy protein (plant-first, fish; NOT fish oil supplements), unsaturated fat, minimally processed foods, ↓added sugars, ↓sodium/↑potassium, alcohol avoidance; DASH in HF: pilot data (hs-cTnI −20%, NT-proBNP −23%; HFpEF diastolic function improvement); MedDiet MetS risk RR 0.81; DASH MetS risk −48%; head-to-head RCT (Filippou 2023): MedDiet = DASH on 24h ambulatory BP (gold standard), MedDiet > DASH office SBP only (−3.2 mmHg); both outperform salt restriction alone; network MA DASH-superiority claim contradicted by direct RCT; ketogenic short-term MetS benefit vs uncertain LDL/long-term CV safety; U-shaped CH-mortality curve (optimal 50–55%); adherence decisive factor |
cardiovascular-prevention, dietary-control, nutrition-guidelines, ultraprocessed-foods, primary-prevention |
2026-05-28 |
| concepts/Metabolic-Syndrome |
MetS = ≥3 of: central obesity, dyslipidaemia, impaired glucose, elevated BP, low HDL-c; prevalence 20–25% adults; 2-fold T2DM risk, 5-fold CVD risk; MedDiet best overall (RR 0.81, 19% MetS risk reduction); DASH strong for BP (−3.2/−2.5 mmHg; 48% less MetS); head-to-head RCT: MedDiet = DASH on 24h ambulatory BP, MedDiet > DASH office SBP (−3.2 mmHg); plant-based: SBP −4.8 mmHg, weight −2.88 kg; ketogenic: short-term TG/weight benefit; low-fat: conflicting results; optimal CH mortality = 50–55% (U-curve); adherence = decisive factor |
metabolic-syndrome, dietary-patterns, mediterranean-diet, cardiovascular-prevention, insulin-resistance |
2026-05-28 |
| concepts/Cuffless-BP-Monitoring |
Cuffless BP technology mechanisms (PPG/tonometry/PAT/PTT), calibration dependency, validation gaps (ISO 81060-7 pending); 2025 AHA/ACC COR 3: No Benefit for clinical use; poor performance tracking exercise/nocturnal/treatment-induced BP changes |
hypertension, blood-pressure-monitoring, digital-health, wearable-technology, photoplethysmography |
2026-04-24 |
| concepts/DTC-Genetic-Testing |
Direct-to-consumer cardiovascular genetic testing: regulatory landscape (23andMe only FDA-authorized), SNP-chip vs. sequencing, monogenic/PRS/pharmacogenomic testing, ACCE framework, clinical approach to DTC results, cascade testing gaps |
genetic-testing, direct-to-consumer-genetics, polygenic-risk-scores, pharmacogenomics, precision-medicine |
2026-04-25 |
| concepts/Periprocedural-CIED-Management |
AHA 2024 framework for periprocedural CIED care: EMI management, device-specific magnet responses (Micra has NO response), leadless/S-ICD/EV-ICD specifics, three-phase multidisciplinary workflow; ICD re-enablement post-procedure is safety-critical |
cied-management, perioperative-care, leadless-pacemaker, electromagnetic-interference, icd |
2026-04-25 |
| concepts/Cardiac-Rehabilitation |
Hub for the cardiac rehabilitation cluster; detail page in heart failure. AHA/AACVPR 2024 nine core components plus ESC 2026 unqualified multimodal definition across Phases 0–III, 24 sessions over 12 weeks minimum, ventilatory thresholds replacing %HRR/%VO2peak; US phases I–IV versus European 0–III are different numbering schemes; automatic referral plus liaison OR 8.41 for enrolment and 1% participation lost per day of delay; European capacity one place per seven patients in need and 40% of programmes unfunded by social security; mortality evidence split — registries 1–2% per session, pooled randomised data neutral, yet graded I A; telerehabilitation IIa B1 while only centre-based CR reduced HF hospitalisation and mortality; PIpELINe HR 0.57 at median age 80; withholding for frailty or comorbidity is III C; HFpEF I B1 in Europe and unfunded by CMS |
cardiac-rehabilitation, secondary-prevention, exercise-training, heart-failure, participation-disparities |
2026-10-26 |
| concepts/AI-in-Cardio-Oncology |
AI/ML applications in cardio-oncology: multi-omics biomarkers (TTNtv/RARG/hemopexin/TCA metabolites), AI risk models (90% discrimination), AI-ECG (ICI myocarditis arrhythmia, n=3364 LV dysfunction), NLP/LLM for EHR extraction; ethical challenges; national registry call |
cardio-oncology, artificial-intelligence, precision-medicine, cardiotoxicity, multi-omics |
2026-04-25 |
| concepts/Hormonal-Therapy-CV-Risk |
CV risks of breast cancer endocrine therapy (AI RR 1.19 vs tamoxifen; CDK4/6 inhibitor QT/HTN) and prostate cancer ADT (GnRH agonist metabolic syndrome; antagonist HR 0.44–0.46 for CV events; newer AR agents RR 1.36) |
cardio-oncology, breast-cancer, prostate-cancer, androgen-deprivation-therapy, cardiovascular-toxicity |
2026-04-29 |
| concepts/Sleep-Disordered-Breathing |
SDB umbrella (OSA/CSA/CSB); AHI vs ODI vs nocturnal hypoxic burden; endotypes; circadian KLF15 pathway; temporal pathophysiology (immediate/subacute/chronic); CPAP RCT failures; bradyarrhythmia/VTA/SCD associations; NABS/ODI screening |
sleep-disordered-breathing, obstructive-sleep-apnea, atrial-fibrillation, ventricular-arrhythmia, arrhythmia-management |
2026-04-29 |
| concepts/Pharmacogenomics-in-HF |
HF drug-response genetics: ADRB1 Arg389Gly (bucindolol 38% mortality reduction), GRK5 Leu41 (10× higher in Black patients; intrinsic beta-blockade), GNB3 (H-ISDN in African Americans), CYP2D6/CYP3A5 dosing implications; EHR preemptive genotyping strategy |
pharmacogenomics, heart-failure, precision-medicine, beta-blockers, CYP450 |
2026-04-29 |
| concepts/Gut-Microbiome-in-HF |
Gut dysbiosis in HF: ischaemia → increased permeability → bacterial translocation → TNF-α/IL-6; TMAO independently predicts 5-year HF mortality; indoxyl sulfate predicts events in DCM; Mediterranean diet reduces HF risk 21%; Saccharomyces boulardii improves LVEF |
gut-microbiome, heart-failure, TMAO, dysbiosis, precision-medicine |
2026-04-29 |
| concepts/Cardiorenal-Syndrome |
Bidirectional HF-kidney interaction; 5-type CRS classification (Acute Dialysis Quality Initiative); CVP-driven renal venous hypertension as primary hemodynamic driver; reversibility assessment framework (TKPP >60 mmHg, H-K Profiles A/B/C); biomarkers (NGAL/ST2/galectin-3); UF trials (CARRESS-HF vs UNLOAD); GDMT paradox; LVAD/HTx kidney management; EMPA-KIDNEY legacy effect |
cardiorenal-syndrome, advanced-heart-failure, kidney-dysfunction, LVAD |
2026-05-17 |
| concepts/SGLT2-Inhibitors-in-CKD |
SGLT2i mechanism (tubuloglomerular feedback; haemodynamic eGFR dip is NOT nephrotoxic); DAPA-CKD (HR 0.61; NNT=19; first non-diabetes CKD benefit) + EMPA-KIDNEY (HR 0.72 active; HR 0.79 combined; legacy effect 12 months); benefit across diabetes/non-diabetes, all eGFR strata ≥20, all albuminuria categories; EMPACT-MI: NO benefit post-MI (HR 0.90) — benefit zone boundary |
sglt2-inhibitors, chronic-kidney-disease, dapagliflozin, cardiorenal-outcomes, randomized-controlled-trial |
2026-05-22 |
| concepts/Diuretic-Resistance |
Mechanisms of loop diuretic resistance in HF/CRS: braking phenomenon, distal tubular hypertrophy, CKD-reduced tubular secretion, hypochloremia; diuretic efficiency metric (ESCAPE HR 2.86); torsemide; thiazide augmentation; ADVOR: acetazolamide (proximal NHE3 blockade) RR 1.46 decongestion P<0.001 but no hard outcome benefit |
diuretic-resistance, heart-failure, kidney-dysfunction, cardiorenal-syndrome, acetazolamide |
2026-05-14 |
| concepts/Mitochondrial-Cardiomyopathy |
Cardiac manifestations of mitochondrial disease; HCM dominant phenotype; MELAS/MERRF/MIDD/KSS/LHON syndromes; ~30% of mitochondrial disease patients; CVD leading cause of death; cardiac screening every 3–5 years |
mitochondrial-genetics, cardiomyopathy, arrhythmia, cardiovascular-disease |
2026-04-25 |
| concepts/Heteroplasmy |
Coexistence of different mtDNA variants; dynamic VAF; biochemical and phenotypic thresholds; age-related accumulation; NuMT detection pitfalls; m.4977DEL predicts MACE; haplogroup CVD associations |
mitochondrial-genetics, cardiovascular-disease, genetics |
2026-04-25 |
| concepts/Incidental-Cardiovascular-Variants |
Bayesian framework (pretest probability + variant pathogenicity → posttest probability) for incidentally identified CVD gene variants from ES/GS/DTC; ACMG-78 CVD genes; LP/P-only cascade testing; 1–8%/year reclassification; 1–3-year follow-up |
incidental-variants, genetic-testing, heritable-cardiovascular-disease, variant-interpretation, precision-medicine |
2026-04-28 |
| concepts/Alcoholic-Cardiomyopathy |
ACM: dilated LV/HFrEF from excessive alcohol; 7–15 drinks/day over 5–15 years; TTN truncating variants increase vulnerability (gene-environment interaction); sex differences; alcohol reduction improves LV function |
cardiomyopathy, alcohol-consumption, heart-failure, genetics |
2026-04-28 |
| concepts/Prepregnancy-Cardiovascular-Health |
Prepregnancy period as critical CVH optimization window; Life's Essential 8 applied to reproductive-age women; graded APO risk with cumulative poor CVH metrics; intergenerational transmission; no large RCTs yet; multilevel interventions |
prepregnancy-cardiovascular-health, maternal-health, adverse-pregnancy-outcomes, lifes-essential-8, primary-prevention |
2026-04-28 |
| concepts/Adverse-Pregnancy-Outcomes |
HDP/preterm birth/SGA/GDM composite; CVD is #1 cause of pregnancy-related death (26.5%); 1-in-5 births affected; APOs associated with long-term maternal CVD and offspring CVD risk; placental malperfusion mechanism |
adverse-pregnancy-outcomes, maternal-health, prepregnancy-cardiovascular-health, hypertensive-disorders-of-pregnancy, gestational-diabetes |
2026-04-28 |
| concepts/Lifes-Essential-8 |
AHA 2022 CVH construct (updated from Life's Simple 7): diet, physical activity, sleep, nicotine, BMI, BP, non-HDL-C, fasting glucose; 0–100 score; mean US women 68.1/100; racial disparities across all metrics |
lifes-essential-8, cardiovascular-health, primary-prevention, ASCVD, guidelines |
2026-04-28 |
| concepts/Hypertensive-Disorders-of-Pregnancy |
HDP umbrella (4 types); 7.5% per pregnancy, 15.3% per woman; 2nd leading cause global maternal mortality; preeclampsia: HF HR 2.7, ESKD RR 6.6, dementia aHR 2.4; ACOG vs international BP threshold controversy; aspirin prevention |
hypertensive-disorders-of-pregnancy, maternal-health, preeclampsia, blood-pressure-in-pregnancy, adverse-pregnancy-outcomes |
2026-04-28 |
| concepts/Preeclampsia |
HT + proteinuria/organ damage after 20 wks; failed spiral artery remodeling → sFlt-1/VEGF imbalance → endotheliosis; placental (early/severe) vs maternal (late/preexisting vascular) phenotypes; aspirin reduces risk 10–20%; lifetime CVD risk aHR 4.9 |
preeclampsia, hypertensive-disorders-of-pregnancy, maternal-health, placenta, angiogenesis |
2026-04-28 |
| concepts/Cardio-Obstetrics |
Multidisciplinary pregnancy heart team; modified WHO classification only prospectively validated; prohibitive conditions (PAH/severe ventricular dysfunction); scope antepartum to 1-year postpartum; HRS 2023 three-tier IAS delivery risk framework; perimortem C-section at site of arrest within 5 min |
cardio-obstetrics, cardiovascular-disease-in-pregnancy, maternal-health, multidisciplinary-team, peripartum-cardiomyopathy |
2026-05-22 |
| concepts/MINOCA |
MINOCA working diagnosis in 5–6% of AMIs; 3-criterion definition; traffic-light algorithm; six causes (plaque disruption/vasospasm/MVD/embolism/SCAD/supply-demand); SWEDEHEART cardioprotective therapy evidence; 4.7% 12-month mortality |
MINOCA, myocardial-infarction, coronary-vasospasm, SCAD |
2026-04-29 |
| concepts/Coronary-Vasospasm |
Epicardial vasospasm (>90% constriction); Prinzmetal's vasospastic angina; 46% MINOCA prevalence by provocation testing; Asian predilection; intracoronary acetylcholine gold standard; CCBs cornerstone; β-blockers contraindicated |
coronary-vasospasm, MINOCA, vasospastic-angina |
2026-04-30 |
| concepts/Pharmacological-Provocation-Testing |
SCB testing for BrS (ajmaline preferred; false-positive rates; clinical scenarios; SCN5A guidance); epinephrine for CPVT; adenosine for SVT/WPW; acetylcholine/ergonovine for CAS; polygenic basis of positive SCB response |
brugada-syndrome, pharmacological-provocation, arrhythmia-diagnosis, channelopathies, sudden-cardiac-death |
2026-04-30 |
| concepts/Coronary-Microvascular-Dysfunction |
Impaired coronary microcirculation (<0.5 mm); CFR <2.0 / microvascular spasm / slow-flow; 30–50% of INOCA patients; cause vs consequence debate in MINOCA; limited pharmacological treatment options |
coronary-microvascular-dysfunction, MINOCA, ischemia |
2026-04-29 |
| concepts/Calmodulinopathy |
CALM1/2/3 mutations (identical CaM protein) → LQTS (CDI loss at Cav1.2, ICaL GOF) or CPVT (RyR2 destabilisation via CaM–RyR2 3D interface); 99% CaM pre-bound; 1:7 mutant:WT sufficient for CDI impairment; verapamil reverses QT in hiPSC-CMs; ClinGen Definitive LQTS / Moderate CPVT |
calmodulinopathy, calcium-handling, long-qt-syndrome, CPVT, channelopathies |
2026-05-10 |
| concepts/POTS |
Postural tachycardia syndrome: HR increase ≥30 bpm adults / ≥40 bpm teens, sustained ≥2 readings, ≥3 months, no orthostatic hypotension, minimum HR 90 bpm; CCS 2020 nomenclature ecosystem — POTS/POTS plus (+ comorbidities: hEDS 25%, CFS/ME 21%)/PSWT/PTOC; non-pharmacologic first (salt 10 g/day + 3 L fluid + semirecumbent exercise); midodrine + low-dose propranolol (strong first-line GRADE); ivabradine/pyridostigmine/fludrocortisone (weak); sinus node ablation, Chiari decompression, jugular venoplasty all contraindicated |
POTS, autonomic-dysfunction, orthostatic-intolerance, dysautonomia |
2026-05-21 |
| concepts/Inappropriate-Sinus-Tachycardia |
IST: resting HR >100 bpm + mean 24h HR >90 bpm, not from primary causes; prevalence 1.2%; ivabradine 5–7.5 mg BID slows HR 25–40 bpm, eliminated symptoms in 70% (small RCT); beta-blockers ineffective; sinus node ablation not routine (high recurrence + complications) |
inappropriate-sinus-tachycardia, autonomic-dysfunction, arrhythmia |
2026-05-20 |
| concepts/Vasovagal-Syncope |
VVS: transient LOC with hypotension/relative bradycardia after prolonged standing or emotional stress; cumulative incidence 42% women/32% men by age 60; two physiologic phenotypes by supine BP; AHA 2017: physical counterpressure Class IIa B-R; midodrine Class IIa B-R (43% RRR in 5 RCTs); pacing IIb in ≥40yr with documented spontaneous pauses (negative tilt selects responders) |
vasovagal-syncope, autonomic-dysfunction, orthostatic-intolerance, syncope |
2026-05-23 |
| concepts/Syncope |
Syncope: transient LOC from cerebral hypoperfusion; 2017 ACC/AHA/HRS guideline framework; trimodal distribution (20/60/80yr); reflex 21% > cardiac 9% = OH 9% > unexplained 37%; Class I: history + ECG mandatory; ICM 55% vs 19% conventional diagnosis; risk scores do NOT outperform clinical judgment; routine neuroimaging/EEG/carotid = III No Benefit |
syncope, risk-stratification, cardiac-syncope, transient-loss-of-consciousness, guidelines |
2026-05-23 |
| concepts/Orthostatic-Hypotension |
OH: SBP ≥20 mmHg or DBP ≥10 mmHg drop on standing; classic (≤3 min), delayed (>3 min — 54% progress to classic at 10yr), initial (<15s), neurogenic (MSA/PD/Lewy/peripheral neuropathy); AHA 2017: water ingestion Class I; midodrine + droxidopa Class IIa B-R; compression garments + physical countermeasures Class IIa C-LD |
orthostatic-hypotension, autonomic-dysfunction, syncope, neurogenic-OH, dysautonomia |
2026-05-23 |
| concepts/Carotid-Sinus-Syndrome |
CSS: reflex syncope with CSH (pause ≥3s or SBP drop ≥50 mmHg on carotid massage); cardioinhibitory/vasodepressor/mixed subtypes; AHA 2017: permanent pacing Class IIa B-R for cardioinhibitory/mixed (76% relative risk reduction); dual-chamber Class IIb B-R; pacing NOT supported for pure vasodepressor type |
carotid-sinus-syndrome, syncope, reflex-syncope, permanent-pacing, autonomic-dysfunction |
2026-05-23 |
| concepts/Remote-Patient-Monitoring |
Wearable DHTs and RPM for CV medicine: hub model; ECG sensitivity 78–88%/specificity 80–86% for AF; PPG AF screening PPV 84–98% (Apple/Fitbit); ambulatory ECG yield 32–34%; no validated cuffless BP; pulse oximetry racial bias; long-term outcome benefit unproven |
wearable-digital-health, remote-patient-monitoring, atrial-fibrillation, heart-failure, cardiovascular-monitoring |
2026-05-17 |
| concepts/Pericarditis |
ACC 2025 novel diagnostic criteria (pleuritic chest pain mandatory + ≥1 of 5 additional findings; 0=unlikely/1=possible/2+=definite); inflammatory (80–90%, elevated CRP) vs non-inflammatory (10–20%) phenotypes; anti-IL-1 agents (anakinra/rilonacept/goflikicept) paradigm shift as preferred second-line over corticosteroids for recurrent inflammatory pericarditis; CMR LGE central for risk stratification; exercise restriction ≥1 month; recurrence 15–30% after first episode |
pericarditis, consensus, guidelines, cardiac-imaging, anti-IL1 |
2026-05-27 |
| concepts/Constrictive-Pericarditis |
Transient (inflammatory, potentially reversible with 3–6 months anti-inflammatory therapy) vs chronic (fibrotic/calcified, requires radical pericardiectomy); causes: idiopathic > post-cardiac surgery > mediastinal radiation (TB in endemic areas); TTE annulus reversus + hepatic vein expiratory reversal; CMR LGE/T2-STIR differentiates transient vs chronic; effusive constrictive pericarditis distinct entity; radical pericardiectomy preferred for chronic CP |
pericarditis, constrictive-pericarditis, cardiac-imaging, heart-failure, pericardiectomy |
2026-05-27 |
| concepts/Pericardial-Effusion |
ACC 2025: defined >50 mL; TTE sizing (trivial/small <1cm/moderate 1–1.9cm/large 2–2.5cm/very large >2.5cm); ~50% idiopathic; CCT Hounsfield units (transudate 0–20/exudate 20–50/hemorrhagic >50–60 HU); cardiac tamponade — hemodynamics related to rapidity not volume; diastolic RV collapse most specific sign; pericardiocentesis recommended for established tamponade; inflammatory effusion without tamponade → anti-inflammatory first |
pericarditis, pericardial-effusion, cardiac-tamponade, cardiac-imaging, pericardiocentesis |
2026-05-27 |
| entities/Tirzepatide |
Dual GIP/GLP-1 receptor agonist; SUMMIT (NEJM 2025): first hard composite endpoint benefit in obesity-HFpEF (HR 0.62 CV death/worsening HF; KCCQ +6.9 pts; weight −13.9%); greater weight loss than semaglutide; all-cause death numerically higher (HR 1.25 NS); SURMOUNT-MMO ongoing (n=15,374; CVD + no T2DM; estimated 2027); SURPASS-CVOT ongoing vs dulaglutide in T2DM+CVD |
heart-failure-preserved-ejection-fraction, GLP-1-receptor-agonist, GIP-receptor-agonist, obesity |
2026-05-25 |
| concepts/Complete-Revascularization |
Complete vs culprit-only PCI in MI; Class I/A; FIRE (n=1,445, ≥75 y) 15.7% vs 21.0% (HR 0.73), CV death/MI HR 0.64, all-cause death HR 0.70; physiology-guided selection leaves ~51% of nonculprit vessels untreated; COMPLETE/FULL REVASC/AIR-STEMI discordance; immediate vs staged timing unresolved |
complete-revascularization, myocardial-infarction, multivessel-coronary-artery-disease, percutaneous-coronary-intervention, coronary-physiology |
2026-10-17 |
| concepts/ICD-Programming |
ICD programming domains (bradycardia, detection, therapy, DFT); delayed (30/40 intervals) vs high-rate detection; ATP at ~88% VT CL before shocks; SVT discriminators with ~230 bpm limit; 2019 HRS/EHRA focused update manufacturer translations for Abbott, BIOTRONIK, Boston Scientific, Medtronic, MicroPort and S-ICD |
ICD-programming, implantable-cardioverter-defibrillator, tachycardia-detection, antitachycardia-pacing, defibrillation-testing |
2026-10-17 |
| concepts/Electrical-Resynchronization-Metrics |
Three families of non-invasive resynchronisation metrics — QRS duration, vectorcardiographic QRS area, and body-surface activation-time metrics (SDAT, LVAT, LV/RV dispersion); QRS area guides LV lead and electrode selection (lateral/anterolateral and proximal best; within-patient R 0.76 vs %ΔLVdP/dtmax); SDAT falls 47% while QRS falls 16% with optimised LBBAP; metrics can rank the same configuration differently |
cardiac-resynchronization-therapy, ventricular-dyssynchrony, qrs-area, body-surface-mapping, electrocardiography |
2026-10-19 |
| concepts/VT-Ablation |
General VT ablation: historical evolution from surgical resection to substrate mapping; activation/entrainment/pace/substrate techniques with circuit-component table; indications and randomised trials (SMASH-VT, VTACH, VANISH, SMS, VANISH2); non-ischaemic and epicardial substrate; PFA and other emerging technologies |
ventricular-tachycardia, catheter-ablation, substrate-mapping, entrainment-mapping, ablation-technology |
2026-10-24 |
| concepts/VT-Ablation-Nonischemic-Cardiomyopathy |
NICM VT substrate (anteroseptal/inferolateral, midwall/epicardial, perivalvular); acute success 38–73%, 1-year recurrence 46–60%; endo-epicardial scar homogenisation 64% vs 39% VA-free at 14 months (HR 0.48) but non-randomised; septal/midmyocardial scar limits success |
ventricular-tachycardia, catheter-ablation, nonischemic-cardiomyopathy, scar-homogenization, epicardial-ablation |
2026-10-24 |
| concepts/Epicardial-VT-Ablation |
Epicardial VT ablation: cardiomyopathy selection (NICM 32–63%, ARVC, Chagas, Brugada, sarcoid); ECG criteria (PdW ≥34 ms, V2 IDT ≥85 ms, SRS ≥121 ms, MDI ≥0.55) with modest reproducibility; subxiphoid, needle-in-needle, CO2 and surgical access; mapping; complications (haemopericardium 5–14%, pericarditis up to 30%) |
epicardial-ablation, ventricular-tachycardia, catheter-ablation, pericardial-access, complications |
2026-10-24 |
| ENTITIES |
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| entities/EMD |
Emerin (Xq28), X-linked Emery-Dreifuss muscular dystrophy — the gene that actually causes atrial standstill. AF/flutter in 61%, of whom 45% progress to standstill; standstill in 46.7% of carriers against 0 of 15 LMNA (P=.001); pacemaker dependency 100%; 33% of all reported standstill cases; 22% thromboembolic stroke, disabling before age 45. Ventricular arrhythmia comparatively rare (nsVT 6.7%, ICD 3.3%), so pacemaker rather than ICD unless LVNC, LVEF ≤35% or documented VA. Carrier females develop later, milder conduction disease and need surveillance; daughters of affected males are obligate carriers. LOEUF 0.31. |
genetics, EMD, emerin, emery-dreifuss-muscular-dystrophy, atrial-standstill, atrial-cardiomyopathy, permanent-pacing |
2026-10-26 |
| entities/NPPA |
Atrial natriuretic peptide precursor (1p36.22) — homozygous p.Arg150Gln causes autosomal recessive atrial dilated cardiomyopathy and carries the highest reported thromboembolic rate of any standstill etiology (54%, 7 of 13). Giant biatrial dilatation (RA up to 744 mL) progressing from supraventricular arrhythmia to complete standstill while LVEF stays 54–74% over 37 years; MR-pro-ANP 14.5 pmol/L against a normal 18–120 confirms loss of ANP signalling rather than toxic gain. Heterozygous frameshifts instead raise ANP and cause familial AF without dilatation. Single Italian founder population (6 families), 25% sibling risk, penetrance after age 20; four sudden deaths without autopsy leave the ICD question unanswerable. |
genetics, NPPA, atrial-natriuretic-peptide, atrial-dilated-cardiomyopathy, atrial-standstill, atrial-fibrosis, thromboembolism |
2026-10-26 |
| entities/DanGer-Shock-Trial |
First positive tMCS RCT: Impella CP vs standard care in STEMI-CS (n=360); 180-day HR 0.74 (0.55–0.99), 12.7% absolute mortality reduction; benefit to 10 years; more bleeding/limb ischaemia/RRT; only 5% of all CS and 32% of STEMI-CS meet eligibility |
cardiogenic-shock, mechanical-circulatory-support, microaxial-flow-pump, STEMI, randomized-controlled-trial |
2026-10-19 |
| entities/IABP-SHOCK-II-Trial |
IABP vs control in AMI-CS (n=600); no 30-day or 6-year mortality benefit; routine IABP not recommended, but use persists and European guidelines retain it for mechanical complications |
cardiogenic-shock, intra-aortic-balloon-pump, acute-myocardial-infarction, randomized-controlled-trial |
2026-10-19 |
| entities/ECLS-SHOCK-Trial |
Early VA-ECMO vs medical therapy in AMI-CS (n=420); 30-day mortality 47.8% vs 49.0% (RR 0.98; P=0.81), no 1-year difference; 4-trial IPD meta-analysis also neutral with more complications |
cardiogenic-shock, VA-ECMO, extracorporeal-membrane-oxygenation, acute-myocardial-infarction, randomized-controlled-trial |
2026-10-19 |
| entities/DOREMI-Trial |
Dobutamine vs milrinone in CS (n=192; SCAI B–E); no difference in primary composite; no inotrope has proven mortality benefit |
cardiogenic-shock, inotropes, dobutamine, milrinone, randomized-controlled-trial |
2026-10-19 |
| entities/PACCS-Trial |
Ongoing RCT of early pulmonary artery catheterisation (<6 h) in HF-CS; current PAC guidance rests on observational data only |
cardiogenic-shock, pulmonary-artery-catheter, hemodynamic-monitoring, heart-failure, randomized-controlled-trial |
2026-10-19 |
| entities/CULPRIT-SHOCK-Trial |
Culprit-only vs immediate multivessel PCI in AMI-CS; death/RRT 45.9% vs 55.4% (RR 0.83; P=0.01); culprit-only with staged revascularisation is the standard |
cardiogenic-shock, multivessel-coronary-artery-disease, percutaneous-coronary-intervention, revascularization, randomized-controlled-trial |
2026-10-19 |
| entities/Altshock-2-Trial |
Early IABP in HF-CS (n=101); no improvement in survival or bridge to heart replacement at 60 days; no positive randomised device trial exists in HF-CS |
