…or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock, serious arrhythmia or acute heart…

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

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…

…a single apparently reassuring measurement. Finding Moderate attack Acute severe attack Life threatening attack : : : : Speech Full sentences Cannot complete a sentence in one breath Single…

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

…Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination is therefore not sufficient to…

…is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media. The lesion may produce a localized medial haematoma…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

…The abrupt arterial obstruction may result from progression of peripheral arterial disease, cardiac or aortic embolisation, acute aortic dissection, thrombosis of a graft or aneurysm…

…tools Acute RV failure is a rapidly progressive syndrome characterized by systemic congestion resulting from impaired RV filling and/or reduced RV output. Recognition 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…

…in acute, unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose During ongoing opioid treatment: a breakthrough…

…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…

…or collecting system. With iodinated contrast, the observed renal dysfunction may therefore reflect a combination of: direct tubular toxicity; renal haemodynamic disturbance and ischaemia; pre…

…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…

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

…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…

…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…

…also consistent with the vector theory; elevation in one lead should be recorded as depression in a lead with an opposite angle of observation. However…

…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…

…immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute myocardial…

…treatment. The presence of ST segment changes or a positive troponin assay identifies patients in whom an invasive strategy is generally preferred over selective angiography…

…single antiplatelet therapy (SAPT), most often aspirin. In selected patients, P2Y12 inhibitor monotherapy may be used as a de escalation strategy after a period of…

…to a single lesion. Consequently, local revascularization must be accompanied by systemic treatment aimed at stabilizing the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary…

…Importance of repeated ECG recordings Acute coronary syndromes are dynamic processes. Factors that promote thrombosis ( pro thrombogenic factors ) are constantly in a struggle with factors…

…to episodes of more severe myocardial ischemia. Collateral circulation may be very effective in reducing ischemia. Indeed, it may be so efficient that a total…

…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…

…of acute myocardial infarction. The maximum troponin value is observed in 12–48 hours. Troponin may be elevated for up to 2 weeks after a…

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…

…bone in question): A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis or orthopaedic…

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

…are the strongest predictors of adverse outcomes. Non acute or asymptomatic bradycardia Non acute bradycardia is a common finding in both healthy and diseased individuals…

…RCA also supplies the inferior left ventricular wall in over 90% of all individuals. Hence, a proximal occlusion (in the RCA) which cuts off blood…

…recovering from myocardial infarction or acute coronary syndrome. Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome…

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

…6 days after acute myocardial infarction. Moreover, early exercise tests should not be maximal, which means that the clinician must set a lower goal regarding…

…previously (refer to Classification of Acute Coronary Syndromes, and Ischemia and the ST Segment and ST segment depressions), a rehearsal of ECG characteristics and criteria…

…once the exercise is stopped. Some experts believe that these ST segment depressions represent a benign form of subendocardial ischemia. Refer to Exercise Stress Testing…

…less common in the acute phase. The chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system involving…

…acute (ongoing) ischemia. Isolated T wave inversions – i.e T wave inversions without concomitant ST segment deviation (elevation or depressions) – is never a sign of…

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…

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…

…acts primarily as a vasopressor. While detailed receptor pharmacology is not specified in the source material, it is utilised alongside inotropes in acute heart failure…

…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…

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

…from the Swedish Cardiac Arrest Registry, which has recorded causes of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes…

…cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have often described a J shaped association between consumption and cardiovascular outcomes, with…

…newly developed during management of an acute illness. The clinical relationship between AF and acute deterioration is often bidirectional. AF with a rapid ventricular response…

…no single BP threshold is diagnostically sufficient: the presence of ongoing acute organ injury is decisive. The pathophysiology reflects failure of vascular autoregulation during a…

…is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is…

…The underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic blood interact to initiate and extend…

…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…

…coronary artery (LMCA) occlusion is a rare but catastrophic manifestation of acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior…

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

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

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

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