…more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of…

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

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

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

…Do not wait for the blood gas result before starting treatment. Clinical assessment History that affects the level of risk Ask briefly and to the…

…aphasia, hemianopia or hand paresis in a person of working age Blood pressure Measure initially in both arms if this does not delay reperfusion treatment…

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

…Danlos syndrome Inflammatory aortitis, including Takayasu arteritis and giant cell arteritis Bicuspid aortic valve Coarctation of the aorta Previous aortic trauma Pregnancy, particularly the third…

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

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…

…by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk PE , also termed massive PE…

…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…

…opioid at the same time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination…

…type Ca 2+ channel blockers Diltiazem, Verapamil Singh–Vaughan Williams classification of antiarrhythmic drugs. Bold text indicates agents commonly used to prevent or treat acute…

…outcomes. The risk of death at 1 year is increased in comparison with patients with preserved renal function, although the association may not be causal…

…experience. Studies have demonstrated that a significant proportion of patients with acute coronary occlusion (ACO) do not exhibit classic ST segment elevation on ECG, leading…

…elevations on ECG. NSTE ACS is caused by partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…Hypotension can be counteracted with simultaneous administration of norepinephrine. All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g…

…or fully occlusive intraluminal thrombus [5] . ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI)…

…However, a concave ST segment does not rule out ischemia, it merely reduces the probability of ischemia as the underlying cause. Concave ST segment elevations…

…rate of treatment are determined by the affected organ function, not by the blood pressure figure alone [2]. A markedly raised blood pressure without acute…

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

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

…strategy The standard treatment after ACS is DAPT for 12 months , irrespective of stent type. The preferred regimen is aspirin plus a potent P2Y12 inhibitor…

…4 years of follow up in a prospective study of patients with acute coronary syndrome. Thus, an individual plaque’s morphology does not reliably establish…

…interpretation of ischemia. All available ECG criteria for acute myocardial infarction and ischemia are based on conventional 12 lead ECG. Established ECG criteria do not…

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

…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…

…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…

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…

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…

…thorough discussion of the electrophysiological principles, ECG changes and clinical implications is provided. The reader should already be familiar with the classification of acute coronary…

…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…

…ventricular cavity. The location of acute myocardial infarction refers to the area of the left ventricle When specifying the location of myocardial infarction, reference is…

…clinical development of canakinumab for this indication did not continue because of safety concerns, particularly fatal infections, and because of cost. Evidence in acute coronary…

…simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection, costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in…

…the effect of interventions and medications, and prognosticate survival. However, exercise stress testing must not be performed within 4 to 6 days after acute myocardial…

…definition an acute myocardial infarction, whereas unstable angina is not an infarction . Unstable angina is only diagnosed if there is no evidence of myocardial infarction…

…block) means that the left ventricle will not be depolarized via the Purkinje network, but rather via spread of the depolarization from the right ventricle…

…Diagnosing acute STEMI The diagnosis is straightforward using the electrocardiogram (ECG). Prehospital personnel have proven to be capable of recognizing STEMI using 12 lead ECG…

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…

…danger is progressive aortic wall disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion…

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…

…dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of an intramural haematoma that compresses the…

…The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute coronary syndromes are commonly related to…

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…

…water soluble and readily crosses cell membranes, allowing distribution throughout water containing tissues, including the myocardium. Its effects therefore depend not only on dose but…

…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…

…severe hypertension without clinical evidence of acute, ongoing target organ damage. Although BP reduction is required, these patients generally do not need hospital admission or…

…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 …

…although not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of…

…reperfusion central to survival. Clinical Presentation and Symptoms The characteristic symptom prompting activation of the STEMI pathway is ischaemic type chest discomfort, although dyspnoea may…

…of acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute…

…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…