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…

…Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway, work of breathing…

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

…or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an inadequate…

…in suspected acute ischaemic stroke. It covers time windows, indications and contraindications for intravenous thrombolysis, weight based tenecteplase dosing, blood pressure thresholds, monitoring, complications and…

…present, neurological examination, gait and truncal stability Acute balance syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke…

…An isolated PAU is one without associated IMH, dissection, or saccular aneurysm. Symptomatic isolated lesions may represent early periulcer haemorrhage or developing IMH and carry…

…mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by prolonged angina…

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…

…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…

…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…

…Williams classification (Table 1). Agents in bold text are commonly used to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification…

…disease and advanced CKD. The clinical course is often more rapidly reversible than that of other forms of acute tubular necrosis, although the complication remains…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…ACS is the acronym for Non ST Elevation Acute Coronary Syndrome. This category includes all acute coronary syndromes without significant ST segment elevations on ECG…

…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…

…increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use…

…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)…

…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

…single blood pressure value does not define a hypertensive emergency. Even a blood pressure above 220/120 mmHg can occur without acute organ damage. Conversely…

…C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial infarction (troponin) should be sampled as early as possible without delaying reperfusion therapy…

…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…

…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…

…More than one mechanism may operate simultaneously. Some acute coronary events occur without an identifiable culprit thrombus. NSTE ACS generally reflects an imbalance between myocardial…

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…

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

Conduction defects ECG Myocardial ischemia and infarction Left bundle branch block (LBBB) in acute myocardial infarction (AMI): clinical implications & Sgarbossa criteria Contrary to right bundle…

…the onset of myocardial infarction. This is utilized in clinical practice by detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed…

…Dosage Acute myocardial infarction: Initial loading dose: 300–500 mg as soon as possible after symptom onset. Prophylaxis against cardiovascular complications (after acute myocardial infarction…

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…

…young individuals. The severity of symptoms and presence of high risk arrhythmias on ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients…

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…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Atherosclerosis and acute coronary syndromes have important inflammatory components. Inflammation contributes to atherothrombosis through activation of…

…and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs, with or without electrocardiographic…

…However, exercise stress testing must not be performed within 4 to 6 days after acute myocardial infarction. Moreover, early exercise tests should not be maximal…

ECG Myocardial ischemia and infarction Non ST Elevation Acute Coronary Syndromes (NSTE ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus…

ECG Myocardial ischemia and infarction ST segment depression due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or…

…of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications, is much less common in the acute phase…

…misunderstanding that isolated T wave inversions indicate acute (ongoing) ischemia. Isolated T wave inversions – i.e T wave inversions without concomitant ST segment deviation (elevation…

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…

…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…

…without an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute…

…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…

…than the brain. Patients with AF in the setting of ACS have more comorbidities and a higher risk of complications than patients without AF; both…

…Associated complications may include encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without…

…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…

…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…

…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…

…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…

…diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis), constrictive pericarditis…

…anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia…