…paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis. The three are distinguished by the history and the speed of the course. An AST…

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…

…Silent or nearly silent chest Very severe airflow obstruction pH below 7.35 with raised pCO₂ Acute or acute on chronic hypercapnic respiratory failure Rapidly…

…Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine value…

…treatment carries more weight than a single apparently reassuring measurement. Finding Moderate attack Acute severe attack Life threatening attack : : : : Speech Full sentences Cannot complete a…

…excellent functional outcome, without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1. Activate the stroke call. 2. Establish the time…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…Symptoms Acute chest and/or back pain is the predominant symptom of both IMH and PAU. PAU pain may resemble the abrupt pain of classic…

…and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina at rest, usually lasting…

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

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

…difficult to differentiate right ventricular hypertrophy (RVH) from posterior acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R…

…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 are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority…

…other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality. Pathophysiology The precise mechanism of contrast induced AKI…

…with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting in delayed treatment. In response to these limitations, a novel classification has…

…not completely obstructed). NSTE ACS typically presents with ST segment depressions and/or T wave inversions. Most patients with NSTE ACS will develop acute myocardial…

…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…

…the concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic…

…a process known as atherothrombosis [2] . Atherothrombosis represents the acute, life threatening complication of coronary atherosclerosis. The transition from a quiescent plaque to a highly…

…be studied in detail. Figure 2. The electrocardiographic natural course in STEMI (ST elevation myocardial infarction). Pitfalls Acute transmural ischemia located in the basal portio

…peripheral venous cannula. 4. Measure the blood pressure in both arms at the first assessment, particularly in chest pain, back pain or suspected acute aortic…

…is indicated as soon as possible in the acute phase but should not delay reperfusion treatment. I C Blood samples Management Recommendation Level of evidence…

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…

…the combined use of aspirin and an oral P2Y12 receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary…

…factors. Plaque erosion Plaque erosion is increasingly recognized and is present in at least one third of acute coronary syndromes in the cited material. Eroded…

…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…

ECG Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS …

…branch block (LBBB) and symptoms of ischemia follows: Left bundle branch block (LBBB) can mimic acute STEMI , as it often presents with similar ECG changes…

…et al, Twerenbold et al) Kinetics Troponin T (cTnT) and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The…

…effects of cyclosporine and tacrolimus. Monitor kidney function. Diuretics and antihypertensives: NSAIDs may reduce the efficacy of diuretics and antihypertensives. Risk of acute kidney injury…

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

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

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

…cavity. The left ventricle is considerably thicker and – except the endocardium – it cannot utilize the oxygen from within the ventricular cavity. The location of acute…

…in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary…

…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…

…4 to 6 days after acute myocardial infarction. Moreover, early exercise tests should not be maximal, which means that the clinician must set a lower…

…However, unstable angina is considered an acute coronary syndrome because it is an imminent precursor to myocardial infarction. Approximately 50% of patients with unstable angina…

…segment depressions with prominent T waves in the majority of the chest leads may indicate an acute occlusion in the LAD (left anterior descending artery)…

…ischemia and is particularly pronounced in patients experiencing acute STEMI. The severity of symptoms in STEMI patients, compared to those with Non ST Elevation Myocardial…

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…

Emergency medicine Lathundar Differential Diagnosis of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome…

…dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury. In classic dissection…

…context of perioperative care in patients with pulmonary arterial hypertension (PAH), progression of right heart failure may indicate the need for inodilator therapy. Furthermore, acute…

…Symptoms may therefore include acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy, the clinical presentation of ACS is generally…

…recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms or signs, with or…

…current figure is approximately 60%. The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary…

…and genetic predisposition. Acute cardiovascular effects Acute ethanol exposure has a negative inotropic effect and promotes peripheral vasodilation through reduced systemic vascular resistance. The resulting…

…ACS, AF may be present before the acute event, detected for the first time during its management, or arise during the course of treatment. Even…

… no isolated BP value is sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent…

…is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is…

…on several interacting factors: The stage of the ischaemic process: acute, evolving or chronic The severity of ischaemia and whether infarction has occurred The extent…

…early clinical priorities include: Recognition of symptoms suggestive of myocardial infarction. Rapid acquisition and interpretation of a 12 lead ECG. Assessment for haemodynamic instability, acute…

…to the sinoatrial nodal branch (SN, 1), conus branch (CB, 2), right ventricular branch (RV, 3), acute marginal branch (AM, 4), atrioventricular nodal branch (AV)…

…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…

Cardiology Heart failure Heart failure is a major public health problem worldwide. While the incidence of coronary heart disease and acute myocardial infarction has been…

…ventricles are not overfilled in acute volume loads. Pericardial Effusion: fluid in the pericardial space Normally, the pericardial sac contains 25 to 50 ml of…