cardiogenic-shock, intra-aortic-balloon-pump, heart-failure, randomized-controlled-trial |
2026-10-19 |
| entities/COMPASS-Trial |
Rivaroxaban 2.5 mg BID + aspirin vs aspirin in stable atherosclerotic disease including symptomatic PAD; CV death/stroke/MI 4.1% vs 5.4%, stopped early; major bleeding 3.1% vs 1.9% (HR 1.70); COR 1A for PAD |
peripheral-artery-disease, chronic-coronary-disease, rivaroxaban, antithrombotic-therapy, randomized-controlled-trial |
2026-10-19 |
| entities/VOYAGER-PAD-Trial |
Rivaroxaban 2.5 mg BID + aspirin after lower-extremity revascularisation; reduces MACE and MALE; COR 1A for post-revascularisation PAD; distinct population from COMPASS |
peripheral-artery-disease, revascularization, rivaroxaban, antithrombotic-therapy, randomized-controlled-trial |
2026-10-19 |
| entities/BEST-CLI-Trial |
Bypass vs endovascular in CLTI; with adequate single-segment saphenous vein, bypass superior (42.6% vs 57.4%; HR 0.68), driven by fewer repeat revascularisations |
chronic-limb-threatening-ischemia, peripheral-artery-disease, surgical-bypass, endovascular-therapy, randomized-controlled-trial |
2026-10-19 |
| entities/BASIL-2-Trial |
Endovascular vs bypass in infrapopliteal-dominant CLTI; endovascular superior for death/major amputation (53% vs 63%; HR 1.35), driven by fewer deaths; contrasts with BEST-CLI |
chronic-limb-threatening-ischemia, peripheral-artery-disease, infrapopliteal-disease, endovascular-therapy, randomized-controlled-trial |
2026-10-19 |
| entities/Evinacumab |
Anti-ANGPTL3 fully human mAb (VelocImmune); FDA/EMA-approved HoFH ≥12yr (15 mg/kg IV q4wk); Raal Phase 3 (n=65): −47% LDL-C, −55% TG; LDLR-independent via EL-dependent VLDL clearance; effective in null-null and non-null LDLR genotypes; ACC/AHA 2026 COR 2b vs ESC 2025 IIa B (paediatric ≥5yr) |
angptl3, familial-hypercholesterolemia, lipid-lowering-therapy, monoclonal-antibody |
2026-05-23 |
| entities/Olezarsen |
GalNAc-ASO targeting APOC3 mRNA; hepatocyte-selective delivery; FDA-approved FCS; ESSENCE-TIMI 73b (NEJM 2025) Phase 3: −58–61 pp TG; remnant cholesterol −70%; LDL-C unchanged; no CV outcomes; safety: injection-site reactions, mild transaminase elevations, thrombocytopenia NS |
antisense-oligonucleotide, hypertriglyceridemia, apolipoprotein-C-III, lipid-lowering-therapy |
2026-05-21 |
| entities/PMCardio-Queen-of-Hearts |
AI ECG model for OMI detection (Powerful Medical, Slovakia); 100% sensitivity for LAD TIMI-0 OMI on first ECG; double sensitivity vs STEMI criteria at fixed specificity; PMcardio software also used for automated HATW score measurement |
artificial-intelligence-ECG, occlusion-MI, ECG-diagnosis |
2026-05-03 |
| entities/Acute-Coronary-Syndrome |
ACS as the clinical presentation of MI — UA/NSTEMI/STEMI spectrum, burden and disparities; Fifth Universal Definition 2026 taxonomy (primary, secondary, procedure-related; 30-day window; 5x/10x thresholds abolished; ICD-11 BA41 sixth digits); the retained STEMI/NSTEMI axis and its ICD-11 codes; the rival OMI/NOMI framework (43% STEMI sensitivity, 38% of LAD TIMI-0 missed, HATW score, AI 100% sensitivity); 13 contradictions |
acute-coronary-syndrome, myocardial-infarction, universal-definition, occlusion-MI, STEMI, NSTEMI, ICD-11, ECG-diagnosis |
2026-10-25 |
| concepts/ACS-Management |
ACS management from first medical contact to discharge: 10-minute ECG and FMC-to-device ≤90 min; hs-cTn pathways and GRACE 2.0; aspirin/P2Y12, UFH or bivalirudin, high-intensity statin, oxygen only if SpO2 <90% (III: No Benefit); PPCI and fibrinolysis timing; NSTE-ACS invasive strategy including SENIOR-RITA; multivessel PCI (III: Harm in shock); DanGer-SHOCK Impella against IABP/ECMO; post-ACS complications; discharge secondary prevention; HA handbook doses; 12 contradictions |
acute-coronary-syndrome, STEMI, NSTE-ACS, antiplatelet-therapy, revascularization, cardiogenic-shock, secondary-prevention, guidelines |
2026-10-25 |
| entities/Chronic-Coronary-Disease |
CCD: beta-blocker paradigm (COR 3 No Benefit if prior MI + EF >50% + >1 year); ISCHEMIA paradigm (no survival benefit from routine revascularisation); CABG for LVEF ≤35%; SGLT2i/GLP-1 RA; INOCA; SCAD; 2026 update: IVUS-CHIP + IVUS-OPTIMAL challenge Class IA IVUS recommendation for complex/left main PCI |
chronic-coronary-disease, secondary-prevention, revascularization, antiplatelet-therapy, guidelines |
2026-05-16 |
| entities/Left-Main-Coronary-Disease |
Unprotected LMCA disease (4–6% of angiographies); PCI acceptable for low-intermediate complexity (SYNTAX ≤33); OPTIMAL trial (NEJM 2026, N=806): IVUS guidance NOT superior to angiography for patient-oriented composite (HR 1.11; P=0.40) at 2.9 years; challenges Class IA IVUS recommendation; expertise and volume may substitute for routine imaging |
left-main-pci, coronary-artery-disease, revascularization, ivus, pci |
2026-05-16 |
| entities/Amiodarone |
Class III antiarrhythmic affecting all 4 AP phases; ACLS first-line for VF; multisystem toxicity (thyroid, lung, liver, eye, skin); t½ 50–60d; warfarin/statin/digoxin/sofosbuvir interactions |
amiodarone, antiarrhythmic-drugs, drug-toxicity, ventricular-arrhythmias, atrial-fibrillation |
2026-04-19 |
| entities/CORIN |
Transmembrane serine protease (left atrial cardiomyocytes); cleaves proANP→ANP; homozygous LOF → isolated LA cardiomyopathy (fibrosis + hypertrophic remodelling) + resistant hypertension + refractory AF; BNP partial compensation; first human monogenic LA-CMP (NEJM 2023); amiloride/soluble corin as therapeutic concepts |
natriuretic-peptides, atrial-cardiomyopathy, genetics, hypertension, atrial-fibrosis |
2026-05-17 |
| entities/ALVC |
LV-predominant arrhythmogenic cardiomyopathy; Padua 2020 criteria (LV LGE ≥1 segment major, plus a pathogenic variant) and 2023 European TF criteria (ring-like LGE ≥3 segments major, 1–2 segments minor; low limb-lead voltages major; no genetic requirement, any aetiology); LVEF–LGE linearity distinguishes it from DCM; RBBB VT originates from the LV in only 17%; conflicts with ESC NDLVC |
arrhythmogenic-cardiomyopathy, sudden-cardiac-death |
2026-10-28 |
| entities/ARVC |
Desmosomopathy; prevalence 0.078%; diagnostic criteria now span 2010 TFC → Padua 2020 (isolated wall-motion abnormality minor, transmural RV LGE major, epsilon downgraded) → 2023 European TF (EMB major, RV LGE minor, non-inferior axis required for major arrhythmia); genotype-specific risk calculators (poor in DSP); ESC 2022 Class I CMR, genetic testing, beta-blockers; PES PPV 35%/NPV 70%; exercise summary (detail in concept page); AAV-PKP2 Phase I/II trials |
cardiomyopathy, inherited-arrhythmias, arrhythmogenic-cardiomyopathy, gene-therapy |
2026-10-28 |
| entities/ATTR-Amyloidosis |
TTR amyloid cardiomyopathy — wild-type and hereditary (V122I 3.4% of African Americans, ~1:230 ATTRv-CM prevalence, incomplete penetrance); red-flag phenotype overlapping HFpEF, LVH and aortic stenosis; four-step non-biopsy diagnosis (clonal screen → DPD/PYP/HMDP scintigraphy with mandatory SPECT → TTR genotyping); three-condition formal criteria, Perugini grading, AUC surveillance table; ESC 2026 disease-modifying therapy Class I/A (vutrisiran, tafamidis or acoramidis); acoramidis mortality not formally significant; nex-z MAGNITUDE paused October 2025; 11 contradictions |
cardiomyopathy, amyloidosis, ATTR, TTR, infiltrative-cardiomyopathy, bone-scintigraphy |
2026-10-26 |
| entities/Nexiguran-Ziclumeran |
CRISPR-Cas9 LNP in vivo TTR gene knockout therapy (nex-z/NTLA-2001); Phase 1 ATTR-CM (n=36): −90% serum TTR at 12 months, durable 24 months; disease stable 66%; manageable safety; single IV infusion — one-time permanent knockdown vs lifelong RNAi/stabilizer dosing; Phase 3 MAGNITUDE trial ongoing |
gene-therapy, attr-cardiomyopathy, CRISPR-Cas9, TTR-knockdown, lipid-nanoparticle |
2026-05-17 |
| entities/Andersen-Tawil-Syndrome |
LQT7; KCNJ2 LOF; triad: arrhythmia + periodic paralysis + dysmorphic features |
channelopathies, inherited-arrhythmias |
2026-04-11 |
| entities/Anderson-Fabry-Disease |
Systemic account of Anderson-Fabry disease: X-linked GLA deficiency with Gb3 and Lyso-Gb3 accumulation across cardiac, renal and neurological tissue. Genetics and molecular basis, classic versus late-onset phenotypes, epidemiology (0.5-4% of unexplained LVH), extracardiac and cardiac red flags, the 14-year diagnostic delay, enzyme replacement with agalsidase alfa/beta and pegunigalsidase, migalastat chaperone therapy, emerging gene therapy, female disease reframed as X-linked dominant, quality of life and multidisciplinary care. Cardiac involvement is summarised here and covered in full on Fabry-Cardiomyopathy, which owns the phenotype, CMR staging, conduction disease and cardiac management including the prohibitions on mavacamten and HCM Risk-SCD |
fabry-disease, lysosomal-storage-disorders, cardiomyopathy, hypertrophic-cardiomyopathy, genetics |
2026-10-30 |
| entities/Atrial-Fibrillation |
Hub: definition and key facts; outcomes table; pathophysiology (electrical remodelling, PV triggers, atrial cardiomyopathy); risk-factor table (obesity/EAT, SDB, MASLD, hypertension, alcohol, drugs); diagnosis and AHA staging; stroke-prevention thresholds ESC vs AHA; AAD table (flecainide/amiodarone/dronedarone); ablation; surgical LAAO; special-populations table; genetics and preclinical biological therapy; 39-source cluster bibliography. Two live controversies: LAAO versus indefinite OAC, and atrial cardiomyopathy versus the AF-first paradigm. Adds factor XI inhibition as a bleeding-sparing challenger that failed its phase 3 efficacy test. |
atrial-fibrillation, anticoagulation, stroke-prevention, atrial-cardiomyopathy |
2026-10-29 |
| concepts/AF-Special-Populations |
AF in heart failure, cancer, noncardiac surgery, ACS/stable CAD and acute ischaemic stroke; TBIP framework; CASTLE-AF HR 0.62; ibrutinib RR 4.69; POAF HR 2.00 for 30-day stroke and 39% recurrence at 5 years; triple-to-dual at 1–4 weeks post-PCI; EPIC-CAD NACE HR 0.44 and NNT 10.6; ELAN timing by stroke severity with no heparin bridging |
atrial-fibrillation, heart-failure, cardio-oncology, perioperative, anticoagulation |
2026-10-25 |
| entities/LAAO |
Left atrial appendage occlusion; device table (Watchman FLX, Amulet, ACP, LAmbre, surgical clip) with manufacturers corrected; ESC 2024 / AHA 2023 / ESC VHD 2025 recommendation table incl. stand-alone epicardial IIb/C, endoscopic-hybrid IIa/C and atrial SMR IIa; six-trial pivotal table (PROTECT AF, PREVAIL, PRAGUE-17, OPTION, CHAMPION-AF, CLOSURE-AF); 12-row design comparison of the three 2026-era trials; why CHAMPION-AF and CLOSURE-AF diverge (risk profile, DAPT vs NOAC, margin structure); procedural safety and CT-versus-TEE artefact on seal and device thrombus; post-implant antithrombotic table; LAAOS III surgical section; ablation and PFA-sequencing interaction; 9 contradictions; 7 sources |
atrial-fibrillation, stroke-prevention, devices, anticoagulation, interventional-cardiology |
2026-10-25 |
| entities/Atrial-Flutter |
CTI-dependent macro-reentry; >50% develop AF; OAC as per AF guidelines |
atrial-fibrillation, cardiac-arrhythmias |
2026-04-12 |
| entities/Brugada-Syndrome |
Type 1 ECG + VF risk; SCN5A the only gene with supported involvement (~20% of probands) among >20 candidate genes; three competing pathophysiology hypotheses, with the repolarisation (Antzelevitch) and depolarisation (Wilde) cases argued by their proponents; ancestry gradient 0.0–0.94% Asian versus 0.0–0.02% European; asymptomatic spontaneous type 1 ~1%/year versus symptomatic 3–7%/year; epicardial RVOT ablation discouraged in asymptomatic patients |
channelopathies, inherited-arrhythmias |
2026-10-28 |
| entities/CPVT |
Exercise/emotion-triggered bidirectional VT with a normal resting ECG; RYR2 GOF (60–70%; 65% in the 2020 Primer), CASQ2, TECRL, TRDN, CALM1/3, with PKP2 in the panel for its pre-cardiomyopathic electrical phase; a third of cases have no gene; rare RYR2 variant in 3% of healthy people; two unresolved mechanism accounts (epicardial dispersion versus His–Purkinje focus); HRS diagnostic criteria and Giudicessi scorecard; variant-stratified beta-blocker/flecainide/ICD response; escalation nadolol → flecainide → LCSD → ICD, with ICD proarrhythmia why the device is last; pregnancy, sports SDM, ESC 2022 table, CASQ2 gene therapy trial NCT07148089 |
channelopathies, inherited-arrhythmias, CPVT, RYR2, sudden-cardiac-death |
2026-10-28 |
| entities/DCM |
