…liver tests Repeat the tests first — a transient rise is common. If the abnormality persists: hepatitis serology (A, B, C, E), iron studies and ferritin…

…Overview Acute coronary syndrome comprises STEMI, NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG…

…causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for ventilatory support . At the same time, exacerbation is…

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

…same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory flow limitation causes air trapping and dynamic hyperinflation. The consequences…

Neurologi Akutsjukvård Lathundar About this quick reference This is a practical quick reference for emergency physicians in suspected acute ischaemic stroke. It covers time windows…

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

Cardiology Emergency medicine Definition and Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for…

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

…collateral circulation is adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate…

…acute PE severity , including clinical findings, RV dysfunction on imaging, and myocardial injury shown by laboratory testing. Comorbidity and aggravating conditions , which may worsen early…

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…

…approximate. When switching between opioids, cross tolerance is incomplete: reduce the calculated equianalgesic dose by 25–50 per cent and titrate. At a high dose…

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

Adapted from AHA, ACC and ESC guidelines.

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

…differentiate between OMI and NOMI, reflecting the growing clinical demand for more accurate and timely identification of acute coronary occlusion (Al Zaiti et al, 2023)…

…wave inversions. Most patients with NSTE ACS will develop acute myocardial infarction, which is then classified as NSTEMI (Non ST Elevation Myocardial Infarction). Patients with…

…Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common initiating mechanism is rupture or erosion of a…

…beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent…

…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)…

…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

…without acute organ damage. Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example…

…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…

…or an initial medical strategy. In haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as…

…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…

…5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients with acute coronary syndrome…

…An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients with acute coronary syndromes. Importantly, the ECG findings dictate…

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…

…STEMI). Hence, an acute myocardial infarction may actually result in LBBB which then masks the ischemic ST T changes on ECG. In summary, left bundle…

…suspected acute coronary syndromes. Several manufacturers have developed highly sensitive troponin assays for troponin I (cTnI) and troponin T (cTNT). The following differences exist between…

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

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…

Cardiology Diagnosis and treatment of bradycardia (bradyarrhythmia) Acute bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should…

ECG Myocardial ischemia and infarction Acute myocardial infarction (AMI) always affects the left ventricle Myocardial infarction is virtually synonymous with left ventricular infarction . All myocardial…

…populations The evidence for anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…

…For example, exercising patients with ongoing myocardial ischemia may provoke life threatening ventricular arrhythmias. Patients with previous acute coronary syndromes (ACS) Exercise stress testing is…

…and unstable angina is less severe than the pain in acute STEMI. This is explained by the fact that NSTEMI and unstable angina are caused…

…to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment. Indeed, North American and European guidelines…

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

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…

…and non cardiac etiologies [1]. Cardiac Causes The primary differential diagnoses include conditions that directly affect the myocardium or major vessels. 1. Acute Coronary Syndrome…

…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…

…therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant women without pre existing heart disease, such as in peripartum cardiomyopathy…

…Myocardial ischemia and infarction Definition and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall…

…to a single lesion or process. Although Type 1 MI and acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result…

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

…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…

…assessment should also clarify: Whether AF is pre existing, newly detected, or newly developed during the acute illness The ventricular rate and its relationship to…

…non invasive ventilation or intubation. Aortic disease An acute aortic dissection is a hypertensive emergency requiring the most rapid BP response. The objective is to…

…AMI): Early infarct associated pericarditis , which develops from several hours to approximately 4 days after infarction and is usually transient. Late post acute myocardial infarction…

…stage of the ischaemic process: acute, evolving or chronic The severity of ischaemia and whether infarction has occurred The extent and degree of myocardial involvement…

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

…occlusion, likely because most such occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic process is dynamic, with…

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

…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…

…is considered to contribute to the fact that the ventricles are not overfilled in acute volume loads. Pericardial Effusion: fluid in the pericardial space Normally…