…failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain, but the effect on the…

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…

…varies widely and may involve intrinsic cardiac disease, extrinsic systemic conditions, or pharmacologic effects. Inflammatory heart disease, caused by infections (viral, bacterial, protozoal, fungal, parasitic)…

…STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based on symptoms, the ECG and…

…set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need for…

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

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

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…syndrome Acute persistent unsteadiness or ataxia without clear spontaneous nystagmus Cerebellar or brainstem infarction, intoxication, Wernicke's encephalopathy, other central disease Neurological examination, gait and…

Cardiology Emergency medicine Definition and Pathophysiology Acute aortic syndromes comprise classic aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU). Aortic dissection accounts for…

…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…

…Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions…

…NSTE ACS/NSTEMI are almost invariably accompanied by ST segment depressions in other leads (particularly V5) and that is not consistent with posterior transmural ischemia…

…per day. Patches have no place in acute, unstable pain: the onset takes 12 to 24 hours and the offset just as long. Breakthrough dose…

…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…

Adapted from AHA, ACC and ESC guidelines.

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

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…

…other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute Coronary Syndrome) & STEMI (ST Elevation Myocardial Infarction) Acute…

…however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia…

…patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular function…

…ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), and ST Elevation Myocardial Infarction (STEMI…

…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…

…blood pressure without acute organ damage should as a rule not be lowered rapidly with intravenous drugs. Restart or optimise oral treatment and ensure follow…

…primary PCI is indicated in patients with symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or…

…acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery is completely occluded and is particularly associated with MVD…

…aspirin and an oral P2Y12 receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous…

…s morphology does not reliably establish that it will cause an acute event. A more clinically useful model considers both the plaque and the patient…

…for interpretation of ischemia. All available ECG criteria for acute myocardial infarction and ischemia are based on conventional 12 lead ECG. Established ECG criteria do…

…In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows…

…block (LBBB) can mimic acute STEMI , as it often presents with similar ECG changes, including ST segment elevations, ST segment depressions, and T wave inversions…

…detecting troponins in patients with suspected acute coronary syndromes. Several manufacturers have developed highly sensitive troponin assays for troponin I (cTnI) and troponin T (cTNT)…

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

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…

…familiar with the classification of acute coronary syndromes. Subsequent chapters will deal with ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial…

…non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal correlation between the symptoms and…

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…

…Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes…

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…

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

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

…due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment. Indeed, North American and European…

…Management Acute ST Elevation Myocardial Infarction (STEMI) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology, definitions, criteria and…

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…

…5]. 3. Acute Pericarditis Pain Characteristics: The pain is typically pleuritic and tends to worsen when the patient lies flat or moves [2], [5]. Localization…

…follow cardiac surgery, coronary angiography or other invasive procedures, and affected patients may be relatively painless compared with those with spontaneous dissection. Clinical manifestations may…

…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…

…double lumen appearance. Clinical presentation and symptoms SCAD generally presents as ACS. Symptoms may therefore include acute chest pain or chest discomfort, with associated manifestations…

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

…electrolyte concentrations, and other factors (potentially also genetic predisposition) interact to trigger ventricular tachycardia or ventricular fibrillation. These factors interact and vary over time. Some…

…Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related…

…establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary ischaemia. These findings determine the urgency and type of intervention…

…Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the kidneys, retina, and brain…

…associated pericarditis , which develops from several hours to approximately 4 days after infarction and is usually transient. Late post acute myocardial infarction pericarditis , traditionally termed…

…an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every…

…The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure and cardiogenic shock…

…have complete LMCA occlusion, likely because most such occlusions result in prehospital cardiac arrest and death. As in other acute coronary events, the thrombotic process…

…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…