…If the first wave is not negative, then the QRS complex does not possess a Q wave, regardless of the appearance of the QRS complex…

…evaluation of treatment effect, the medication is continued — abrupt withdrawal carries a risk of rebound. The referring physician should have made this decision; document which…

…Clinical Rationale Physical activity comprises bodily movement that increases energy expenditure, including walking, household tasks, active commuting and recreational activities. Exercise is a more structured…

…sudden cardiac arrest and cardiopulmonary resuscitation cpr/ Approximately 80% of individuals who suffer a sudden cardiac arrest have ventricular fibrillation prior to the cardiac arrest…

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…

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

…by a macroreentrant atrial circuit, which manifests on the electrocardiogram (ECG) as organized, continuous atrial electrical activity. This activity most commonly presents as a characteristic…

…activity Limit recurrent myocardial infarction, cardiovascular morbidity, and mortality The modern concept of rehabilitation has evolved from early post infarction physical activity programmes into a…

…dosing Definition and Pathophysiology Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a hepatic protein that regulates the availability of the low density lipoprotein receptor …

…pulseless electrical activity (PEA), and asystole can all occur in one patient. The typical depiction of sudden cardiac death as a gradual transition from sinus…

…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…

…the atria generates electrical impulses at a rate exceeding that of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal…

…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…

…up with a meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and…

…determines the diagnosis, and it is asked of a patient who is haemodynamically stable enough for there to be time to ask it. Indications Wide…

…blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive…

…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…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…with downstream effects involving interleukin 6 and C reactive protein, has been a major therapeutic target. This concept is clinically relevant because cardiovascular risk may…

Cardiology Pharmacology & dosing Definition and Pathophysiology Digoxin, a cardiac glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart…

…phosphodiesterase inhibitor (PDEI) activity, which may contribute to its inotropic profile. The drug possesses an active, acetylated metabolite with a half life exceeding 80 hours…

…Definition and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in type 2 diabetes…

Cardiology Pharmacology & dosing Definition and pathophysiology Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol…

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

…current (I), voltage (V) and resistance (R) is described by Ohm's law: V = I • R Pacemakers generate a constant voltage (V). The current…

…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…

…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…

…enabling them to function as electrical conductors. As a result, the electrical currents produced by the myocardium are transmitted through the body to the skin…

…electrical activity in the heart) and store electrocardiograms. The pacemaker is powered by a lithium battery with a lifespan of 5–10 years. A shorter…

…an abnormal and rapid heart rate, whereas tachycardia is defined as the subjective perception of a rapid heart rate. These terms are often used interchangeably…

…is explained by the increase in intracellular calcium levels, which causes a shortening of the action potential. Digoxin shortens the action potential in all cardiac…

…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…

…as follows: Sympathetic activity causes constriction of the veins, which increases the venous return to the heart. Contracting muscles function as a pump that propels…

…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…

…a different radiotracer to capture myocardial blood flow under baseline conditions. Raw Image Analysis : Raw images are reviewed to identify potential artifacts, extracardiac tracer activity…

…variations in the activity of the autonomic nervous system and changes in the automaticity of the sinoatrial node. Rhythm Normal rhythm A rhythm is defined…

…should be considered a basic clinical skill. Pacing activity may be visible or invisible, depending on e.g the type of pacemaker, intrinsic cardiac activity…

…LBBB) results from anatomical or functional impairment of the left bundle branch (LBB), leading to a blockage of electrical impulse conduction through this bundle. Consequently…

…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…

…without the need for physical activity. Advantages of regadenoson over adenosine Regadenoson has advantages over adenosine: Regadenoson is a selective A2A receptor agonist : A2A receptors…

…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…

…lack of supply In clinical practice, ischemia is often described as a consequence of an imbalance between oxygen demand and supply. According to this theory…

…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…

…uncertain about the implications of sinus tachycardia. A crucial task is to distinguish three types of sinus tachycardia. These types differ fundamentally in terms of…

…pressure favor coronary blood flow. A CPP of approximately ≥ 15 mmHg is required to induce spontaneous electrical activity in myocardial cells. CPP below 15 mmHg…

…pumping) activity at all, an escape rhythm must arise in an ectopic focus (located distal to the block). Third degree AV block is a very…

…of withdrawal and the risk of seizures and delirium [1,2]. In delirium tremens the aim should be a calm, mildly somnolent but rousable patient…

…Rapidly inactivated by esterases. Effects • Clevidipine is a dihydropyridine L type calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has…

…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…

…is associated with persistent disease activity, rheumatoid factor and anti cyclic citrullinated peptide antibodies. RA is also accompanied by a higher prevalence of conventional cardiovascular…

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

…AVB) may indicate septal involvement in the inflammatory process. A broad spectrum of pharmacologic agents can induce bradycardia or conduction disorders. These include beta blockers…

…portion of its transmembrane pore, ivabradine reduces the slope of diastolic depolarisation and produces a dose dependent reduction in sinus rate. Its principal therapeutic distinction…

Cardiology Clinical medicine Definition and pathophysiology Peripheral artery disease (PAD) is a clinical disorder caused by stenosis or occlusion of the aorta or arteries supplying…

…expansion and, in some cases, a dissecting haematoma may precede rupture. The tear commonly develops at the interface between infarcted and viable myocardium. The incidence…

…the ECG after mild aerobic activity. If the heart rate is greater than 100 beats/min, repeating the ECG after a longer resting period is…