LV dilatation + dysfunction; TTN most common gene; DANISH trial reduced ICD class to IIa; IV iron (ESC 2026: TSAT <20%); second hit paradigm; 12 definitive genes; gene therapy pipeline; Pinto 2016 relative diagnostic criteria; genotype-specific LVRR (TTN↑; LMNA/FLNC↓); apparent healing phenomenon |
cardiomyopathy, genetics |
2026-10-25 |
| entities/Heart-Failure |
HF syndrome hub: definition and the two-phenotype table (ESC 2026 HFrEF <50% versus AHA 2022's four categories); staging A-D including the Stage B beta-blocker extension to LVEF <50%; epidemiology and shared pathophysiology including cardiorenal and ionic remodelling; diagnosis - natriuretic peptides, echocardiography, three-step amyloidosis work-up, invasive haemodynamics and remote PA monitoring; eGFR thresholds for every HF drug; decompensated-HF pointer; advanced HF (transplant, LVAD, TRIC-I-HF tricuspid TEER HR 0.40, cardiorenal, kidney transplant); special populations (CH, CTRCD, PH-LHD, perioperative, obesity, genetics); pointers to two phenotype and three management pages; 10 contradictions |
heart-failure, HFrEF, HFpEF, classification, guideline, decompensated-heart-failure |
2026-10-25 |
| entities/HFrEF |
HFrEF phenotype (LVEF <50%, absorbing the old HFmrEF band): registry share ~60% with 20% one-year and 53-67% five-year mortality; eccentric remodelling; aldosterone escape despite ACE inhibition as the mechanistic basis for MRA; electrical remodelling and the sudden-death substrate; diagnosis including the obesity natriuretic-peptide caveat; HFimpEF - remission not recovery, 40% relapse within six months on withdrawal, TTNtv reverse-remodelling ~70%; pointers to HFrEF-Management; 2 contradictions (HA handbook still uses HFmrEF; the 41-49% band lacks dedicated evidence) |
heart-failure, HFrEF, classification, pathophysiology, diagnosis, HFimpEF |
2026-10-25 |
| entities/Omecamtiv-Mecarbil |
Selective cardiac myosin activator (myotrope); first-in-class; GALACTIC-HF (NEJM 2021; n=8,232; LVEF ≤35%; median 21.8 months): primary composite HR 0.92 (P=0.03); CV death HR 1.01 NS; all-cause death HR 1.00 NS; LVEF ≤28% HR 0.84 vs LVEF >28% HR 1.04 (prespecified interaction); calcium-independent mechanism (no ischemia/arrhythmia excess); not approved or guideline-listed |
cardiac-myosin-activator, heart-failure-reduced-EF, omecamtiv-mecarbil, systolic-function, myotrope |
2026-05-15 |
| entities/HFpEF |
HFpEF phenotype (LVEF >=50%, never previously <50%): ESC versus AHA criteria; H2FPEF and HFA-PEFF scores; ASE 2025 stepwise algorithm (LARS <=18% primary, LAVi demoted); exercise echo; latent-HFpEF invasive provocation (peak PAWP >25 mmHg, PAWP/CO slope >2 WU, fluid challenge >18, passive leg raise >=19); comorbidity-driven and obesity phenotypes; ATTR amyloidosis 5-13%, Fabry, atrial myopathy, titin stiffness, TET2 clonal haematopoiesis, PH-HFpEF with PADN HR 0.49 open-label; pointers to HFpEF-Management; 5 contradictions |
heart-failure, HFpEF, echocardiography, diastolic-function, classification, diagnosis |
2026-10-25 |
| entities/Semaglutide |
GLP-1 receptor agonist; SELECT (n=17,604; CVD + no T2DM + BMI >27): MACE HR 0.80 — first MACE benefit without diabetes; STEP-HFpEF 2023 (HFpEF + obesity, no T2DM): KCCQ-CSS +7.8 pts + weight −10.7 pp; SOUL 2025 (oral; T2DM; n=9,650): MACE HR 0.86 (P=0.006) — first oral GLP-1 RA CV superiority; kidney composite HR 0.91 NS; FLOW (injectable; CKD): HR 0.76; ESSENCE (MASH, NEJM 2025): superior on both histologic endpoints |
heart-failure-preserved-ejection-fraction, semaglutide, GLP-1-receptor-agonist, type-2-diabetes, oral-semaglutide |
2026-05-25 |
| concepts/GLP-1-Receptor-Agonists |
GLP-1 receptor agonist drug class: mechanism (insulin secretion, appetite suppression, anti-inflammatory, antiatherosclerotic); class CVOT superiority (liraglutide LEADER HR 0.87; semaglutide SC SUSTAIN-6 HR 0.74; dulaglutide REWIND HR 0.88; oral semaglutide SOUL 2025 HR 0.86 — first oral GLP-1 RA with CV superiority); SELECT (semaglutide + CVD + no T2DM HR 0.80); oral vs injectable bioavailability (0.4–1% vs 89%); kidney dissociation (SOUL oral HR 0.91 NS vs FLOW injectable HR 0.76); HFpEF (STEP-HFpEF, SUMMIT); MASH (ESSENCE, SYNERGY-NASH); ACC 2025 NuSH framework |
GLP-1-receptor-agonist, type-2-diabetes, cardiovascular-outcomes, obesity, weight-management |
2026-05-25 |
| concepts/NuSH-Therapies |
ACC 2025 CCG framework for liraglutide/semaglutide/tirzepatide as "nutrient-stimulated hormone" obesity pharmacotherapy; no "try and fail" lifestyle before pharmacotherapy; weight thresholds (10–15% CVD, >15% HFpEF); SELECT MACE HR 0.80 (no T2DM); SUMMIT HR 0.62 HFpEF; eligibility BMI ≥30 or ≥27 + comorbidity; compounded agents discouraged; comorbidity de-escalation framework |
NuSH-therapy, GLP-1-receptor-agonist, obesity-management, cardiovascular-prevention, weight-management |
2026-05-25 |
| entities/Finerenone |
Nonsteroidal MRA (Kerendia/Bayer); FINEARTS-HF 2024 (n=6,001): first MRA with positive primary endpoint in HFpEF/HFmrEF (total HF events + CV death RR 0.84; P=0.007); HF events RR 0.82; CV death HR 0.93 NS; kidney composite HR 1.33 NS (opposite to CKD trials); hyperkalemia 3.0% vs 1.4%; benefit with and without SGLT2i |
heart-failure, HFpEF, finerenone, mineralocorticoid-receptor-antagonist, randomized-controlled-trial |
2026-05-16 |
| entities/Vericiguat |
Oral sGC stimulator; first new HF drug class with outcomes evidence since SGLT2i; VICTORIA (n=5050) primary HR 0.90 P=0.02; NNT ~24; no mortality benefit; no SGLT2i co-treatment data; contraindicated with nitrates/PDE5i |
heart-failure, HFrEF, vericiguat, nitric-oxide-cGMP, clinical-trial |
2026-05-10 |
| entities/Sacubitril-Valsartan |
ARNI (neprilysin inhibitor + AT1R blocker); Class I HFrEF: PARADIGM-HF HR 0.80 P<0.001 NNT 21, all-cause death HR 0.84, stopped early; PARAGON-HF HFpEF: primary RR 0.87 P=0.06 (negative); subgroup LVEF 45–57% and women; COR 2b AHA 2022 HFpEF; renal protection HR 0.50; NYHA improvement OR 1.45 |
heart-failure, HFrEF, HFpEF, sacubitril-valsartan, angiotensin-neprilysin-inhibition |
2026-05-11 |
| entities/CRT |
The CRT device and the decisions around it: ESC 2026 and AUC 2025 indication tables side by side, with the LBBB 120–149 ms band graded in opposite directions (ESC III/A below 130 ms vs AUC A(7)); CRT-D versus CRT-P via the COMPANION/CARE-HF indirect comparison and MRI-directed defibrillator avoidance (10% scar threshold, 6.9% vs 26.1% events); AF one tier down unless AVJ ablation; BUDAPEST-CRT upgrade; PICM 19.5% over 3.3 years with risk starting at 20–39% pacing; seven-study CSP/LOT-CRT comparison; septal versus lateral scar deciding which strategy works; QRS-area lead selection; COMPANION/CARE-HF/MADIT-CRT trial table; LVAD+CRT-D R(2–3) |
cardiac-resynchronization-therapy, heart-failure, HFrEF, left-bundle-branch-block, biventricular-pacing |
2026-10-30 |
| entities/S-ICD |
Subcutaneous ICD; no intracardiac leads; no ATP capability; primary prevention LVEF ≤35% A(7) (PRAETORIAN noninferior; UNTOUCHED 95.9% shock-free); HCM A(7); CHD venous obstruction A(8); dialysis A(7); sustained MMVT M(4–5) — ATP needed; ARVC M(5); SENSE algorithm + dual-zone mandatory |
implantable-cardioverter-defibrillator, subcutaneous-ICD, sudden-cardiac-death, arrhythmia |
2026-05-11 |
| entities/CCM |
Cardiac contractility modulation; nonexcitatory refractory-period pulses; LVEF 25–45% + QRS <130ms + NYHA II–III not eligible for CRT; FDA-approved 2019; all scenarios M(4–5) in AUC 2025; FIX-HF-5C: pVO₂ +1.1 mL/kg/min, KCCQ +9.7 points; no mortality benefit; fills narrow-QRS HF gap |
cardiac-contractility-modulation, heart-failure, HFrEF, narrow-QRS, device-therapy |
2026-05-11 |
| entities/CTEPH |
Group 4 PH; PEA treatment of choice; BPA Class I (upgraded 2022) for inoperable; RACE/MR BPA trials; lesion classification; complication trends halved 2013–2022; expert centre criteria; riociguat Class I. ESC 2019 origin: entity first named CTED, Table 13 risk factors (incl. non-O blood group, chronic osteomyelitis, factor VIII), PEA bilateral endarterectomy + post-op ECMO standard, 249-patient BPA registry (mPAP 43→24); threshold inconsistency ≥25 mmHg (2019) vs >20 mmHg (2022) |
pulmonary-hypertension, CTEPH, right-heart-failure |
2026-10-15 |
| entities/DES |
Desmin; wide cardiomyopathy spectrum (DCM/RCM/ACM); 80% cardiac penetrance; high conduction disease burden often requiring CIED; skeletal myopathy; no gene-specific risk calculator |
genetics, arrhythmogenic-cardiomyopathy, dilated-cardiomyopathy, conduction-disease |
2026-05-05 |
| entities/DSP |
Desmoplakin; ALVC archetype; left-dominant/biventricular; female sex risk factor (unique); "hot phases" myocarditis-like episodes; ring-like LGE; DSP risk calculator; 2010 TFC poor performance; exercise effect uncertain |
genetics, arrhythmogenic-cardiomyopathy, DSP-cardiomyopathy |
2026-05-05 |
| entities/DSG2 |
Desmoglein-2; classical ARVC phenotype; may have earlier onset than PKP2; more biventricular involvement; autosomal dominant; limited penetrance data |
genetics, arrhythmogenic-cardiomyopathy, ARVC, desmosome |
2026-05-05 |
| entities/DSC2 |
Desmocollin-2; classical ARVC phenotype similar to PKP2; often autosomal recessive; limited penetrance data; small case series |
genetics, arrhythmogenic-cardiomyopathy, ARVC, desmosome |
2026-05-05 |
| entities/Early-Repolarization-Syndrome |
J-point elevation in VF survivors; J-wave syndrome partner of Brugada; quinidine/isoproterenol |
channelopathies, inherited-arrhythmias |
2026-04-11 |
| entities/FLNC |
Filamin-C; truncating variants cause ALVC with 82% SCD/VA; myofibrillar myopathy overlap |
genetics, arrhythmogenic-cardiomyopathy |
2026-04-12 |
| entities/HCM |
Hub for hypertrophic cardiomyopathy - the most common monogenic cardiac disorder, ~1 in 500 adults, 70% obstructive and one third nonobstructive with 5-10% progressing to a burned-out dilated phenotype. Four spokes: genetics and phenotypes; diagnosis and risk assessment; mechanism; and management, each with its own detail pages. AHA 2024 and ESC 2023 diverge on whether an apical aneurysm warrants an ICD, where mavacamten sits in the drug ladder, whether universal exercise restriction is indicated, and whether the risk calculator is a threshold or a decision aid - and ESC 2022 and ESC 2023 grade the same >=6% ICD threshold differently |
cardiomyopathy, sudden-cardiac-death, genetics |
2026-10-30 |
| entities/Idiopathic-Ventricular-Fibrillation |
Diagnosis of exclusion after VF; short-coupled R-on-T PVCs; ICD Class I |
channelopathies, inherited-arrhythmias |
2026-04-11 |
| entities/JUP |
Plakoglobin; Naxos disease (AR); woolly hair + palmoplantar keratoses + ARVC triad; 97% penetrance by adolescence; more severe than PKP2-ARVC; biventricular common |
genetics, arrhythmogenic-cardiomyopathy, ARVC, desmosome, Naxos-disease |
2026-05-05 |
| entities/KCNH2 |
hERG/Kv11.1; LOF → LQT2; GOF → SQTS1; SupRep validated in rabbit models; dominant-negative for AF |
genetics, channelopathies |
2026-04-11 |
| entities/KCNJ2 |
Kir2.1; LOF → ATS/LQT7; GOF → SQTS3; IK1 suppression used in biological pacemaker research |
genetics, channelopathies |
2026-04-12 |
| entities/KCNQ1 |
Kv7.1/IKs; LOF → LQT1 (30–35% LQTS); recessive → Jervell-Lange-Nielsen; SupRep validated |
genetics, channelopathies |
2026-04-11 |
| entities/LMNA |
Lamin A/C; AF/conduction disease precede DCM by decades; highest malignant VA risk in cardiomyopathy |
genetics, arrhythmogenic-cardiomyopathy |
2026-04-12 |
| entities/Long-QT-Syndrome |
Hub: most prevalent channelopathy (1:2,534 measured; ≥1:2,000 working estimate); diagnostic criteria and Schwartz Score; tangent-method pitfall; gene-specific ECG patterns, triggers and lifestyle; QTc event-rate tables; acquired-LQTS latent estimates 10–15% vs 25% vs 30%; triple therapy (BB + mexiletine + LCSD); ICD 31% adverse events at 5 years; postpartum risk 16% in LQT2 vs <1% in LQT1 and fetal death 24.4% vs 3.4% by parent of origin; risk-score timing controversy; SupRep and LQT3 base editing; genetics and pathophysiology on the spoke |
channelopathies, inherited-arrhythmias, long-qt-syndrome, sudden-cardiac-death |
2026-10-28 |
| entities/MYBPC3 |
Sub-hub for the commonest HCM gene, holding what is gene-specific: >350 mutations with >60% truncating and 40-50% of all HCM variants; bi-allelic truncation uniformly fatal in the first year with transplantation the only cure; founder mutations from Iceland at 58% of HCM to centre-east France at 8.4%; the South Asian 25-bp intron 32 deletion in 4% of the population with 6.99-fold HF risk; incomplete penetrance at roughly 55% lifetime with no validated individual predictor; ACMG SF v3.0 listing with a 2.18-year lifespan reduction and cardiomyopathy cause-of-death OR 14.04 in 57,933 Icelandic genomes; and the gene-therapy pipeline of exon skipping, RNA trans-splicing, AAV replacement and CRISPR. Protein structure, phosphorylation and pathomechanisms now sit on HCM-Mechanism, with Sarcomere-Biology and Haploinsufficiency as its own detail pages |
