…Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial…

Kardiologi Akutsjukvård Lathundar Overview Acute coronary syndrome comprises STEMI, NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable…

…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…

…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…

…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…

…lasts, and whether anything actually triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus…

Cardiology Emergency medicine Definition and Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for…

…and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with…

…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…

…instability and represents approximately 5–10% of cases. Intermediate high risk PE occurs in haemodynamically stable patients with both RV dysfunction on imaging and elevated…

…and females). Differentiating posterolateral ischemia from right ventricular hypertrophy (RVH) It is occasionally difficult to differentiate right ventricular hypertrophy (RVH) from posterior acute ischemia. Both…

…respiratory depression. Avoid the combination, or reduce both Red flags and pitfalls A respiratory rate < 8/min, or an increasing level of sedation , are…

…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…

Adapted from AHA, ACC and ESC guidelines.

…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…

…approach is primarily supported by observational studies and clinical experience. Studies have demonstrated that a significant proportion of patients with acute coronary occlusion (ACO) do…

…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 or ECG changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis…

…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…

…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…

…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…

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

…primary PCI is indicated in patients with symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or…

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…

…driven atherothrombosis, while interruption of antiplatelet therapy after recent stenting is associated with increased risk of major adverse cardiovascular events (MACE) and stent thrombosis. Premature…

…s morphology does not reliably establish that it will cause an acute event. A more clinically useful model considers both the plaque and the patient…

…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…

…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…

…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…

…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…

…the tourniquet 10–15 cm proximal to the intended puncture site, let the arm hang, ask the patient to pump with the hand, and pa

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

…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…

…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…

…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…

…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…

…NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE ACS (Non ST Elevation Acute Coronary Syndromes) . This chapter deals with the pathophysiology…

…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…

…the acute phase. The chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system involving both prehospital and…

…waves with an amplitude between +1 and 1 mm. Ischemic T wave inversions It is a widespread misunderstanding that isolated T wave inversions indicate acute…

…both cardiac and non cardiac etiologies [1]. Cardiac Causes The primary differential diagnoses include conditions that directly affect the myocardium or major vessels. 1. Acute…

…trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic…

…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…

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

Myocardial ischemia and infarction Definition and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal…

…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…

…establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These findings determine the urgency and type of intervention…

…haemorrhage may coexist with severe hypertension. The decision to lower BP in acute stroke requires attention to the type of stroke and the possibility of…

…associated pericarditis , which develops from several hours to approximately 4 days after infarction and is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed…

…with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently develop myocardial necrosis and…

Emergency medicine Myocardial ischemia and infarction Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis…

…occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic process is dynamic, with varying degrees of occlusion that…

…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…

Echocardiography Pericardial diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis)…

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