…examination : : : : Acute vestibular syndrome Acute or subacute onset, continuous dizziness lasting hours to days, often with nausea, nystagmus, motion intolerance and difficulty walking Vestibular neuritis…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…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…

…Important presentations include: Hypotension or shock Acute severe aortic regurgitation with heart failure Cardiac tamponade from haemopericardium Myocardial ischaemia from coronary ostial compromise Focal neurological…

…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…

…thrombosis for clinical research and outcome assessment. Predisposing factors Domain Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus, renal failure, heart failure…

…wall rupture Free wall rupture may be catastrophic or subacute. In the catastrophic form, an acute tear causes haemopericardium, tamponade, and sudden: Loss of pulse…

…free wall rupture after infarction Anticoagulant associated bleeding Renal failure Systemic inflammatory disease Catheter based electrophysiological and structural cardiac procedures In patients with acute pericarditis…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…but the other causes are either subacute or non acute. The history taking must be systematic and accurate because the history itself is often sufficient…

…Endocarditis with alpha streptococcus is most often subacute and can develop gradually over several days to weeks. More acute endocarditis is often caused by staphylococcus…

…in patients with ischemic heart disease, the majority of all ischemic episodes are asymptomatic (refer to The Ischemic Cascade). Acute coronary syndromes occur when atherosclerotic…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…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…

…arrhythmias, and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical…

…patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia, while sensory and motor…

…validated clinical risk tools Acute RV failure is a rapidly progressive syndrome characterized by systemic congestion resulting from impaired RV filling and/or reduced RV…

…indicated with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic…

…The clinical rationale for DAPT is particularly strong after ACS and coronary stent implantation. ACS is associated with a high risk of platelet driven atherothrombosis…

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

…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…

…adventitial inflammation, and spotty calcification. However, the concept has important limitations. Although thin capped fibroatheromas may have imaging characteristics associated with rupture, fewer than 5…

…50 per cent and titrate. At a high dose, in old age or in renal failure, reduce it further. Starting doses in acute pain in…

…ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), and ST Elevation Myocardial Infarction (STEMI…

…detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed highly sensitive troponin assays for troponin I (cTnI) and troponin T (cTNT…

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…

…failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery is completely occluded and is particularly associated with…

…biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation, defined by hsCRP ≥2 mg/L…

…with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute…

…may be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea…

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…

Adapted from AHA, ACC and ESC guidelines.

…block (LBBB) can mimic acute STEMI , as it often presents with similar ECG changes, including ST segment elevations, ST segment depressions, and T wave inversions…

…ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs, with or…

…in patients with acute coronary syndromes. Importantly, the ECG findings dictate the management of acute coronary syndromes. Hence, an ECG must be performed and interpreted…

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…

…patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to rich collateral circulation in the ischemic area…

…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…

…in patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and cardiogenic…

…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…

…in patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular…

…due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment. Indeed, North American and European…

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

…early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic arrest and asystole represent severe manifestations of impulse generation or conduction failure…

…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…

…delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an inadequate response. First line treatment is oxygen in hypoxaemia, repeated…

…closed circumferential cast , and the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or…

…treatment. Cardiac and pulmonary complications Acute hypertension may precipitate myocardial ischemia or infarction, acute heart failure, or pulmonary oedema. Patients may present with chest pain…

…heart failure are often better categorised as myocardial injury. Clinical Presentation and Symptoms Patients with Type 2 MI frequently present with acute chest pain and…

…atrial fibrillation. Acute and paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter…

…a pivotal therapeutic target [4]: Beta Blockers : Administered to reduce adrenergic stimulation [4]. Sedation and Intubation : Along with anxiolytics, these measures minimize sympathetic surges [4]…

…high and pharmacological interventions are often futile. A transcutaneous pacemaker is often necessary in the acute setting and is currently the only treatment with class…

…without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is…

…7.35 and a PaCO₂ above 6.0 kPa despite optimal medical treatment with bronchodilators, steroids and controlled oxygen. Acute on chronic hypercapnic failure in…

…the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding : : CNS New…

…receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure…

…that promote plaque formation and progression. As the burden of retained atherogenic particles accumulates over time, the probability of an acute atherosclerotic cardiovascular event increases…

…dosing Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome…

…with cardiovascular benefit regardless of the pharmacological route used. In patients with acute coronary syndromes (ACS), the early post event period is particularly vulnerable, and…