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…

…messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines…

…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…

…Moderate attack Acute severe attack Life threatening attack : : : : Speech Full sentences Cannot complete a sentence in one breath Single words or unable to speak Position…

…CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion…

…course and triggers Syndrome Typical course Common or important causes Targeted examination : : : : Acute vestibular syndrome Acute or subacute onset, continuous dizziness lasting hours to days…

…without a visible intimal flap or false lumen. It is commonly attributed to rupture of the vasa vasorum, although improved imaging demonstrates small intimal disruptions…

…without diagnostic electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort…

…pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed…

Cardiology Emergency medicine Definition and pathophysiology Acute pulmonary embolism (PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and…

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…

…Bold text indicates agents commonly used to prevent or treat acute and subacute ventricular arrhythmias Classification of ventricular tachycardia (VT) Ventricular arrhythmia Definition and classification…

…represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic…

…substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting in delayed treatment. In response to these limitations…

…The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and…

…inversions and pathological Q waves may be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic…

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

…Atherothrombosis represents the acute, life threatening complication of coronary atherosclerosis. The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary…

…segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other hand, are much less likely to be caused by…

…instability and hypertension [4]. Step 2: look systematically for acute organ damage Organ or condition Findings to look for Initial investigation : : : CNS Confusion, reduced consciousness…

…V7, V8 and V9 in patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2…

…only revascularization treats the artery responsible for the acute clinical event during the index procedure. Complete revascularization aims to treat all lesions producing myocardial ischaemia…

…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…

…and infarction Definition and conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and…

…of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or…

…to infarction due to the collaterals. Occasionally, patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to…

…ST segment depressions, and T wave inversions. These overlapping features frequently lead to confusion between LBBB and acute STEMI. In fact, studies have shown that…

…the onset of acute myocardial infarction. The maximum troponin value is observed in 12–48 hours. Troponin may be elevated for up to 2 weeks…

Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

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…

ECG Myocardial ischemia and infarction ECG in acute myocardial ischemia: ischemic ST segment & T wave changes This chapter discusses typical and atypical changes in the…

…guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal correlation…

…affected, then the left ventricle is virtually always affected due to the coronary anatomy (refer to the chapter Coronary Arteries and Localization of Infarction & Ischemia)…

…coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine as an adjunct to, rather…

…pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not…

…and prognosticate survival. However, exercise stress testing must not be performed within 4 to 6 days after acute myocardial infarction. Moreover, early exercise tests should…

…and unstable angina. Although ECG changes in NSTEMI and unstable angina have been discussed previously (refer to Classification of Acute Coronary Syndromes, and Ischemia and…

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

…of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications, is much less common in the acute phase…

…wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided. Only aspects relevant to ischemia will…

…pain that characteristically radiates to the back [5]. 3. Acute Pericarditis Pain Characteristics: The pain is typically pleuritic and tends to worsen when the patient…

…acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury. In classic dissection, an intimal tear permits blood to…

…of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to their distinct pharmacodynamic mechanisms. These drugs are broadly utilised to augment…

…include acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy, the clinical presentation of ACS is generally similar to that…

…Angina occurring after a recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms…

…studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades. Furthermore, early revascularization in acute coronary syndromes…

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

…or newly developed during the acute illness The ventricular rate and its relationship to symptoms and haemodynamic status Whether heart failure is present and whether…

…isolated BP value is sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent or…

…temporally and clinically distinct complications of acute myocardial infarction (AMI): Early infarct associated pericarditis , which develops from several hours to approximately 4 days after infarction…

…underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic blood interact to initiate and extend thrombosis…

…Definition and Pathophysiology ST segment elevation myocardial infarction (STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or…

…myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute obstruction can lead to rapid hemodynamic deterioration, cardiogenic shock…

…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…

…acute pericarditis (perimyocarditis), constrictive pericarditis, pericardial effusion and tamponade. Less common are cysts and tumors of the pericardium, as well as congenital malformations leading to…

…pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol. An anticoagulant is…