…part via NMDA receptors. With prolonged alcohol exposure the nervous system adapts through reduced GABA mediated inhibition and increased glutamatergic activity. When the alcohol level…

…where needed, coagulation expertise at the same time [1]. Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and…

…peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red…

Cardiology Clinical medicine Definition and Clinical Rationale Physical activity comprises bodily movement that increases energy expenditure, including walking, household tasks, active commuting and recreational activities…

…ECG Ventricular fibrillation, pulseless electrical activity (PEA) and sudden cardiac arrest This chapter will focus on ventricular fibrillation and pulseless electrical activity (PEA). These are…

Arrhythmias and arrhythmology Pharmacology & dosing Definition and Pathophysiology Sotalol is a nonselective beta adrenoceptor blocker devoid of intrinsic sympathomimetic activity that also prolongs cardiac repolarization…

…minutes is the practical threshold for treatment, known as t1. After about 30 minutes of continuous convulsive activity, t2, the risk of permanent neuronal injury…

…crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces blood pressure while increasing catecholamine activity. Effects Primarily causes afterload reduction…

…organized, continuous atrial electrical activity. This activity most commonly presents as a characteristic saw tooth pattern at rates typically exceeding 200 beats per minute. While…

…with cardiovascular disease, including those recovering from myocardial infarction. It extends beyond exercise training to incorporate individualized physical activity counselling, risk factor modification, nutritional care…

…clearance of circulating LDL cholesterol (LDL C). Increased PCSK9 activity therefore contributes to higher LDL C concentrations. The genetic evidence provides the rationale for therapeutic…

…VF) and pulseless ventricular tachycardia (VT). The bradyarrhythmias include all bradyarrhythmias, pulse less electrical activity (PEA), and asystole. Bradyarrhythmias are discussed in the chapter Management…

…and drug induced reactions. Approximately 90% of anaphylactic cardiac arrests present with pulseless electrical activity (PEA) as the initial rhythm, while the remainder manifest ventricular…

…may precede the full tachycardia. It is characterized by short, rapid bursts of atrial activity. In the majority of cases, the arrhythmia is self limiting…

…spontaneous cardiac rhythm. The likelihood of achieving spontaneous cardiac activity is a function of the duration of circulatory standstill and the underlying cause, as elaborated…

…electrical currents. An ECG lead is a graphical description of the electrical activity of the heart and it is created by analyzing several electrodes. In…

…alcohol, a missed meal, physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the…

…arrhythmia unit. Assessment of the effect of adenosine, which can be given during the recording and unmask the atrial activity. The investigation is diagnostic, not…

…while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes…

…The hypotensive effect of enalaprilat depends on plasma volume and plasma renin activity. Volume depletion and high plasma renin activity increase the effect of enalaprilat…

…organ hypoperfusion. In severe cases, bradycardia may progress to bradyarrhythmic arrest or pulseless electrical activity (PEA), presenting as cardiovascular collapse and cardiac arrest. Evaluation and…

…pressure or other conventional risk factors. Colchicine is an established anti inflammatory drug that may inhibit inflammasome activity, reduce interleukin 1β and interleukin 6…

…via the autonomic nervous system. It attenuates carotid sinus baroreceptor activity and acts centrally and peripherally to enhance vagal tone. These sympatho inhibitory effects decrease…

…vasodilation. Although primarily defined by these mechanisms, levosimendan also exhibits some type 3 phosphodiesterase inhibitor (PDEI) activity, which may contribute to its inotropic profile. The…

…nervous system activity Improvement in cardiac metabolic efficiency, including increased oxygen delivery and beta hydroxybutyrate oxidation Reduced sodium hydrogen exchanger subtype 3 activity Attenuation of…

…plaque stability, thrombogenic responses and immune activity. Statin intolerance refers to adverse effects attributed to statin treatment that improve or resolve after reducing the dose…

…thrombus formation and sympathetic activation. Rho kinase may increase vascular smooth muscle sensitivity to calcium by inhibiting myosin phosphatase activity. Patients with VA are generally…

…at low and high heart rate, the behavior of the pacemaker in the presence and absence of intrinsic cardiac activity, Modern pacemakers are packed with…

…it is exhaled. The final partial pressure of carbon dioxide in exhaled air represents the sum of ventilation, metabolic activity, and perfusion. Increased aerobic metabolism…

…finding in acute coronary syndromes). Between 3 8 minutes, pulseless electrical activity (PEA) develops. PEA progresses to asystole within minutes, as outlined in the studies…