genetics, hypertrophic-cardiomyopathy, sarcomere, MYBPC3, gene-therapy |
2026-10-30 |
| entities/MYH6 |
Alpha-myosin heavy chain; atrial-predominant; sick sinus syndrome and EOAF association |
genetics, atrial-fibrillation |
2026-04-11 |
| entities/MYH7 |
Beta-myosin heavy chain; 2nd most common HCM gene; high-risk SCD mutations R403Q/R453C |
genetics, hypertrophic-cardiomyopathy |
2026-04-11 |
| entities/Aficamten |
Next-in-class cardiac myosin inhibitor (Cytokinetics); SEQUOIA-HCM 2024: phase 3 RCT vs placebo — peak VO2 +1.7 ml/kg/min (P<0.001), all 10 secondary endpoints significant, SRT eligibility −78 days, NT-proBNP −80%, benefit consistent regardless of beta-blocker use; MAPLE-HCM 2025: superior to metoprolol monotherapy (peak VO2 +2.3 ml/kg/min); LVEF <50% 1–3.5% (transient); shallow dose-response; no drug-drug interactions |
hypertrophic-cardiomyopathy, cardiac-myosin-inhibitor, obstructive-HCM, pharmacology, LVOTO |
2026-05-17 |
| entities/Vutrisiran |
GalNAc-siRNA (25 mg SC Q12W) silencing hepatic TTR mRNA; HELIOS-B 2025 (n=655): first RNAi therapy to reduce mortality in ATTR-CM — HR 0.65 all-cause death through 42 months; 81% TTR knockdown; benefits on and off tafamidis background; approved for ATTRv-PN and ATTR-CM |
attr-cardiomyopathy, RNA-interference, vutrisiran, amyloidosis, gene-silencing |
2026-05-16 |
| entities/Zilebesiran |
GalNAc-siRNA silencing hepatic angiotensinogen; phase 1 (n=107, four UK sites): single 800 mg SC dose → >90% angiotensinogen suppression through 24 weeks and −22.5/−10.8 mmHg 24-hour ambulatory BP at week 24; effect abolished by a high-salt diet and augmented by irbesartan; injection-site reactions only treatment-related event, no hypotension/hyperkalaemia/renal signal; no hypothesis testing and no outcomes data — supports quarterly or twice-yearly dosing |
hypertension, RNA-interference, siRNA, angiotensinogen, blood-pressure-lowering |
2026-10-29 |
| entities/Patisiran |
LNP-siRNA (IV Q3W) targeting TTR 3'UTR; 86.8% TTR knockdown; APOLLO-B 2023 (n=360; 12 months): 6MWT +14.69 m (P=0.02) + KCCQ +3.7 pts (P=0.04) met; hard composites NS (underpowered/too short); deaths 4 vs 10 HR 0.36 NS; not approved for ATTR-CM; approved for ATTRv-PN; proof-of-concept for cardiac RNAi; succeeded by vutrisiran |
attr-cardiomyopathy, patisiran, RNA-interference, TTR-knockdown, heart-failure |
2026-05-17 |
| entities/Mavacamten |
First cardiac myosin inhibitor; Class I AHA 2024 (obstructive HCM) vs Class IIa ESC 2023; ODYSSEY-HCM 2025: ineffective in nonobstructive HCM (both primary endpoints missed P=0.07/0.06; CHF 6.6% vs 1.7%); biomarker-clinical dissociation (NT-proBNP −59% without clinical benefit); contraindicated in pregnancy |
cardiomyopathy, pharmacology, hypertrophic-cardiomyopathy, nonobstructive-HCM, cardiac-myosin-inhibitor |
2026-05-16 |
| entities/NDLVC |
New ESC 2023 phenotype: non-dilated LV with non-ischaemic scar; replaces ALVC/arrhythmogenic DCM; overlaps almost entirely with ALVC but the 2023 European Task Force criteria reject the substitution — same patient can be ALVC or NDLVC depending on guideline; NDLVC also includes LV dysfunction without scar |
cardiomyopathy, sudden-cardiac-death |
2026-10-28 |
| entities/PKP2 |
Most common ARVC gene (~2/3 cases); desmosomal + Nav1.5 + Cx43; flecainide eliminates VA in PKP2cKO mice (RCT pending); 3 AAV-PKP2 Phase I/II trials (Rocket/LEXEO/Tenaya); MyoAAV4A variant; exercise major penetrance risk |
genetics, arrhythmogenic-cardiomyopathy, ARVC, gene-therapy |
2026-05-05 |
| entities/PLN |
Phospholamban/SERCA2a regulator; R14del founder; exercise NOT risk factor (unique among ACM); sex NOT risk factor; mixed HF+VA phenotype; gene-specific calculator usable pre-diagnosis; micro voltages; high end-stage HF risk |
genetics, arrhythmogenic-cardiomyopathy, PLN-cardiomyopathy |
2026-05-05 |
| entities/RCM |
Restrictive physiology + normal wall thickness; often transplant-required; biatrial enlargement |
cardiomyopathy, genetics |
2026-04-11 |
| entities/RYR2 |
SR Ca²⁺ release channel; GOF → CPVT1; 263 variants in 964 CPVT patients (Chang 2025); domain-specific onset: CSol/pore 8y, NTD 12y; variant-specific BB/flecainide/ICD response; R420Q vs R420W different phenotypes; markslab-cpvtdb.org; too large for AAV; CRISPR-SaCas9 repair in mice |
genetics, calcium-handling, CPVT, RYR2, ryanodine-receptor, variant-interpretation |
2026-05-05 |
| entities/CASQ2 |
Calsequestrin-2; Ca²⁺ buffer + RYR2 inhibitor via triadin/junctin; CPVT2 (AR, 2–5%); 100% penetrance; earlier onset/greater severity/more BB-resistant than CPVT1; AD evidence Moderate only; HCM disputed; most advanced CPVT gene therapy target — single AAV9 injection >85% arrhythmia reduction ≥1 year |
genetics, calcium-handling, channelopathies, CPVT, gene-therapy |
2026-05-10 |
| entities/SCN5A |
Nav1.5; GOF → LQT3 (INaL/window current); LOF → BrS + CCD + DCM; overlap syndromes (1795insD: simultaneous GOF+LOF); MEPPC (R222Q GOF); too large for AAV; MOG1 workaround |
genetics, ion-channels, channelopathies, SCN5A, dilated-cardiomyopathy |
2026-05-05 |
| entities/Short-QT-Syndrome |
QTc ≤360 ms (ESC 2022); 8 subtypes; just over 200 reported patients, 40% arrest by age 40, 83% of arrests at rest, annual event rate 1.3% at ages 20–40; short QT alone not a risk marker; quinidine first-line; amiodarone/sotalol ineffective in SQTS1; trigger PVC mechanism unexplained |
channelopathies, inherited-arrhythmias |
2026-10-28 |
| entities/TTN |
Titin; most common DCM gene and most common EOAF gene (27% of variants); second-hit theory |
genetics, dilated-cardiomyopathy |
2026-04-11 |
| entities/TMEM43 |
Transmembrane protein 43; p.Ser358Leu founder (Newfoundland); near-fully penetrant males; highly malignant; early ICD indicated; exercise harm; poor R-wave progression; first non-desmosomal ARVC gene |
genetics, arrhythmogenic-cardiomyopathy, ARVC, sudden-cardiac-death |
2026-05-05 |
| entities/Obstructive-Sleep-Apnea |
OSA: repetitive upper airway collapse during sleep; 21–74% prevalence in AF; acute + chronic AF substrate; CPAP treatment; AHI vs. hypoxemic burden |
obstructive-sleep-apnea, atrial-fibrillation, CPAP |
2026-04-18 |
| entities/Hypertension |
ESC 2024 + AHA 2025 dual-guideline coverage: ESC 3-category (Non-elevated/Elevated/Hypertension) vs AHA 4-tier classification; ESC SBP target 120–129 mmHg Class I vs AHA <130 mmHg Class I; SCORE2/SCORE2-OP risk stratification for elevated BP; primary aldosteronism screening all confirmed HT (ESC IIa) vs resistant only (AHA); RDN ESC IIb,A for uncontrolled on <3 drugs; BPROAD (NEJM 2025): SBP <120 mmHg superior in T2DM HR 0.79; BaxHTN (NEJM 2025): baxdrostat −8.7/−9.8 mmHg SBP |
hypertension, blood-pressure-management, cardiovascular-risk, guidelines, aldosterone-synthase-inhibitor |
2026-05-20 |
| entities/Type-2-Diabetes |
T2DM cardiovascular risk: HTN most common comorbidity; BPROAD (NEJM 2025; n=12,821) — intensive SBP <120 mmHg vs <140 mmHg: HR 0.79 (P<0.001); stroke primary driver; albuminuria HR 0.87; ACEi/ARB if eGFR <60 or albuminuria ≥30 mg/g |
type-2-diabetes, hypertension, cardiovascular-risk, blood-pressure-control |
2026-05-20 |
| entities/Pulmonary-Embolism |
Acute PE: AHA/ACC 2026 Cat A–E classification; CTPA diagnosis; D-dimer age-adjusted/YEARS; LMWH>UFH; DOACs>VKAs; PERT; advanced therapies by category; CTEPD surveillance; extended anticoagulation with half-dose DOAC; HI-PEITHO 2026 RCT: CDL superior to anticoagulation alone for intermediate-risk PE (RR 0.39, P=0.005, no ICH). ESC 2019 added: four-tier predecessor scheme, watch-and-rescue thrombolysis (rescue Class I, routine primary Class III), UFH bolus in high-risk PE vs LMWH in 2026, IVC filters also for recurrence on therapeutic anticoagulation, thrombolytic regimens and contraindications, CTEPH risk-factor table |
pulmonary-embolism, venous-thromboembolism, anticoagulation |
2026-10-15 |
| entities/Ischemic-Stroke |
2026 AHA/ASA guideline: tenecteplase COR 1A (replaces alteplase); EVT expanded (ASPECTS 3–5 COR 1A; BAO 24h COR 1A); post-EVT SBP <140 mmHg COR 3:Harm; elastic stockings COR 3:Harm; DAPT 21d for minor AIS/TIA; PES for dysphagia COR 2a |
acute-ischemic-stroke, endovascular-thrombectomy, thrombolysis, stroke-management |
2026-04-24 |
| entities/Peripheral-Artery-Disease |
Lower extremity PAD; 10–12M US; 4 clinical subsets (asymptomatic/claudication/CLTI/ALI); rivaroxaban+aspirin; high-intensity statin; SET as initial claudication therapy; BEST-CLI/BASIL-2 CLTI revascularisation |
peripheral-artery-disease, guidelines, revascularization, CLTI, claudication |
2026-04-24 |
| concepts/CLTI |
Chronic limb-threatening ischemia: rest pain/nonhealing wounds/gangrene >2 wk; WIfI/GLASS staging; multispecialty team mandatory; BEST-CLI (bypass superior with GSV) vs BASIL-2 (endovascular superior for infrapopliteal) |
CLTI, peripheral-artery-disease, revascularization |
2026-04-24 |
| concepts/PAD-Exercise-Therapy |
SET COR 1A: ≥30–45 min active walking, ≥3×/week, ≥12 weeks; CLEVER trial (SET = endovascular for aortoiliac); SET after revascularisation COR 1A; structured community/home exercise equally effective; unstructured ("go for a walk") is COR 2b; ~2% real-world referral rate despite Medicare coverage |
peripheral-artery-disease, exercise-therapy, claudication, supervised-exercise, rehabilitation |
2026-05-09 |
| concepts/PAD-Medical-Therapy |
Rivaroxaban 2.5 mg BID + aspirin COR 1A (COMPASS/VOYAGER PAD); high-intensity statin COR 1A (MALE −30%, amputation −35%); PCSK9i COR 2a; ACEi/ARB first-line HTN; GLP-1/SGLT-2i COR 1A in T2DM; cilostazol COR 1A for claudication (contraindicated in HF); pentoxifylline COR 3:No Benefit; smoking cessation COR 1A |
peripheral-artery-disease, antithrombotic-therapy, guideline, statin, GDMT |
2026-05-09 |
| concepts/Acute-Limb-Ischemia |
ALI: acute limb hypoperfusion ≤2 wk; Rutherford I–III classification; 4–6 h ischaemia tolerance; surgical thromboembolectomy vs catheter thrombolysis; compartment syndrome monitoring |
peripheral-artery-disease, vascular-emergency, revascularization |
2026-04-24 |
| concepts/Ankle-Brachial-Index |
ABI: ratio ankle systolic / higher brachial systolic; abnormal ≤0.90; TBI ≤0.70 for non-compressible vessels; cornerstone PAD diagnostic test |
peripheral-artery-disease, diagnostics |
2026-04-24 |
| concepts/Infective-Endocarditis |
IE framework: 2023 Duke-ISCVID criteria (surgical evidence + mNGS major criteria); echocardiography; advanced imaging; microbiology; NBTE differential |
infective-endocarditis, diagnostics, echocardiography, cardiac-surgery, guideline |
2026-04-25 |
| concepts/Blood-Culture-Negative-Endocarditis |
BCNE: prior antibiotics #1 cause (up to 30% IE); diagnostic algorithm (72h expand to mNGS/serology); fastidious pathogens (Coxiella/Bartonella/Whipple/Chimaera/Fungi); empiric regimens; NBTE |
infective-endocarditis, blood-culture-negative-endocarditis, molecular-diagnostics, fastidious-organisms |
2026-04-25 |
| concepts/Renal-Denervation |
Catheter-based renal sympathetic ablation for uncontrolled/resistant hypertension; FDA-approved (Spyral/Paradise 2023); 4–10 mmHg SBP reduction; 60–70% response rate; patient selection framework; no kidney function impairment. now the reference precedent for PADN — positive unblinded PADN-HF-PH (HR 0.49) repeats the SYMPLICITY sequence, with sham-controlled confirmation running (NCT07214376) |
hypertension, resistant-hypertension, renal-denervation, catheter-based-therapy, sympathetic-nervous-system |
2026-10-15 |
| concepts/CAVD-Mechanisms |
Molecular mechanisms of calcific aortic valve disease: VEC disruption, Lp(a)/LDL-C osteogenic cascade, EVs/TNAP, CHIP, interferonopathies; initiation vs progression distinction; statin paradox; ongoing trials (pelacarsen, colchicine) |
calcific-aortic-valve-disease, valvular-heart-disease, molecular-mechanisms, aortic-stenosis, lipoprotein-a |
2026-04-25 |
| entities/Mitral-Valve-Prolapse |
MVP: Barlow vs fibroelastic deficiency; TGF-β pathway central; FLNA/DCHS1/DZIP1/TNS1/LMCD1/SLC6A4 genes; serotonin transporter link; calcineurin/NFAT therapeutic target; equal sex prevalence but worse female outcomes |
