…ALT 50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and…

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

…acute on chronic hypercapnic respiratory failure Rapidly falling pH An urgent ventilatory problem Focal chest pain or unilaterally reduced breath sounds Consider pneumothorax New arrhythmia…

…a postrenal cause cannot confidently be excluded. 10. Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute…

…improvement only if air entry, speech, work of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by…

…Acute overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3. Assess airway…

…practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner is trained. Brief attacks triggered by the position…

…hypertension, and concomitant abdominal aortic aneurysm. Clinical Presentation and Symptoms Acute chest and/or back pain is the predominant symptom of both IMH and PAU…

…acute myocardial ischaemia. It includes patients with recent changes in symptoms or clinical signs, with or without diagnostic electrocardiographic abnormalities and with or without an…

…states or iatrogenic vascular injury. Acute occlusion may also occur in an artery with established collateral circulation, particularly an occluded bypass graft; in such cases…

…PE and therefore requires an emergency management pathway. Patients without haemodynamic instability require more detailed prognostic evaluation using two complementary domains: Indicators of acute PE…

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…

…morphine per day, and 25 micrograms/hour to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain…

…prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on…

Adapted from AHA, ACC and ESC guidelines.

…and advanced CKD. The clinical course is often more rapidly reversible than that of other forms of acute tubular necrosis, although the complication remains associated…

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

…acute coronary syndromes and myocardial infarctions. The reader should study this chart carefully. Figure 1. Flowchart showing the natural course of coronary artery disease and…

…Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in…

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

…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…

…in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A…

…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…

…ST segment elevation acute myocardial infarction). 1 Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12 lead ECG should be interpreted immediately…

…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…

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

…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…

…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…

…the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows: The size…

…to confusion between LBBB and acute STEMI. In fact, studies have shown that LBBB is the most common cause of false activations of the catheterization…

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

…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…

…acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula in a…

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

…The absence of symptoms indicates that the bradycardia is compensated by an increase in stroke volume. Symptomatic bradycardia may present with chronic or acute symptoms…

…thicker and – except the endocardium – it cannot utilize the oxygen from within the ventricular cavity. The location of acute myocardial infarction refers to the area…

…and because of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial…

…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…

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

…with acute coronary syndromes is permeated by the mantra time is myocardium, which refers to the progressive loss of myocytes following the occlusion of a…

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…

…acute STEMI (ST elevation myocardial infarction). Overview of management Click the diagram to enlarge. Chest pain (discomfort) is the hallmark symptom of myocardial ischemia and…

…indicate acute (ongoing) ischemia. Isolated T wave inversions – i.e T wave inversions without concomitant ST segment deviation (elevation or depressions) – is never a sign…

…Sudden onset with diaphoresis [4]. Aortic Dissection Severe, often sharp pain radiating to the back [5]. N/A N/A Acute Pericarditis Pleuritic, often retrosternal…

…ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that remains uncontrolled despite optimal therapy Acute type A dissection has a particularly rapid early mortality…

…patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute heart failure and cardiogenic shock…

…formation of an intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS)…

…provoked by less exertion. Angina occurring after a recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

…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…

…with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in decompensated heart failure (DHF). In the critically ill patient, AF may…

…110 mmHg with acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence of ongoing acute organ injury is…

…hours to approximately 4 days after infarction and is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed Dressler syndrome , which is a manifestation…

…characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion…

…reduction of myocardial energy requirements and mitigation of reperfusion injury are complementary objectives of initial STEMI management. The principal acute complications fall into two broad…

…suggestive of significant LMCA disease, including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy…

…failure is a major public health problem worldwide. While the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50…

…failure is a major public health problem worldwide. While the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50…

…Thus, the pericardium is considered to contribute to the fact that the ventricles are not overfilled in acute volume loads. Pericardial Effusion: fluid in the…