…DW, Wickman LL, Swart GL. The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 1995; 30:16975…

…small to be detected by skin electrodes; the ECG presents the electrical activity of the atrial and ventricular myocardium. Automaticity of pacemaker cells The automaticity…

…The battery is used to deliver pacing pulses, sensing (analyzing electrical activity in the heart) and store electrocardiograms. The pacemaker is powered by a lithium…

…which is synonymous with tachyarrhythmia. Except for sinus tachycardia during physical activity, all tachycardias should be considered pathological and the task is to clarify the…

…of the heart rate is due to increased Vagus nerve activity caused by digoxin. Increased Vagus activity diminishes the automaticity in the sinoatrial node (which…

…detail. Symptom during exercise stress testing Perceived exertion The patient's perceived exertion is a way of estimating the intensity of the physical activity. It…

…the myocardium). Thus, increased sympathetic activity results in increased heart rate and stronger contractions. Physical exercise increases the venous return to the heart, which results…

…to the assessment of exercise capacity. Metabolic equivalents (METs) can be used to estimate the energy cost of physical activity. One metabolic equivalent (1 MET…

…under baseline conditions. Raw Image Analysis : Raw images are reviewed to identify potential artifacts, extracardiac tracer activity, and assess image quality and patient motion. Alignment …

…These age variations in heart rate are due to variations in the activity of the autonomic nervous system and changes in the automaticity of the…

…the lowest heart rate allowed by the pacemaker; intrinsic cardiac activity below the base rate will trigger pacing. The base rate is usually set to…

…system ensures rapid and synchronized spread of depolarization, which is essential for coordinated and efficient atrial and ventricular activity. The conduction system includes the sinoatrial …

…cause of pacemaker mediated tachycardia is endless loop tachycardia, which also depends on the ventricular stimulation being triggered by atrial activity. In endless loop tachycardia…

…vasodilators replicate the effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over adenosine Regadenoson has advantages over adenosine…

…and high retention, with a linear relationship between myocardial blood flow and measured tracer activity over a wide range (Murthy et al.). As evident in…

…oxygen supply. The most characteristic manifestation of ischemic heart disease is angina pectoris developing during physical activity; myocardial oxygen demand increases during physical activity, but…

…means that the automaticity is diminished). Chronotropic incompetence (inability of the sinoatrial node to adequately increase its automaticity during physical activity). Sinus arrest & sinus pause…

…of sinus tachycardia are as follows: Normal (physiologic) sinus tachycardia: The automaticity (rate of spontaneous depolarization) in the sinoatrial node is increased during physical activity…

…cardioversion (ventricular tachycardia). Non shockable rhythm : Cardiac rhythm that cannot be defibrillated or cardioverted. These rhythms include pulse less electrical activity (PEA), asystole, and bradycardia…

…Importantly, for the ventricles to have any electrical (and thus pumping) activity at all, an escape rhythm must arise in an ectopic focus (located distal…

…lowers blood pressure by inhibiting ACE. Effects • The hypotensive effect of enalaprilat depends on plasma volume and plasma renin activity. Volume depletion and high plasma…

…uncontrolled heart failure, and concomitant valvular disease. Risk factor modification, physical activity, dietary and lifestyle measures, high intensity statin therapy, and appropriate antithrombotic treatment form…

…risk plaques may coexist within one coronary tree, and inflammatory activity may be widespread rather than confined to a single lesion. Plaque composition is heterogeneous…

…directly attributable to CVD. Excess mortality becomes apparent approximately 7–10 years after diagnosis and is associated with persistent disease activity, rheumatoid factor and anti…

…jaw, neck, or upper back. Chest discomfort triggered by emotional stress. Palpitations associated with physical activity, a large meal, emotional upset, or cold exposure. The…

…asystole, or pulseless electrical activity (PEA). Evaluation and Physical Examination The source material does not provide specific details regarding the physical examination maneuvers for patients…

…Long term efficacy data remain limited, and the possibility that chronic If channel blockade could increase sympathetic activity, with adverse remodelling or pro arrhythmic c

…classic claudication. Asymptomatic or atypical PAD remains clinically important. Reduced activity may lead to progressive functional decline, sedentary behaviour and loss of independence. Identification of…

…pressure. Loss of consciousness. Electromechanical dissociation or pulseless electrical activity despite ongoing sinus rhythm on the ECG. Subacute rupture may be suggested by: Nausea. Hypotension…

…an exercise ECG test without repeating the resting ECG. B: Repeat the ECG after mild aerobic activity. C: Immediately refer to a heart rhythm specialist…