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…

…fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal…

…according to KDIGO Acute kidney injury is present when at least one of the following criteria is met [1]: A rise in creatinine of at…

…Finding Moderate attack Acute severe attack Life threatening attack : : : : Speech Full sentences Cannot complete a sentence in one breath Single words or unable to speak…

…CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion…

…acute unilateral vestibulopathy, commonly called vestibular neuritis, but posterior circulation stroke is the most important dangerous differential diagnosis. Clear focal neurological findings are absent in…

…to rupture of the vasa vasorum, although improved imaging demonstrates small intimal disruptions in approximately 20%–60% of cases. These disruptions may initiate or complicate…

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

…and possible reperfusion. The principal pathophysiological determinant of early adverse outcome is acute RV failure. In acute PE, obstruction of pulmonary blood flow increases RV…

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…

…to approximately 40–50 mg of oral morphine per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24 hours…

…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…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

…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…

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

…criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in peripheral…

…Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, 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…

…ST segment elevation in acute myocardial ischemia ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia…

…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…

…infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not delay reperfusion treatment…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…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…

…Some acute coronary events occur without an identifiable culprit thrombus. NSTE ACS generally reflects an imbalance between myocardial oxygen supply and demand. In many cases…

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…

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

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…

…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…

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…

…of cost. Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants…

…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…

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

…However, the chest pain caused by NSTEMI and unstable angina is less severe than the pain in acute STEMI. This is explained by the fact…

…ST segment depressions with prominent T waves in the majority of the chest leads may indicate an acute occlusion in the LAD (left anterior descending…

…For the same reason, patients with STEMI are at higher risk of life threatening ventricular arrhythmias in the acute phase. Ventricular tachycardia (VT) and ventricular…

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…

…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…

…intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS), myocardial infarction (MI)…

…an elevation in cardiac troponin. The underlying pathological mechanism is not restricted to a single lesion or process. Although Type 1 MI and acute coronary…

…caused by acute or chronic coronary artery disease, with the latter being the most common. The figure 80% occurs in most textbooks in the field…

…Acute cardiovascular effects Acute ethanol exposure has a negative inotropic effect and promotes peripheral vasodilation through reduced systemic vascular resistance. The resulting mild reduction in…

…infarction may indicate an increased long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important…

…arteries in the kidneys, retina, and brain. Its clinical retinal signature includes flame haemorrhages, cotton wool spots, and papilloedema. Associated complications may include encephalopathy, acute…

…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…

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

…including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy of 5000 patients with non…

…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…

…is considered to contribute to the fact that the ventricles are not overfilled in acute volume loads. Pericardial Effusion: fluid in the pericardial space Normally…

…though cardioversion will occur Target rate in the acute phase: a resting ventricular rate < 110/min is a sufficient initial target in most patients…