…STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based on symptoms, the ECG and…

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

…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…

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

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…gait and truncal stability Acute balance syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke's encephalopathy, other…

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

…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…

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

…is central to determining the intensity of monitoring, supportive treatment, anticoagulation, and possible reperfusion. The principal pathophysiological determinant of early adverse outcome is acute RV…

…NSTEMI are almost invariably accompanied by ST segment depressions in other leads (particularly V5) and that is not consistent with posterior transmural ischemia. To conclude…

…per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose…

…g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with large T wave amplitude), and QT…

Adapted from AHA, ACC and ESC guidelines.

…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…

…an acute coronary occlusion, rather than rigid ECG thresholds. Several machine learning models for ECG interpretation have been developed to differentiate between OMI and NOMI…

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

…however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia…

…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…

…stable plaques are characterized by a thick fibrous cap and a small lipid core, the pathophysiology of Acute Coronary Syndromes (ACS) is driven by the…

…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…

…can also cause autonomic instability and hypertension [4]. Step 2: look systematically for acute organ damage Organ or condition Findings to look for Initial investigation…

…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…

…contraindication and the coronary anatomy is suitable. In cardiogenic shock, the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other…

…aspirin and an oral P2Y12 receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous…

…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…

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

…originate from other branches of the same coronary artery or another coronary artery, will alleviate the ischemia, improve myocardial function and increase resistance to episodes…

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

…I and T during acute myocardial infarction As noted above, cardiac troponin I (cTnI) concentrations tend to increase to higher levels than cTnT during acute…

…and antihypertensives: NSAIDs may reduce the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other…

…Neonates and small children The flows apply to water by gravity according to the manufacturers' standard measurements. Blood and colloids flow more slowly, and every…

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

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

…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)…

…and impair neutrophil chemotaxis toward inflammatory sites. Its cardiovascular effects therefore appear to reflect modulation of vascular inflammation rather than lipid lowering. Other anti inflammatory…

…often leads to a mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders…

…after acute myocardial infarction in order to assess the presence of myocardial ischemia, evaluate angina pectoris, evaluate exercise performance, evaluate the effect of interventions and…

…are due to partial (incomplete) coronary artery occlusions , which implies that there remains residual blood flow in the artery. Moreover, management of NSTEMI and unstable…

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…

…Indeed, ventricular tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or…

ECG Myocardial ischemia and infarction T wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided…

…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…

…to anatomy correlation. Pain may be absent, particularly in iatrogenic aortic injury. Iatrogenic lesions commonly follow cardiac surgery, coronary angiography or other invasive procedures, and…

…utilised alongside inotropes in acute heart failure to support systemic blood pressure through its infusion rate parameters. Clinical Presentation and Symptoms Acute heart failure necessitating…

…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…

…1 MI and acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential diagnoses and alternative causes…

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

…Progressive dilation can subsequently impair left ventricular ejection fraction. Enlargement of the left ventricle predisposes to atrial and ventricular arrhythmias. In advanced alcohol related cardiomyopathy…

…contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and…

…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…

…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…

…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…

…presenting feature. The source material emphasizes that patients and families should be educated to recognize chest discomfort or dyspnoea as potentially indicating myocardial infarction, particularly…

…are found to have complete LMCA occlusion, likely because most such occlusions result in prehospital cardiac arrest and death. As in other acute coronary events…

…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…

…myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood tests and other…

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