valvular-heart-disease, mitral-valve-prolapse, molecular-mechanisms, genetics, TGF-beta |
2026-04-25 |
| entities/Bicuspid-Aortic-Valve |
BAV: 1.5% prevalence; 89% heritability; NOTCH1/GATA4-6/SMAD6 monogenic variants; 3–4× male predominance; accelerated calcification vs trileaflet valves due to abnormal shear stress |
valvular-heart-disease, bicuspid-aortic-valve, congenital-heart-disease, genetics, aortic-stenosis |
2026-04-25 |
| entities/Rheumatic-Heart-Disease |
RHD: >40M prevalent cases; 80% women; group A streptococcal molecular mimicry (M protein/laminin/myosin); VCAM-1/IFN-γ/IL-17/TGF-β; ficolin/MBL complement pathway; ProTα and female sex predilection; no effective medical therapy |
rheumatic-heart-disease, valvular-heart-disease, molecular-mechanisms, immunology, global-health |
2026-04-25 |
| entities/Maternal-Health-Disparities |
Non-Hispanic Black women bear disproportionate APO/maternal mortality burden; structural racism as root cause; weathering/allostatic load; "superwoman schema"; insurance churn; community/policy multilevel interventions |
maternal-health, health-disparities, adverse-pregnancy-outcomes, structural-racism, social-determinants |
2026-04-28 |
| entities/Peripartum-Cardiomyopathy |
PPCM: LVEF <45% last month pregnancy/5 months postpartum; vasculohormonal model (prolactin 16-kDa/sFlt-1/activin-A); ~15% carry DCM genes (2/3 TTN); IPAC: recovery almost exclusively first 6 months; major events EF <30%; BOARD framework; WCD preferred over ICD; bromocriptine (REBIRTH trial 2026 pending); 4× higher incidence Black women; CHC contraindicated; mWHO IV if any residual LV dysfunction |
peripartum-cardiomyopathy, cardiomyopathy, heart-failure, pregnancy, genetics, maternal-health |
2026-05-17 |
| entities/Obesity |
Chronic multifactorial disease; US 40.3% obesity / 9.4% severe; HF/SCD/AF/CAD/VTE risk; BMI limitations; NuSH therapies (ACC 2025): semaglutide SELECT MACE HR 0.80 (no T2DM), tirzepatide SUMMIT HFpEF HR 0.62; weight thresholds 10–15% CVD, >15% HFpEF; obesity paradox; class 3 = relative contraindication to HTx |
obesity, cardiovascular-disease, metabolic-syndrome, cardiometabolic-risk |
2026-05-25 |
| concepts/Obesity-Paradox |
Overweight/class 1 obesity confers better short-term CVD outcomes than normal weight; documented post-PCI, post-CABG, HFrEF, HFpEF, AHF; proposed mechanisms: lead time bias, fitness confounding, lean paradox |
obesity, cardiovascular-disease, heart-failure, coronary-artery-disease, prognosis |
2026-04-29 |
| concepts/Visceral-Adiposity |
VAT and ectopic fat (pericardial/epicardial/hepatic) as independent CVD risk markers; EAT drives AF and SCD substrate; metabolically healthy obesity is transient; exercise reduces VAT without weight loss |
obesity, cardiovascular-disease, visceral-adiposity, epicardial-fat, atrial-fibrillation |
2026-04-29 |
| concepts/Epicardial-Adipose-Tissue-Arrhythmogenesis |
Three EAT arrhythmogenic pathways: (1) structural infiltration → zigzag conduction/re-entry; (2) Cx43 electrotonic coupling → RMP depolarisation; (3) paracrine secretome (TNF-α/IL-1β/IL-6/TGF-β1/leptin) → APD prolongation, connexin downregulation, fibrosis; ECG correlates: P-wave/PR/QRS/TpTe |
epicardial-adipose-tissue, arrhythmias, atrial-fibrillation, electrophysiology, obesity |
2026-05-01 |
| concepts/Circadian-Rhythm-Cardiac-Electrophysiology |
Extrinsic (SCN/ANS) and intrinsic (BMAL1/CLOCK) circadian regulation of cardiac electrophysiology; Kcnh2/Gja1/Scn5a/Hcn4/Pkp2 as top REGs; KLF15→KChIP2 indirect pathway; Kv11.1 protein half-life and LQT2 time-of-day APD amplification; loss of morning SCA peak in modern populations; aging reduces circadian amplitude |
circadian-rhythm, sudden-cardiac-death, cardiac-electrophysiology, ion-channels, arrhythmia-mechanisms |
2026-05-01 |
| concepts/Noncoding-RNA-in-CVD |
Umbrella overview of all ncRNA classes (miRNA, snoRNA, Y-RNA, tsRNA, lncRNA, circRNA, exRNA) and their roles in CVD; computational tools; RNA therapeutics pipeline |
noncoding-RNA, microRNA, lncRNA, RNA-therapeutics, extracellular-RNA |
2026-04-29 |
| concepts/Cancer-Associated-Arrhythmia |
Drug-by-drug arrhythmia profiles in cancer (AF/QT/VA/bradycardia); ibrutinib RR 4.69 AF; ibrutinib-diltiazem/amiodarone MAJOR interaction (6–9× levels); pirtobrutinib 3.2% AF; ibrutinib-AF management (hemodynamic stability approach; Factor Xa preferred; dabigatran contraindicated); QTcF preferred; MADIT-CHIC CRT |
arrhythmia, cardio-oncology, atrial-fibrillation, QT-prolongation, BTK-inhibitors |
2026-10-29 |
| concepts/Autonomic-Dysfunction-in-Cancer |
Autonomic dysfunction in cancer patients/survivors: decreased HRV, orthostatic hypotension, IST/POTS; anthracycline/taxane/HSCT aetiology; exercise reversal; ivabradine for IST |
arrhythmia, cardio-oncology, autonomic-dysfunction, cancer-survivorship |
2026-04-29 |
| concepts/Long-Noncoding-RNA |
lncRNA classification (lincRNA/intronic/eRNA/AS-lncRNA; guide/scaffold/decoy/ceRNA); CVD loci (ANRIL/MIAT/H19/MALAT1/Mhrt/Chast/Chaer); lipid metabolism; cardiac hypertrophy; stroke; investigational tools |
lncRNA, noncoding-RNA, cardiac-hypertrophy, atherosclerosis, RNA-therapeutics |
2026-04-29 |
| concepts/MEPPC |
Multifocal ectopic premature Purkinje-related complexes; SCN5A R222Q gain-of-function; increased window current → premature Purkinje action potentials; narrow complex polymorphic PVCs; reversible DCM; flecainide/hydroquinidine/amiodarone responsive |
SCN5A, channelopathies, premature-ventricular-complexes, ventricular-arrhythmias |
2026-05-05 |
| concepts/Modifier-Genes |
Genetic factors that modify penetrance/expressivity of monogenic arrhythmia disorders; NOS1AP, KCNH2-K897T, KCNE1-D85N, AKAP9, iPSC-CM discovery approach |
modifier-genes, long-qt-syndrome, sudden-cardiac-death, NOS1AP |
2026-05-05 |
| entities/NOS1AP |
Nitric oxide synthase adaptor protein; most validated LQTS modifier gene (GWAS-derived); also implicated in drug-induced LQTS and AMI-VF |
modifier-genes, long-qt-syndrome, sudden-cardiac-death |
2026-05-05 |
| entities/Dronedarone |
Non-iodinated amiodarone derivative; multichannel blocker (IK-Ach 100x, INa 10x potency); ATHENA 24.2% RRR; contraindicated in NYHA III/IV HF (ANDROMEDA) |
dronedarone, atrial-fibrillation, antiarrhythmic-drugs, heart-failure |
2026-05-07 |
| entities/Flecainide |
Class 1C AAD; post-repolarization refractoriness mechanism; AF cardioversion up to 95% IV; pill-in-the-pocket; CAST context; RyR2 blockade in CPVT; contraindicated in CAD/structural disease |
flecainide, atrial-fibrillation, antiarrhythmic-drugs, proarrhythmia, CPVT |
2026-05-07 |
| concepts/Amiodarone-Induced-Thyroid-Disorders |
Type 1 AIT (iodine-driven autonomous overproduction; methimazole) vs Type 2 AIT (destructive thyroiditis; prednisone) vs mixed (both); AIH (Wolff-Chaikoff; levothyroxine); 23% ICU mortality in thyroid storm; ETA thyroidectomy criteria; 3-way warfarin/DOAC-thyrotoxicosis-amiodarone anticoagulant interaction |
amiodarone, thyroid-dysfunction, thyrotoxicosis, drug-toxicity, antiarrhythmic-drugs |
2026-05-07 |
| concepts/Wide-Complex-Tachycardia |
WCT (50–80% VT, context-dependent); clinical history PPVs (MI 98%, CHF/angina 100%); AV dissociation visible on ECG in ~1/5 VTs; algorithm taxonomy: multistep (Brugada/Vereckei/LLA), Bayesian (Lau 2000), VT-as-default (Griffith), single-criterion (Pava), point-based (Jastrzebski/Pachón); SWCT electrically constrained (near-identical to baseline) vs VT electrically free; Pachón 4 baseline criteria (100%/99% Sp); automated methods (WCT Formula AUC 0.97, VT Prediction 0.90, WCT Formula II 0.96 — require paired baseline ECG); Brugada Sp 59.5%; Chen LLA Sp 90.8%; Basel SN 93.3%; real-world performance unknown; limitations: fascicular VT, class Ic/III drugs, BBR-VT; default = VT; procainamide drug of choice |
wide-complex-tachycardia, ventricular-tachycardia, supraventricular-tachycardia, electrocardiography, ECG-algorithm |
2026-05-22 |
| concepts/Fascicular-Ventricular-Tachycardia |
LPF-VT (~80% of fascicular VTs); RBBB+left axis; verapamil-sensitive; Purkinje reentry → fast initial activation → all standard WCT algorithms misclassify as SVT; 4-criterion model vs RBBB+LAHB: atypical V1 + positive aVR + V6 R/S ≤1 + QRS ≤140 ms; ≥3 criteria Sn 82.1%/Sp 78.3% |
fascicular-ventricular-tachycardia, ventricular-arrhythmias, electrocardiography, idiopathic-VT, verapamil-sensitive |
2026-05-21 |
| concepts/Amiodarone-Pulmonary-Toxicity |
"Amiodarone effect" (ubiquitous asymptomatic lipoid pneumonia) vs "amiodarone toxicity" (9 distinct patterns: CEP/COP/AFOP/amiodaronoma/NSIP-like/IPF-like/DIP/ARDS/DAH); 3-mechanism pathophysiology (cytotoxic/immune/angiotensin); cumulative incidence 4.2%/7.8%/10.6% at 1/3/5 years; 3-fold APT risk per decade >60; DLCO key monitoring marker (≥15% sensitive, isolated decrease alone does NOT warrant stopping); KL-6 NPV 92%; CT density >70 HU absent in 27–55%; surgical biopsy avoid; prednisolone taper ≤5 mg/day; 21–33% hospitalisation mortality |
amiodarone, drug-induced-lung-disease, pulmonary-toxicity, antiarrhythmic-drugs, drug-toxicity |
2026-05-07 |
| concepts/GWAS-Cardiac-Genetics |
GWAS in inherited cardiac disease + CAD: 346 CAD loci; genetics-to-therapeutics pipeline (PCSK9i/statins/ezetimibe/bempedoic acid/LPA agents/colchicine/ANGPTL3); Mendelian randomization validates LDL-C/Lp(a)/TG and deprioritises HDL-C/CRP/vitamin D; inverse HCM-DCM loci; 21 BrS loci; NOS1AP LQTS modifier; European-ancestry limitation |
GWAS, polygenic-risk-score, coronary-artery-disease, cardiomyopathy, mendelian-randomization |
2026-05-16 |
| concepts/Gene-Editing-Risk-Benefit-Framework |
Structured criteria for gene editing candidacy in ICCs: WPW (ablation >90% — gene editing disproportionate) vs PRKAG2 syndrome (multisystem monogenic, ablation insufficient — gene editing appropriate); criteria: disease severity, existing therapy effectiveness, monogenic architecture, delivery feasibility |
gene-editing, CRISPR-Cas9, inherited-cardiac-conditions, gene-therapy, precision-medicine |
2026-05-07 |
| entities/PRKAG2-Cardiac-Syndrome |
Autosomal dominant γ2-AMPK subunit mutation; cardiac hypertrophy + pre-excitation (WPW) + glycogen storage + progressive conduction disease; ablation insufficient; paradigm case where gene editing is appropriate over standard ablation |
gene-editing, inherited-cardiac-conditions, CRISPR-Cas9, arrhythmia |
2026-05-07 |
| concepts/mWHO-Classification |
Modified WHO 5-tier maternal cardiac risk: Class I (2.5–5%) → IV (40–100%, pregnancy contraindicated); Class IV includes PAH, LVEF <30%/NYHA III–IV, prior PPCM with any residual LV dysfunction, severe MS/AS, systemic RV dysfunction, severe aortopathy >45/50 mm, vascular EDS, complicated Fontan; NT-proBNP >128 pg/mL at 20 wks predicts events; only prospectively validated tool |
pregnancy, cardiovascular-risk, maternal-health, risk-stratification, guidelines |
2026-05-10 |
| entities/Takotsubo |
International Registry (n=1750; 26 centres): 89.8% women; physical triggers 36% > emotional 27.7%; 28.5% no trigger; neuropsychiatric comorbidity 55.8%; in-hospital complications 21.8% = ACS; LVEF 40.7%; death 5.6%/yr; MACCE 9.9%/yr; ACEi/ARB ↑ survival; beta-blockers NO benefit; men: death 12.9% vs women 5.0%/yr |
takotsubo-cardiomyopathy, heart-failure, cardiomyopathy, prognosis, brain-heart-axis |
2026-05-10 |
| concepts/Brain-Heart-Axis |
Bidirectional CNS–cardiac axis; neuropsychiatric comorbidity 55.8% in TTS vs 25.7% ACS; catecholamine-excess hypothesis for TTS; neurogenic stunned myocardium; beta-blocker survival benefit NOT confirmed despite mechanism rationale |
brain-heart-axis, takotsubo-cardiomyopathy, autonomic-nervous-system, catecholamines, neuro-cardiac |
2026-05-10 |
| concepts/Beta-Blocker-Post-MI |
Beta-blocker therapy after MI: cornerstone in HFrEF/LVEF<40%; LVEF≥50% no-indication: REDUCE-AMI (NEJM 2024) + IPD-MA (NEJM 2026, n=17,801, HR 0.97) — no benefit confirmed; ABYSS (NEJM 2024, n=3,698): NI not met (HR 1.16) but driven by soft CV hosp — hard outcomes identical; SMART-DECISION 2026: discontinuation NI met (HR 0.80); ACC/AHA Class I contradicted by IPD-MA evidence; BLOCK COPD (NEJM 2019): BB without cardiac indication in COPD increases hospitalisation (HR 1.91) — COPD-specific caveat added |
beta-blockers, myocardial-infarction, secondary-prevention, coronary-artery-disease, preserved-ejection-fraction |
2026-05-21 |
| concepts/Potassium-and-Ventricular-Arrhythmias |
