…instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute…

…7.35 with raised pCO₂ Acute or acute on chronic hypercapnic respiratory failure Rapidly falling pH An urgent ventilatory problem Focal chest pain or unilaterally…

…progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the following criteria is…

…PEF or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an…

…non inferior to alteplase with respect to an excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1…

…present, neurological examination, gait and truncal stability Acute balance syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke…

…associated with extensive atherosclerosis and frequently occurs in older patients with multiple vascular comorbidities. An isolated PAU is one without associated IMH, dissection, or saccular…

…and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest, electrical or…

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

…Features associated with an unfavourable short term prognosis include: Tachycardia Low systolic blood pressure Respiratory insufficiency, manifested by tachypnoea and/or low arterial oxygen saturation…

…right ventricular hypertrophy (RVH) from posterior acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R waves ( Figure 2…

…in old age or in renal failure, reduce it further. Starting doses in acute pain in an opioid naive adult Agent Route Starting dose Comment…

…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…

…the tubules, interstitium, renal vasculature or collecting system. With iodinated contrast, the observed renal dysfunction may therefore reflect a combination of: direct tubular toxicity; renal…

…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…

…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…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, acute or chronic…

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…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 …

…markedly raised blood pressure without acute organ damage should as a rule not be lowered rapidly with intravenous drugs. Restart or optimise oral treatment and…

…in patients without contraindications. I A In the absence of ST segment elevation, primary PCI is indicated in patients with symptoms suggestive of acute myocardial…

…pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the infarct related artery (IRA), or it…

…regimen remains the default for most patients with ACS, including those with NSTE ACS. It applies whether ACS is managed with PCI or without revascularization…

…mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material. Superficial plaque erosion. Thrombosis associated with a calcified nodule. Epicardial or microvascular…

…V9). Criteria for ischemia/infarction have been established for these leads (please refer to ECG leads or Additional leads in acute myocardial infarction). Importance of…

…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…

…or obscure acute myocardial ischemia and infarction, creating significant diagnostic challenges. These complexities led researchers to study patients presenting with LBBB and suspected acute myocardial…

…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…

…TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non…

…the head of the humerus. A pressure bag or a 50 mL syringe with a three way tap — intraosseous flow requires pressure ; gravity is not…

…flat. Lead V1 : Inverted or flat T wave is rather common, particularly in women. The T wave inversion is concordant with the QRS complex. Leas…

…and presence of high risk arrhythmias on ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia…

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…

…1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation…

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

…stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges posed…

…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…

…and infarction ST segment depression due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment…

…in patients experiencing acute STEMI. The severity of symptoms in STEMI patients, compared to those with Non ST Elevation Myocardial Infarction (NSTEMI) or unstable angina…

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

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

…aorta: Stanford type A: involves the ascending aorta, with or without extension into the arch or descending aorta. Stanford type B: does not involve the…

…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…

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI…

…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…

…influenced effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease…

…instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These…

…these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety, or distress have transient BP elevation that improves…

…Malaise Fever Pericardial or chest discomfort Leukocytosis Elevated erythrocyte sedimentation rate Pericardial effusion Pericardial pain is often sharp and pleuritic. It may worsen with inspiration…

…more frequent in people with diabetes and becomes more common with advancing age. Presentations without pain may include: Sudden breathlessness Syncope or sudden loss of…

…myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting…

…arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock, malignant ventricular arrhythmias, or sudden cardiac death. The resulting extensive ischemia causes…

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

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

…is considered to have several functions, despite the fact that it can be removed without affecting cardiac function or hemodynamics. The following functions are attributed…

…A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness…