…of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of…

…a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively…

…Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in…

…of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory…

…angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…with advanced age, smoking, coronary artery disease, chronic obstructive pulmonary disease, renal insufficiency, systemic hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute…

…takotsubo cardiomyopathy, valvular disease, arrhythmias, and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS…

…flow in less advanced disease. Clinical manifestations may be relatively modest when collateral circulation is adequate. For example, a patient with acute graft occlusion may…

…hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease…

Myocardial ischemia and infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the…

…it further. Starting doses in acute pain in an opioid naive adult Agent Route Starting dose Comment : : : : Morphine IV 2.5–5 mg, repeated after…

…sudden heart rate decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with large…

…is often more rapidly reversible than that of other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…of acute coronary syndromes and myocardial infarctions. The reader should study this chart carefully. Figure 1. Flowchart showing the natural course of coronary artery disease…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A…

…European Society of Cardiology (ESC) and 2025 American College of Cardiology/American Heart Association (ACC/AHA) guidelines emphasize a unified, risk stratified continuum of disease…

…ST segment elevation in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia …

…acute glomerular disease or scleroderma renal crisis [1,2]. A hypertensive emergency means a markedly raised blood pressure together with ongoing or new organ damage…

…cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic ST segment or T wave changes, particularly with intermittent ST segment elevation…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly…

…stabilizing the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic…

…repeated ECG recordings Acute coronary syndromes are dynamic processes. Factors that promote thrombosis ( pro thrombogenic factors ) are constantly in a struggle with factors striving to…

…Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS (NSTEMI…

…affects cardiovascular and total mortality. Left bundle branch block is more common in individuals with structural and ischemic heart disease. Assessment of ischemia on ECG…

…the onset of myocardial infarction. This is utilized in clinical practice by detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed…

…heparin). Patients with gastrointestinal disorders. Patients with severe kidney disease (glomerular filtration rate < 30 mL/min). Patients with mild to moderate heart failure, kidney…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…The reader should already be familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and…

…arrest. The most common acute symptoms are dizziness (pre syncope), hypotension (chock), syncope, chest pain, heart failure and cardiac arrest. In cases with intermittent symptoms…

ECG Myocardial ischemia and infarction Acute myocardial infarction (AMI) always affects the left ventricle Myocardial infarction is virtually synonymous with left ventricular infarction . All myocardial…

…coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary disease…

…Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs, with or without…

…grafting [CABG]). Stress testing is used to establish the diagnosis of ischemic heart disease as well as estimating the extent of ischemia. After revascularization procedures…

…grouped. The chain of care in NSTEMI and unstable angina Management of patients with acute coronary syndromes is permeated by the mantra time is myocardium…

…with one notable exception. Occurrence of upsloping ST segment depressions with prominent T waves in the majority of the chest leads may indicate an acute…

…ECG), Criteria & Management Acute ST Elevation Myocardial Infarction (STEMI) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology, definitions…

…inversions without concomitant ST segment deviation (elevation or depressions) – is never a sign of acute ischemia. T wave inversions with concomitant ST segment deviations are…

…Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest…

…aortic valve involvement, coronary compromise or malperfusion. Important presentations include: Hypotension or shock Acute severe aortic regurgitation with heart failure Cardiac tamponade from haemopericardium Myocardial…

…rate parameters. Clinical Presentation and Symptoms Acute heart failure necessitating inotropic or vasopressor support typically manifests in patients with left ventricular systolic dysfunction, low cardiac…

…and symptoms SCAD generally presents as ACS. Symptoms may therefore include acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy…

…are reported more frequently in females, older adults and people with diabetes. Ischaemic heart disease may also present without prominent discomfort through heart failure, arrhythmias…

…commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being the most common…

…Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related…

…long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important. Cardioversion is generally not immediately…

…with HFpEF, acute hypertension is a frequent trigger of decompensation and may produce abrupt pulmonary oedema, sometimes requiring non invasive ventilation or intubation. Aortic disease…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…ischaemic process: acute, evolving or chronic The severity of ischaemia and whether infarction has occurred The extent and degree of myocardial involvement The anatomical territory…

…of a 12 lead ECG. Assessment for haemodynamic instability, acute severe heart failure and cardiogenic shock. Identification of life threatening arrhythmias. Assessment for high risk…

…disease, including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy of 5000 patients with…

…of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart failure has…

…of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart failure has…

…pericardium, its surroundings, the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination…

…is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in…