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…

…a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively…

…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…

…10. Call anaesthetics and intensive care early with life threatening features or an inadequate response. First line treatment is oxygen in hypoxaemia, repeated doses of…

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

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…rupture may occur. Compared with classic type A dissection, aortic regurgitation, pulse deficits, and malperfusion are less frequent in type A IMH. IMH is classified…

…pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms…

…adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia…

…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…

…right ventricular hypertrophy (RVH) from posterior acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R waves ( Figure 2…

…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…

…subset of patients with acute coronary occlusion (ACO) who do not meet the established ECG criteria for STEMI, leading to delays in potentially life saving…

…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…

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

…break through the intimal layer, provoking localized thrombosis. This is predominantly observed in older patients with heavily calcified, tortuous vessels [2] . Regardless of the initiating…

…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…

…for example in pregnancy, acute glomerular disease or scleroderma renal crisis [1,2]. A hypertensive emergency means a markedly raised blood pressure together with ongoing…

…onset in patients without contraindications. I A In the absence of ST segment elevation, primary PCI is indicated in patients with symptoms suggestive of acute…

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…

…with increased risk of major adverse cardiovascular events (MACE) and stent thrombosis. Premature DAPT interruption is described as the strongest predictor of stent thrombosis in…

…5% of such lesions caused a clinical event during 3.4 years of follow up in a prospective study of patients with acute coronary syndrome…

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

…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…

…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…

…elevated in patients with renal failure, this is more pronounced for troponin T ( Seng et al ). Troponin I rises faster than troponin T in acute…

…reduce the antiplatelet effect of acetylsalicylic acid. Use with caution in patients on low dose acetylsalicylic acid for cardioprotection. Pharmacokinetic interactions Methotrexate: NSAIDs inhibit tubular…

…the hand is suitable for finer cannulae. Avoid the lower limb in adults. In shock with collapsed vessels, the antecubital fossa or the external jugular…

…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…

…and presence of high risk arrhythmias on ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia…

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…

…anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome. Patients with stable or…

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

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

…grouped. The chain of care in NSTEMI and unstable angina Management of patients with acute coronary syndromes is permeated by the mantra time is myocardium…

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

…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…

…depressions) – is never a sign of acute ischemia. T wave inversions with concomitant ST segment deviations are, however, typical of ischemia but in that scenario…

…A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than…

…Important presentations include: Hypotension or shock Acute severe aortic regurgitation with heart failure Cardiac tamponade from haemopericardium Myocardial ischaemia from coronary ostial compromise Focal neurological…

…rate parameters. Clinical Presentation and Symptoms Acute heart failure necessitating inotropic or vasopressor support typically manifests in patients with left ventricular systolic dysfunction, low cardiac…

…acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy, the clinical presentation of ACS is generally similar to that in…

…at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI), in which myocardial…

…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…

…synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use…

…long term risk of stroke. In patients with acute decompensated heart failure, AF with rapid ventricular response is particularly important. Cardioversion is generally not immediately…

…pressure. Renal and microvascular complications Renal involvement may manifest as deterioration in renal function and urinary abnormalities. Malignant hypertension may cause acute microangiopathy, with renal…

…difficulty in a patient recently treated for AMI. Dyspnoea may occur, particularly when the effusion is substantial or when haemodynamic consequences develop. In patients with…

…symptoms generally do not resolve simply with cessation of activity, unlike typical exertional angina. A precipitating factor is identifiable in up to one half of…

…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…

…heart failure with mid range ejection fraction) are relatively new entities and there are currently no effective treatments that modify the natural course in these…

…heart failure with mid range ejection fraction) are relatively new entities and there are currently no effective treatments that modify the natural course in these…

…its surroundings, the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood…

…and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region…