POTCAST (NEJM 2025, n=1200, ICD patients): targeting high-normal K 4.5–5.0 mmol/L reduces composite VT/ICD therapy/arrhythmia hosp/all-cause death HR 0.76 (P=0.01; NNT=12.3); mechanism = avoidance of low-normal K, not achievement of high-normal; benefit present even without reaching target; MRA subgroup HR 0.75 ≈ non-MRA HR 0.77 — potassium rise may explain part of MRA landmark trial benefit |
ventricular-arrhythmias, potassium, ICD, mineralocorticoid-receptor-antagonist, arrhythmia-prevention |
2026-05-16 |
| entities/Frailty-in-Cardiovascular-Disease |
Frailty/prefrailty in post-MI elderly; SPPB 4–9 as rehabilitation target; Fried criteria; PIpELINe trial (NEJM 2025): multidomain rehab HR 0.57 for CV death/CV hosp, HF hosp HR 0.20; PAD subgroup no benefit |
frailty, elderly, cardiac-rehabilitation, myocardial-infarction, secondary-prevention |
2026-05-16 |
| entities/Sotatercept |
First-in-class ACTRIIA-Fc activin-signaling inhibitor for PAH; PULSAR→SPECTRA→STELLAR (FC II/III, 84% ↓ clinical worsening)→ZENITH (FC III/IV, REVEAL Lite 2 ≥9, HR 0.24 for death/transplant/hospitalization, stopped early); epistaxis/telangiectasia/↑Hb safety signal |
pulmonary-arterial-hypertension, sotatercept, activin-signaling, TGF-beta-superfamily, biologic-therapy |
2026-05-16 |
| concepts/VT-Ablation-Ischemic-Cardiomyopathy |
First-line catheter ablation vs antiarrhythmic drugs (sotalol/amiodarone) for VT in post-MI ischemic cardiomyopathy; VANISH2 (NEJM 2025): HR 0.75 composite primary endpoint (P=0.03); mortality NS; biggest effect on treated sub-threshold VT (HR 0.26); drug arm 21.6% nonfatal adverse events; challenges "drugs first" paradigm |
ventricular-tachycardia, catheter-ablation, ischemic-cardiomyopathy, antiarrhythmic-drugs, ICD |
2026-05-16 |
| concepts/ACMG-Secondary-Findings |
73-gene ACMG SF v3.0 framework for reporting LP/P variants in clinical ES/GS; 4% population carry ≥1 actionable genotype (Iceland WGS n=57,933); cancer group −3 yr lifespan; LDLR −6.47 yr and MYBPC3 −2.18 yr are only CV genes with individual lifespan signal; KCNQ1/TGFBR2 cause-of-death associated; 10 candidate expansion genes (MYL4/F5-Leiden-hom/PKD1/PKD2) |
actionable-genotypes, ACMG-secondary-findings, genetics, population-genomics, genetic-testing |
2026-05-17 |
| concepts/Colchicine-in-Cardiovascular-Disease |
Anti-inflammatory secondary prevention: COLCOT (post-MI; 23% RRR) and LoDoCo2 (stable ASCVD; 31% RRR) vs CLEAR (NEJM 2025; n=7,062; HR 0.99; P=0.93 — no benefit), CHANCE-3 (neutral), CONVINCE (neutral); biological-clinical dissociation confirmed in CLEAR (CRP reduced but no MACE benefit); ESC Class IIa and FDA approval pre-date CLEAR; net benefit now uncertain |
colchicine, anti-inflammatory-therapy, secondary-prevention, acute-myocardial-infarction, coronary-artery-disease |
2026-05-18 |
| entities/COPD |
COPD as comorbidity in HFpEF: present in 14–34% of HFpEF populations; independent prognostic risk factor — hospitalization RR 1.66, all-cause mortality RR 1.62, post-discharge mortality RR 2.57 (meta-analysis, n=18,602); shared microvascular inflammation pathway; SGLT2i and ARNI (sacubitril/valsartan) as dual-benefit candidates; BLOCK COPD (NEJM 2019): metoprolol without cardiac indication increases COPD hospitalisation (HR 1.91); bisoprolol MA (Feng 2023; 35 RCTs): FEV1 +0.46 L, ↓IL-6/IL-8/CRP — effect independent of HF but low-quality evidence; active contradiction between bisoprolol MA and BLOCK COPD awaiting RCT resolution |
COPD, HFpEF, heart-failure, comorbidities, prognosis |
2026-05-21 |
| entities/AL-Amyloidosis |
Plasma cell dyscrasia producing misfolded immunoglobulin light chains (75–80% lambda); cardiac (70–80%, leading cause of death) and renal (60–70%) most common; daratumumab-CyBorD preferred first-line (ANDROMEDA: 78% VGPR+); SCT 10–20% eligible (CR 40%, median OS 7.6 yr); 5-year survival 15%→48% (1980s→2010s); antifibril antibodies (birtamimab, anselamimab) in phase 3; mass spectrometry gold standard for AL vs ATTR fibril typing |
al-amyloidosis, plasma-cell-dyscrasia, cardiac-amyloidosis, amyloidosis, hematology |
2026-05-18 |
| concepts/AL-Amyloidosis-Staging |
Mayo 2004 (NT-proBNP + troponin; best early death), Mayo 2012 (adds dFLC >180 mg/L; best late survival), European modification (NT-proBNP >8500 = stage IIIb), Boston University (BNP + troponin I), renal staging (24h protein + eGFR); dFLC <50 mg/L = excellent prognosis regardless of cardiac stage; organ response: cardiac 24 months, renal 29 months, hepatic 35 months; dFLC utility diminishing in modern daratumumab era |
al-amyloidosis, amyloid-staging, plasma-cell-dyscrasia, cardiac-amyloidosis, biomarkers |
2026-05-18 |
| entities/MASLD |
MASLD (formerly NAFLD): 38% adult prevalence; CVD is leading cause of death; increases CV events ×1.5 (×2.5 with advanced fibrosis), AF ×1.2–1.5, HF ×1.2–1.5, T2DM ×2.2; FIB-4 for staging; resmetirom first FDA-approved drug (MAESTRO-NASH: MASH resolution 62.9% vs 34.3%); semaglutide ESSENCE phase 3 superior on both histologic endpoints; tirzepatide SYNERGY-NASH (MASH resolution 56–62%; fibrosis 51–55%); FGF21 analogues (efruxifermin SYMMETRY: cirrhosis reversal 29% vs 11%); SGLT2i (dapagliflozin: fibrosis reduction 45% vs 20%); no head-to-head comparisons; combination therapy next frontier |
MASLD, metabolic-syndrome, cardiovascular-risk, GLP-1-agonists, resmetirom |
2026-05-18 |
| concepts/Mineralocorticoid-Receptor-Antagonists-Post-MI |
MRA evidence in AMI: eplerenone Class I/A in MI+LVEF<40%+HF/DM (EPHESUS: 15% RRR); spironolactone Class I/A in HFrEF (RALES: 30% RRR); CLEAR (NEJM 2025; n=7,062; largest AMI RCT): routine spironolactone 25 mg neutral (HR 0.91/0.96; ITT); on-treatment HR 0.79/0.83 approaching significance; LVEF data not collected; gynecomastia 2.3%, hyperkalemia 1.1%, eGFR −1.8 ml/min/1.73m²; MRA benefit is EF/HF-dependent not a class effect across all AMI patients |
spironolactone, acute-myocardial-infarction, mineralocorticoid-receptor-antagonist, randomized-controlled-trial, STEMI |
2026-05-18 |
| entities/FBN1 |
Fibrillin-1 gene (15q21.1); 65 exons; haploinsufficiency threshold mechanism; TGF-β sequestration role; EGF-like domain mutations; >500 private mutations; also causes MASS phenotype, familial ectopia lentis, Weill-Marchesani, Shprintzen-Goldberg |
marfan-syndrome, fibrillin-1, connective-tissue-disorders, genetics |
2026-05-23 |
| entities/Marfan-Syndrome |
FBN1 haploinsufficiency → aortic root aneurysm + ectopia lentis + dolichostenomelia; TGF-β/ERK dysregulation with fibrillin-1 mechanosignalling as the myocardial exception; Ghent 2010 (4 sporadic + 3 family-history routes, systemic score ≥7, bona fide FBN1 definition, childhood staging); measured prevalence 1.5–17.2/100,000, at or below the rare-disease threshold; mitral prolapse in more than half not 75%; beta-blocker or ARB at maximal dose equivalent (I/A); root repair ≥50 mm (I/B), ≥45 mm with risk features (IIa); valve-sparing preferred (I/B); mWHO IV above 45 mm in pregnancy, ARB contraindicated; competitive and strength sport excluded, moderate aerobic encouraged; Loeys-Dietz key differential |
marfan-syndrome, connective-tissue-disorders, aortic-aneurysm, fibrillin-1, tgf-beta-signaling, heritable-thoracic-aortic-disease |
2026-10-26 |
| entities/Loeys-Dietz-Syndrome |
TGFBR1/TGFBR2 LOF → paradoxically enhanced aortic TGF-β signalling; MFS overlap + hypertelorism, bifid uvula, arterial tortuosity; diffuse aneurysms dissecting at smaller diameters; critical Marfan differential; vascular disease more aggressive |
marfan-syndrome, connective-tissue-disorders, aortic-aneurysm, tgf-beta-signaling, genetics |
2026-05-23 |
| entities/Aneurysm-Osteoarthritis-Syndrome |
SMAD3 inactivating mutations; aortic aneurysms + arterial tortuosity + early-onset osteoarthritis + LDS-like craniofacial features; paradoxical TGFβ upregulation despite LOF; grouped with MFS-related aortopathies |
connective-tissue-disorders, aortic-aneurysm, tgf-beta-signaling, genetics, related-marfan-diseases |
2026-05-23 |
| concepts/PCSK9-Inhibitors |
PCSK9 biology (LDL receptor recycling; GoF/LoF variants); evolocumab 60% LDL-C reduction; alirocumab; FOURIER (HR 0.85 primary/HR 0.80 secondary; PAD −42% limb events); ODYSSEY Outcomes (HR 0.85; nominal 15% all-cause mortality); LDL-C benefit to <10 mg/dL; very-low LDL-C safe; optimal patient selection; inclisiran siRNA Q6 months |
PCSK9-inhibitors, cardiovascular-outcomes, LDL-cholesterol, dyslipidemia, lipid-lowering-therapy |
2026-05-23 |
| entities/Evolocumab |
Fully human PCSK9 mAb (Repatha/Amgen); 140 mg Q2W or 420 mg monthly; ~60% LDL-C reduction; HoFH genotype table (null-null: no response; defective: 47%); FOURIER CVOT HR 0.85/HR 0.80; PAD subgroup 42% major adverse limb event reduction; no neutralizing antibodies; EBBINGHAUS neurocognitive substudy |
PCSK9-inhibitors, LDL-cholesterol, cardiovascular-outcomes, lipid-lowering-therapy, monoclonal-antibody |
2026-05-23 |
| entities/Alirocumab |
Fully human PCSK9 mAb (Praluent/Regeneron-Sanofi); titrated 75→150 mg Q2W or fixed 300 mg Q4W; ~60% LDL-C at max dose; HoFH highly genotype-dependent; ODYSSEY Outcomes CVOT (n=18,924; post-ACS; HR 0.85; nominal 15% all-cause mortality; not statistically significant in hierarchy) |
PCSK9-inhibitors, LDL-cholesterol, cardiovascular-outcomes, lipid-lowering-therapy, monoclonal-antibody |
2026-05-23 |
| entities/Inclisiran |
GalNAc-siRNA PCSK9 inhibitor; RISC-catalytic durable hepatic mechanism; plasma t½ <48h; ORION-10+11 Phase 3 (NEJM 2020; n=3,178): SC 284 mg Q6m → LDL-C −52.3%/−49.9% (P<0.001), PCSK9 −83%/−79%; safety comparable to placebo except mild ISAEs; ORION-4 CVOT (Lancet 2024): HR 0.84 (P=0.01; did not meet pre-specified P<0.005 threshold — statistically neutral by own criteria) |
PCSK9-inhibitors, LDL-cholesterol, siRNA, lipid-lowering-therapy, RNA-therapeutics |
2026-05-27 |
| concepts/Atherosclerosis-Pathophysiology |
Plaque initiation (endothelial damage → Ox-LDL deposition); foam cell cycle (macrophage scavenger receptor → cytokines → monocyte recruitment); minimally vs extensively oxidized LDL; myeloperoxidase/lipoxygenase; HDL oxidation impairs reverse cholesterol transport; TLR4/NF-κB as chronic inflammatory driver; PCSK9's role in macrophage activation + VSMC transformation; PCSK9-resistin CRD structural homology hypothesis |
atherosclerosis, inflammation, oxidative-stress, foam-cells, cardiovascular-disease |
2026-05-24 |
| concepts/Cardiogenic-Shock |
Cardiogenic shock consolidated into one page: definition without a blood-pressure threshold (lactate >2 mmol/L supplies the biochemical evidence) with 30-40% short-term and ~50% one-year mortality; SARC phenotypes and the 71% frailty figure; SUSPECT-CS; SCAI A-E with the RHC values by stage and the C/D SVRi distinction plus vasodilatory, mixed and isolated-RV comparator columns; CPO = (MAP x CO)/451 with the 12-24h CPO/lactate escalation rule; congestion profiles and HF-CS under-triage; vasopressor and inotrope tables including the dopamine, epinephrine and DOREMI comparisons; culprit-only PCI from CULPRIT-SHOCK; tMCS evidence - DanGer Shock HR 0.74 in the 5% who qualify, against IABP-SHOCK II, ECLS-SHOCK, Altshock-2 and the 4-trial VA-ECMO IPD meta-analysis all negative; PV-loop device haemodynamics and complication rates by device; three-step weaning thresholds; 12 contradictions |
cardiogenic-shock, heart-failure, hemodynamic-monitoring, mechanical-circulatory-support, vasopressors, inotropes |
2026-10-25 |
| concepts/Decompensated-HF-Management |
Decompensated heart failure, the term ESC 2026 substituted for acute heart failure, in its four categories; natriuretic peptide rule-out (NT-proBNP <300) and age-banded rule-in thresholds with >5000 generally warranting admission; IV loop diuretics I/A with decongestion measured rather than assumed (urine sodium >=70 mEq/L at 2h or >=100 mL/h at 6h); IV acetazolamide or oral hydrochlorothiazide IIa/B1 and urine-sodium-guided therapy IIb/B1; vasodilators IIb/C only above SBP 110, inotropes and pressors IIb/C, routine opiates III/C; the acute pulmonary oedema pathway with frusemide, GTN, morphine and NIV; decompensated right-sided failure and its decongestion-perfusion trade-off; in-hospital SGLT2 inhibitor I/B1 and STRONG-HF I/B2 before discharge; 10 contradictions |
heart-failure, decompensated-heart-failure, diuretics, pulmonary-oedema, decongestion, guidelines |
2026-10-25 |
| concepts/HFrEF-Management |
