…Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma…

…serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not…

…an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment…

…early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the…

…plugging. Expiratory flow limitation causes air trapping and dynamic hyperinflation. The consequences are increased work of breathing, exhaustion and, in the most severe cases, hypotension…

…suggest aortic dissection CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify…

…most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination…

…Symptom onset in PAU may indicate lesion expansion and involvement of the adventitia, requiring urgent imaging because of the risk of rupture. Type A IMH…

…cardiomyocyte necrosis occurring in the clinical setting of acute myocardial ischaemia and is diagnosed according to the fourth universal definition of MI. Type 1 MI…

Clinical medicine Emergency medicine Definition and pathophysiology Acute limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that…

…of monitoring, supportive treatment, anticoagulation, and possible reperfusion. The principal pathophysiological determinant of early adverse outcome is acute RV failure. In acute PE, obstruction of…

…Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the basal portion of the left…

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

…acute and subacute ventricular arrhythmias Classification of ventricular tachycardia (VT) Ventricular arrhythmia Definition and classification Ventricular tachycardia (VT) Definition : ≥3 consecutive QRS complexes generated in…

…mechanism of contrast induced AKI is incompletely defined. In many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of…

…findings. OMI is defined by acute coronary artery occlusion causing transmural ischemia and requiring urgent reperfusion, even in the absence of classic ST elevation. Multiple…

…of ST segment elevations in the former. Refer to Figure 1, which illustrates the natural course of coronary artery disease, from risk factors to acute…

…and the cell membranes collapse whereby cellular proteins are released into the circulation. It is possible to detect elevated levels of myocardial proteins in blood…

…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…

…deposition, culminating in a partially or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non…

…ischemia, it merely reduces the probability of ischemia as the underlying cause. Concave ST segment elevations are very common in the population (discussed below). Study…

…may need active treatment and prompt follow up, but not necessarily acute normalisation in the emergency department [1,3]. Step 1: confirm the blood pressure…

…as possible in the acute phase but should not delay reperfusion treatment. I C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial…

…strategy. In haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as potential causes of shock…

…months , irrespective of stent type. The preferred regimen is aspirin plus a potent P2Y12 inhibitor, usually prasugrel or ticagrelor. In patients undergoing PCI for ACS…

…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…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…is slightly simplified. In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications…

…depressions, T wave changes) are typically concealed in the setting of LBBB. A patient with acute STEMI may therefore display a normal LBBB pattern. LBBB…

…and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The maximum troponin value is observed in 12–48 hours…

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…

…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…

…acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (Non STEMI, NSTEMI) in…

…Figure 1. Management of acute bradycardia in the emergency setting. Parameter Assessment A Airway Voice Breath sounds B Breathing Respiratory rate (12–20 / min) Chest…

…ventricle in 90% of the cases. As compared with the right ventricle, the left ventricle contracts against much greater resistance (i.e. the pressure in…

…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…

…electrocardiographic changes, and with or without acute elevations in cardiac troponin concentrations. Based on the presenting electrocardiogram (ECG) and the presence of troponin elevation, ACS…

…with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial ischemia…

…grouped. The chain of care in NSTEMI and unstable angina Management of patients with acute coronary syndromes is permeated by the mantra time is myocardium…

…Occurrence of upsloping ST segment depressions with prominent T waves in the majority of the chest leads may indicate an acute occlusion in the LAD…

…chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system involving both prehospital and hospital based services. In…

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…

…particularly in females, the elderly, or patients with diabetes [4]. Associated Findings: The sudden onset of symptoms coupled with diaphoresis should always raise concern for…

…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…

Cardiology Critical care Pharmacology & dosing Definition and Pathophysiology In the management of acute heart failure and cardiogenic shock, intravenous vasoactive agents are categorised according to…

…to demonstrate an intramural haematoma or double lumen Type 1 is reported in fewer than one third of cases in the pregnancy related source material…

…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…

…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…

…of intracellular signalling and protein synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In…

…urgency and type of intervention. The assessment should also clarify: Whether AF is pre existing, newly detected, or newly developed during the acute illness The…

…Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute stroke requires attention to the type of stroke…

…ischemia and infarction Definition and pathophysiology Post infarction pericarditis encompasses two temporally and clinically distinct complications of acute myocardial infarction (AMI): Early infarct associated pericarditis …

…myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic…

…is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic symptoms…

…occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic process is dynamic, with varying degrees of occlusion that…

…Types of heart failure. Type Description Ejection fraction (%) HFREF Heart Failure with Reduced Ejection Fraction <40% HFmrEF Heart Failure with midrange Ejection Fraction 40–49…

…Types of heart failure. Type Description Ejection fraction (%) HFREF Heart Failure with Reduced Ejection Fraction <40% HFmrEF Heart Failure with midrange Ejection Fraction 40–49…

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