…dangerous differential diagnoses [1,2]. STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based…

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

…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…

…ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an…

…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…

…lumen. It is commonly attributed to rupture of the vasa vasorum, although improved imaging demonstrates small intimal disruptions in approximately 20%–60% of cases. These…

…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…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

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…

…hour to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24…

…a sudden heart rate decrease (e.g due to sinus pause or post VPC pause) results in augmentation of early afterdpolarization amplitude (typically seen with…

…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…

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

…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…

…pain, back pain or suspected acute aortic syndrome. 5. Use the correct cuff size. A cuff that is too small overestimates the blood pressure. 6…

…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…

…the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery…

…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…

…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…

…factor]) which stimulate nearby arteries to grow new vessels into the ischemic zone. Newly formed vessels, which may originate from other branches of the same…

…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…

…children 24 G Yellow 15–20 mL/min Neonates and small children The flows apply to water by gravity according to the manufacturers' standard measurements…

…myocardium to contract simultaneously. Since the membrane potential is relatively unchanged during the plateau phase, the potential differences in the myocardium will be small during…

…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)…

…sites. Its cardiovascular effects therefore appear to reflect modulation of vascular inflammation rather than lipid lowering. Other anti inflammatory strategies have produced less favourable results…

…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…

…congestion. In pregnant patients presenting with suspected acute heart failure, urgent hospital admission and referral to an expert centre with advanced heart failure care capabilities…

…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…

…or process. Although Type 1 MI and acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential…

…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…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…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…

…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…

…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…