HFrEF treatment pathway: the four pillars with trial data (PARADIGM-HF HR 0.80 NNT 21, 36-hour ACE-I washout; RALES RR 0.70; DAPA-HF HR 0.74 NNT 21; EMPEROR-Reduced HR 0.75 NNT 19); no sequence has been tested, so STRONG-HF prefers simultaneous initiation and the guideline declines to specify an order; additional agents (ivabradine SHIFT, vericiguat VICTORIA HR 0.90, DIGIT-HF HR 0.82, GALACTIC-HF HR 0.92 not approved); IV iron Class I for symptoms but IIa for hospitalisation, with HEART-FID negative; drugs to avoid; the amiodarone harm signal in NYHA III; CABG COR 1 versus PCI HR 0.99 and why viability imaging does not select responders; ICD (SCD-HeFT sources the <=35% threshold) and CRT (MADIT-CRT QRS >=150 ms HR 0.48) plus TEER selection; bisoprolol preferred in COPD; 19 contradictions |
heart-failure, HFrEF, GDMT, four-pillars, device-therapy, revascularisation, heart-failure-management, guidelines |
2026-10-25 |
| concepts/HFpEF-Management |
HFpEF treatment pathway, organised around the absence of any mortality benefit: the eight outcome trials in one table (EMPEROR-Preserved HR 0.79 NNT 31, DELIVER HR 0.82, FINEARTS-HF RR 0.84, TOPCAT HR 0.89 NS, PARAGON-HF P=0.06, STEP-HFpEF KCCQ +7.8, SUMMIT HR 0.62); two foundational drugs since 2026 (SGLT2i and MRA, both Class I/A) against AHA 2022 COR 2b for MRA; dynamic diuretic dosing Class I/A; obesity-HFpEF semaglutide or tirzepatide IIa/B1 and bariatric surgery IIb/C; ARNi IIb/C; iron treatment stopping at HFrEF and why ESAs are avoided; beta-blockers not foundational, the inverse of HFrEF; aetiology-specific therapy for ATTR, Fabry and PH-HFpEF; 16 contradictions |
heart-failure, HFpEF, SGLT2-inhibitors, MRA, GLP-1-receptor-agonists, obesity-HFpEF, heart-failure-management, guidelines |
2026-10-25 |
| concepts/Adult-Immunization-CVD |
ACC 2025 CCG vaccination framework for CVD patients: influenza (annual; MACE RR 0.64; IAMI HR 0.72 post-MI; 6× acute MI risk with infection); pneumococcal (PCV20/PCV21; HTN alone not qualifying); COVID-19 (annual; 3× severe disease risk in CVD; mRNA myocarditis 1–19/million, benign); RSV (one-time ≥60–75y; ~80% efficacy year 1); zoster (2-dose Shingrix ≥50y; MI/stroke/HF/arrhythmia reduction lasting 8yr); cardiovascular-focused messaging most effective for uptake |
vaccination, cardiovascular-prevention, influenza, immunization, preventive-cardiology |
2026-05-25 |
| entities/CTX310 |
CTX310 is an investigational in vivo CRISPR-Cas9 gene-editing drug product developed by CRISPR Therapeutics for a single-treatment, permanent reduction of atherogenic lipoproteins.… |
CRISPR-Cas9, angptl3, gene-editing, lipid-lowering-therapy, lipid-nanoparticle |
2026-10-15 |
| entities/CRISPR-Therapeutics |
A Boston-based biotechnology company developing in vivo CRISPR-Cas9 gene-editing therapeutics, with a pipeline concentrated on hepatically expressed targets delivered by lipid nanoparticle.… |
CRISPR-Cas9, gene-editing, gene-therapy, lipid-lowering-therapy, clinical-trial |
2026-10-15 |
| entities/Fabry-Disease |
Redirect stub — see entities/Anderson-Fabry-Disease for the full entry (indexed separately at that key) |
fabry-disease |
2026-10-15 |
| concepts/Beta-Blockers |
Beta-adrenergic receptor antagonists competitively block catecholamine binding at β1 (predominantly cardiac) and β2 (predominantly bronchial and vascular smooth muscle) receptors,… |
beta-blockers, heart-failure, myocardial-infarction, COPD, antiarrhythmic-drugs |
2026-10-15 |
| concepts/Pulmonary-Artery-Denervation |
Pulmonary artery denervation (PADN) is a transcatheter procedure that applies radiofrequency energy to the pulmonary arterial wall from within the lumen in order to ablate its sympathetic nerve supply… |
pulmonary-artery-denervation, pulmonary-hypertension, heart-failure, right-ventricular-failure |
2026-10-15 |
| concepts/AF-Burden |
Atrial fibrillation (AF) burden is the amount of AF an individual has — a quantitative treatment of AF that replaces the binary question of whether AF is present with how much of it there is.… |
atrial-fibrillation, stroke-prevention, subclinical-atrial-fibrillation, risk-stratification, cardiac-monitoring |
2026-10-16 |
| concepts/Cardiac-Refractoriness |
Refractoriness is the property of cardiac tissue that, for a period after each excitation, prevents or impairs re-excitation. Two measures are used.… |
cardiac-electrophysiology, effective-refractory-period, his-purkinje-system, conduction-system-pacing, reentry |
2026-10-16 |
| concepts/LOT-CRT |
Left bundle branch area pacing–optimized CRT: an LBBAP lead replaces the RV lead while a coronary sinus lead paces the LV; greatest QRS narrowing and consistent echocardiographic benefit in IVCD and wide-QRS CRT, with observational (not randomised) outcome evidence.… |
lot-crt, left-bundle-branch-area-pacing, cardiac-resynchronization-therapy, conduction-system-pacing, heart-failure |
2026-10-19 |
| concepts/VT-Management |
Hub for VT management: acute termination and electrical-storm algorithm, chronic antiarrhythmic therapy, ICD and programming, catheter ablation (VANISH2 first-line in ischaemic cardiomyopathy; DCM 38–73% acute success), syndrome-specific care for CPVT/LQTS/Brugada/IVF/SQTS/ARVC/HCM, and special populations. |
ventricular-tachycardia, arrhythmia-management, catheter-ablation, antiarrhythmic-drugs, implantable-cardioverter-defibrillator |
2026-10-24 |
| concepts/PFA-Atrial-Arrhythmias |
Pulsed field ablation for atrial arrhythmias — mechanism and tissue selectivity, depth ceiling, harmonised catheter classification and platform table, dosing, dual-energy systems, anaesthesia, imaging and ICE, CIED/LAAO interactions, step-by-step workflow, training; five RCTs, registries, persistent AF, blanking period, non-PV applications and the atrial safety profile. |
pulsed-field-ablation, atrial-fibrillation, catheter-ablation, pulmonary-vein-isolation, electroporation, atrial-flutter |
2026-10-25 |
| concepts/Ventricular-PFA |
Pulsed field ablation in ventricular myocardium: the 6–8 mm depth ceiling, off-label atrial catheters failing epicardial circuits, preclinical papillary/moderator band and bipolar transmurality data, the dual-energy lattice tip, the AVAAR registry and high-voltage focal VCAS, plus coronary spasm, conduction-system injury and endpoint reliability. |
pulsed-field-ablation, ventricular-tachycardia, catheter-ablation, transmural-ablation, papillary-muscle, scar-related-vt |
2026-10-25 |
| entities/Sphere-9 |
Affera/Medtronic dual-energy lattice-tip platform: 9-mm expandable nitinol lattice sphere with 275 mm² effective area and nine thermocouple-microelectrodes; RF mode doubles ventricular lesion depth versus a conventional irrigated tip and reaches 80% bipolar transmurality, PF mode adds electroporation; clinical VT data from an 18-patient series and the 126-patient AVAAR registry; atrial approval via SPHERE Per-AF. |
catheter-ablation, lattice-tip, dual-energy-ablation, radiofrequency-ablation, pulsed-field-ablation, ventricular-tachycardia, atrial-fibrillation |
2026-10-25 |
| concepts/Cardiopulmonary-Resuscitation |
Cardiac arrest response — BLS at 100–120/min and 5–6 cm with 30:2, ACLS drug table (adrenaline 1 mg q3–5 min, amiodarone 300 mg then 150, lignocaine max 3 mg/kg, MgSO₄ for torsades), L-E-A-N endotracheal route, 5H/5T reversible causes, post-ROSC oxygen 92–98% and temperature management. Open questions: compression pauses in the protocol, adrenaline given without outcome data, no TTM target, mechanical CPR and ECPR absent |
cardiac-arrest, CPR, ACLS, defibrillation, resuscitation, emergency |
2026-10-25 |
| concepts/Cardiac-Tamponade |
Pericardial effusion causing haemodynamic compromise rather than size alone (~200 mL acute); pulsus paradoxus, raised JVP with prominent x descent, Kussmaul's sign, clear chest; ECG low voltage and alternans, echo chamber collapse; volume expansion, avoid positive pressure, echo-guided pericardiocentesis or open drainage. The handbook's warning that treating it as heart failure with diuretics, ACE-I or vasodilators is lethal |
cardiac-tamponade, pericardial-effusion, obstructive-shock, pericardiocentesis, emergency |
2026-10-25 |
| concepts/Hypertensive-Crisis |
Emergency (>180/120 with organ damage) versus urgency (same pressure, stable, treated orally); without a compelling feature reduce SBP ≤25% in the first hour then to 160/100 over 2–6 h; dissection, eclampsia and phaeochromocytoma take <140 within the hour. IV agents with doses (labetalol, nitroprusside, hydralazine, phentolamine) and a condition-versus-avoid table. The wiki's hypertension page had no crisis content at all |
hypertensive-emergency, hypertensive-urgency, hypertension, labetalol, nitroprusside, emergency |
2026-10-25 |
| concepts/Acute-Aortic-Syndrome |
Umbrella for classic dissection, intramural haematoma, penetrating aortic ulcer and (in the JACC formulation) incomplete dissection — now the single page for dissection as well, after merging the former Aortic-Dissection page. Stanford A/B plus TEM classification by entry and malperfusion, non-A non-B with its 26% retrograde type A risk after TEVAR; three-step diagnosis (pretest probability, then aortic pain with normal ECG, normal troponin and raised D-dimer, then ECG-gated CT neck-to-pelvis) and the imaging mimics; anti-impulse therapy with labetalol and nitroprusside doses and the rate-before-pressure rule; type A operative strategy (resuspension, open distal anastomosis, hemiarch, malperfusion repair), the type B medical/TEVAR boundary, IMH and PAU management, aorta centre and aorta code. Contradictions: three different heart-rate targets all Class I, a systolic target lower than any other hypertensive emergency and uncited, and no trial of surgery versus watchful waiting in stable type A |
acute-aortic-syndrome, aortic-dissection, intramural-haematoma, penetrating-aortic-ulcer, vascular-emergency, hypertension, cardiothoracic-surgery, d-dimer, imaging |
2026-10-25 |
| concepts/Thoracic-Aortic-Aneurysm |
Dilated at 4.0 cm and aneurysmal at 4.5 cm by ACC/AHA, a definition ESC 2024 declines and replaces with "significant dilatation" plus the number; measurement convention fixes the decision (inner-edge CT, leading-edge echo, indexed to body size); growth rates by cause and the ≥0.5 cm/year or ≥0.3 cm/year×2 trigger; surveillance with echo explicitly inadequate beyond the proximal ascending aorta; repair thresholds by segment and context; TEVAR over open repair in the descending aorta except in HTAD; CSF drainage and cold renal perfusion as Class I Level A; no elective repair when life expectancy <2 years |
thoracic-aortic-aneurysm, aortic-disease, surveillance, tevar, aortic-repair, bicuspid-aortic-valve, heritable-thoracic-aortic-disease |
2026-10-25 |
| concepts/Abdominal-Aortic-Aneurysm |
≥30 mm infrarenal dilatation; ultrasound screening for men ≥65 who smoked is the one Level A screening recommendation; surveillance by diameter from every 4 years at 25–29 mm to every 6 months near repair; repair at ≥55 mm in men and ≥50 mm in women (I/A), not offered when life expectancy <2 years; EVAR preferred for ruptured AAA and reasonable for unruptured with suitable anatomy, with type I and III endoleaks requiring reintervention; smoking cessation is the only intervention with a large effect and statins are the only drug with a growth signal — beta-blockers and ARBs have failed in AAA unlike in Marfan |
abdominal-aortic-aneurysm, aortic-disease, screening, evar, open-repair, rupture, surveillance |
2026-10-25 |
| concepts/Heritable-Thoracic-Aortic-Disease |
Syndromic (Marfan, Loeys-Dietz, vascular Ehlers-Danlos, Turner) and non-syndromic inherited aortopathy; three-generation family history and cascade testing irrespective of age; thresholds set by gene rather than by population diameter (PRKG1 ~42 mm, ACTA2 ~45 mm, Marfan 50 mm); beta-blocker or ARB Class I/A in Marfan and celiprolol in vEDS; whole-arterial-tree surveillance in Loeys-Dietz; preconception imaging with beta-blockade continued and ARBs withdrawn in pregnancy |
heritable-thoracic-aortic-disease, aortic-disease, genetics, marfan-syndrome, loeys-dietz-syndrome, vascular-ehlers-danlos, turner-syndrome, cascade-screening |
2026-10-25 |
| concepts/PAH-Treatment |
Group 1 PAH treatment: treat-to-target with 3-strata diagnosis and 4-strata follow-up; AVT and the ~10% CCB pathway; general measures (exercise I/A, diuretics, oxygen, iron, anticoagulation IIb); initial ERA+PDE5i I/B (AMBITION; macitentan+tadalafil) with bosentan+sildenafil III; drug-class and route table; escalation to parenteral prostacyclin; sotatercept STELLAR/ZENITH/HYPERION; transplant/ECMO; Eisenmenger and SSc-PAH caveats; 8 contradictions |
pulmonary-arterial-hypertension, PAH, treatment, pulmonary-hypertension, vasodilators, risk-stratification |
2026-10-25 |