…dangerous differential diagnoses [1,2]. STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based…

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

…shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded…

…speech, work of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus…

…The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of onset…

…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…

…Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for approximately 80%–90% of acute…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

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…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…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…

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

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

ECG Introduction The traditional classification of acute coronary syndromes (ACS) into ST segment elevation myocardial infarction (STEMI), non STEMI (NSTEMI), and unstable angina (UA) has…

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

…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)…

…upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other hand, are much…

…and current antihypertensive treatment. Missed doses or abrupt withdrawal of a beta blocker, clonidine or another sympatholytic drug. Cocaine, amfetamine, other sympathomimetics, herbal remedies and…

…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…

…the principal precipitating mechanisms include ischaemia related heart failure, acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery…

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

…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…

…from other branches of the same coronary artery or another coronary artery, will alleviate the ischemia, improve myocardial function and increase resistance to episodes of…

…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…

…the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal…

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…

…neutrophil chemotaxis toward inflammatory sites. Its cardiovascular effects therefore appear to reflect modulation of vascular inflammation rather than lipid lowering. Other anti inflammatory strategies have…

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…

…Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be…

…infarction Non ST Elevation Acute Coronary Syndromes (NSTE ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus of this chapter is…

…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…

…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…

…is often indicative of a noncardiac source [4]. 3. Pneumonia with Pleurisy Pain Characteristics: Pleuritic pain is a common presentation [2]. 4. Other Systemic/Local…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

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…

…and acute coronary syndromes are commonly related to atherothrombotic events, myocardial ischaemia may also result from other mechanisms. Differential diagnoses and alternative causes of troponin…

…recorded causes of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical…

…drinking in either sex. Other definitions of unhealthy drinking include at least two drinks daily in women or three in men, or at least four…

…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…

…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…

…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…

…As in other acute coronary events, the thrombotic process is dynamic, with varying degrees of occlusion that may provide a window of opportunity for reperfusion…

…the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart…

…the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart…

…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…

…any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute…