…the work of breathing, the peripheral perfusion and the signs of shock 2 Two large bore peripheral cannulae. Consider an arterial line if the patient…

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

…preexisting acidosis, drug overdose, hypothermia, and hyperkalemia. Clinical Presentation and Symptoms The clinical manifestation of bradycardia depends on the adequacy of cardiac output. Isolated sinus…

…regardless of all other circumstances. The initial rhythm is an indicator of the underlying etiology, duration of cardiac arrest, quality of CPR, and a prognostic…

…minutes, pulseless electrical activity (PEA) develops. PEA progresses to asystole within minutes, as outlined in the studies by DeBehnke et al. and Safar et al…

…despite optimal neurohormonal blockade and adequate volume control. It is also utilized for ventricular rate control in atrial fibrillation, particularly when other therapeutic options cannot…

…Seizures later than this, focal seizures or status epilepticus should raise strong suspicion of another or an additional cause [1]. Delirium tremens most often begins…

…by the drug. Management of all other cases aligns with the approach used for atrial fibrillation and atrial flutter. Beta blockers, digoxin, and calcium channel…

…node Flecainide has no effect on the activity in the SA node. Propafenone may decrease automaticity in the SA node and thereby lower heart rate…

…intrinsic sympathomimetic activity that also prolongs cardiac repolarization, thereby exerting combined class II and class III antiarrhythmic effects. The drug comprises both d and l…

…these mechanisms, levosimendan also exhibits some type 3 phosphodiesterase inhibitor (PDEI) activity, which may contribute to its inotropic profile. The drug possesses an active, acetylated…

…concomitant medications, potential drug interactions, the presumed mechanism of ischaemia, patient preferences, local availability, and cost. The pathophysiological substrate of angina may differ between patients…

…tension pneumothorax, preexisting acidosis, drug overdose, hypothermia, and hyperkalemia. When bradycardia occurs in the context of inflammatory heart disease, it often reflects myocardial pathology that…

…during physical activity). Sinus arrest & sinus pause (intermittent failures to discharge impulses). Sinoatrial block (delayed or blocked impulse conduction between the sinoatrial node and the…

…provide greater benefit than either drug alone. Long term efficacy data remain limited, and the possibility that chronic If channel blockade could increase sympathetic activity…

…including Japanese, Chinese and Malay patients, may have higher statin blood levels; lower starting doses are therefore appropriate. Drug interactions are particularly important. Inhibition of…

…increased Vagus nerve activity caused by digoxin. Increased Vagus activity diminishes the automaticity in the sinoatrial node (which lowers heart rate) and also slows conduction…

…minutes of continuous convulsive activity, t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated without unnecessary…

Phentolamine Drug Phentolamine Brand names Oraverse ®, Rogitine ® Indications Hypertensive crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces…

…duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular…

…aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension. Nicardipine Drug Nicardipine Brand names Cardene ® Indications Hypertension, hypertensive emergency/crisis…

…aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension. Nicardipine Drug Nicardipine Brand names Cardene ® Indications Hypertension, hypertensive emergency/crisis…

…with manifest clinical disease are at high risk of progression and generally require all appropriate evidence based measures, including drug treatment and therapeutic lifestyle change…

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

…blood pressure, nonpharmacological management should be actively implemented. Adults with blood pressure ≥140/90 mmHg should receive both lifestyle and antihypertensive drug therapy. For grade…

…Nitroprusside Figure 1. The approximate position of each drug according to its vasoconstrictor effect (vertical axis) and its positive inotropic effect (horizontal axis). Grey =…

…your national or regional poison control centre, and activate the emergency medical response system using your local emergency number. Contact the nearest intensive care unit…

…and current reference values (GLI 2012 is the standard). Patient preparation — given with the appointment letter: Drug or habit Period to be withheld before the…

…Assessment Before Prescription Physical activity should be assessed and prescribed using the components of: Frequency Intensity Time or duration Type Progression The prescription should be…

…Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, early repolarization. Electrolyte disorders, acidosis, hypoxemia and ischemia all aggravate the…

…and Pathophysiology Atrial flutter is defined by a macroreentrant atrial circuit, which manifests on the electrocardiogram (ECG) as organized, continuous atrial electrical activity. This activity…

…beyond exercise training to incorporate individualized physical activity counselling, risk factor modification, nutritional care, education, psychosocial support, vocational guidance, medical surveillance, and appropriate pharmacological treatment…

…and thereby enhances LDL C removal from plasma. Two principal therapeutic strategies have emerged: Inhibition of circulating PCSK9 activity , using the monoclonal antibodies evolocumab and…

…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…

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

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…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…

…spike is followed by a wide QRS complex and a pulse that can be felt. The other predictable error is forgetting that pacing hurts a…

…body weight and haemoglobin A1c Increased uricosuria, with plasma uric acid reduction of approximately 10% to 15% Possible effects on erythropoietin activity and erythropoiesis SGLT2…

…activity. Patients with VA are generally younger than those with atherosclerotic non ST elevation acute coronary syndromes. Cigarette smoking is a prominent association, whereas other…

…not sense depolarization outside these boundaries, which may lead to undersensing of true intrinsic activity and thus inappropriate pacemaker activity. As discussed in the previous…

…sum of ventilation, metabolic activity, and perfusion. Increased aerobic metabolism, perfusion, and ventilation result in a higher end tidal carbon dioxide level. Continuous ETCO 2…

…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…

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

…physical activity. It is based on the subjective physical sensations experienced during exercise, including increased heart rate, increased respiratory rate and depth, increased sweating, and…

…SA) node and atrioventricular (AV) node. Parasympathetic stimulation reduces the automaticity in the sinoatrial node, which lowers the heart rate. The parasympathetic activity also diminishes…

…cost of physical activity. One metabolic equivalent (1 MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to…

…with signal intensity comparable to background activity, typically representing infarcted tissue or non viable myocardium. Perfusion patterns and reversibility Perfusion patterns are systematically analyzed by…

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

…Figure 3. Spontaneous atrial activity is sensed by the atrial lead and triggers ventricular stimulations. The QRS complex is wide due to ventricular depolarization proceeding…

…coordinated and efficient atrial and ventricular activity. The conduction system includes the sinoatrial (SA) node, atrioventricular (AV) node, Bundle of His, bundle branches (left and…

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

…than stenotic arteries, which are already dilated. This results in flow heterogeneity and perfusion defects in areas supplied by the disease artery. Thus, vasodilators replicate…

…of redistribution can move from areas of higher concentration to regions with lower concentration, for reasons other than perfusion differences, making image interpretation more ambiguous…

…wall motion abnormalities. Figure 1. Standardized myocardial segmentation and nomenclature for echocardiography. The left ventricle is divided into 17 segments for 2D echocardiography. One can…

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

…fibrillation, ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable rhythm : Tachyarrhythmias that can be treated with defibrillation (ventricular fibrillation) or cardioversion (ventricular tachycardia)…

…from each other. This condition is referred to as atrioventricular (AV) dissociation. Importantly, for the ventricles to have any electrical (and thus pumping) activity at…