…an emergency management pathway. Patients without haemodynamic instability require more detailed prognostic evaluation using two complementary domains: Indicators of acute PE severity , including clinical findings…

…toe pressure < 30 mmHg. Decompensated heart failure — compression of both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis…

…a blood gas and an ECG all come before complete identification of the substance. Treatment of acute poisoning consists of four parallel components: supportive treatment…

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

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

…contrast media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and…

…speech, work of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus…

…without an increased risk of symptomatic intracerebral haemorrhage or death [3]. Acute overview 1. Activate the stroke call. 2. Establish the time of symptom onset…

…by the position of the head relative to gravity: perform Dix Hallpike and, if needed, the supine roll test. Spontaneous attacks without a clear trigger…

…the aortic lumen and the haematoma and without a visible intimal flap or false lumen. It is commonly attributed to rupture of the vasa vasorum…

…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…

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…

…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…

…8/min, or an increasing level of sedation , are signs of overdose. Sedation precedes respiratory depression; monitor it. Naloxone is titrated to spontaneous breathing, not…

…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…

…that of other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality. Pathophysiology The precise mechanism of contrast…

…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…

…Acute Coronary Syndrome. This category includes all acute coronary syndromes without significant ST segment elevations on ECG. NSTE ACS is caused by partial occlusion of…

…Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common initiating mechanism is rupture or erosion of a…

…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…

…acute, life threatening complication of coronary atherosclerosis. The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary mechanisms: Plaque Rupture…

…ST segment does not rule out ischemia, it merely reduces the probability of ischemia as the underlying cause. Concave ST segment elevations are very common…

…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…

…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…

…haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as potential causes of shock. Patients with…

…in patients who: Have tolerated DAPT without significant bleeding. Have high ischaemic risk. Do not have a high risk of major or life threatening bleeding…

…are: Plaque rupture with exposure of thrombogenic material. Superficial plaque erosion. Thrombosis associated with a calcified nodule. Epicardial or microvascular coronary spasm. Spontaneous coronary artery…

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…

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

…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…

…et al, Twerenbold et al) Kinetics Troponin T (cTnT) and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The…

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…

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…

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

…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…

…ventricular cavity. The location of acute myocardial infarction refers to the area of the left ventricle When specifying the location of myocardial infarction, reference is…

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

…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…

…the effect of interventions and medications, and prognosticate survival. However, exercise stress testing must not be performed within 4 to 6 days after acute myocardial…

…infarction Non ST Elevation Acute Coronary Syndromes (NSTE ACS): Non ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA) The focus of this chapter is…

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

…Diagnosing acute STEMI The diagnosis is straightforward using the electrocardiogram (ECG). Prehospital personnel have proven to be capable of recognizing STEMI using 12 lead ECG…

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

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…

…primary rupture of the vasa vasorum, followed by disruption of the intima. Intramural haematoma differs from classic dissection because haemorrhage occurs within the media without…

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…

…and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial wall, usually through formation of an…

…UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

…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…

…ACS, AF may be present before the acute event, detected for the first time during its management, or arise during the course of treatment. Even…

…encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of 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…

…stable, asymptomatic patients without severe ischaemia. Evaluation and Physical Examination The initial evaluation should be structured to establish a working diagnosis of STEMI rapidly, identify…

…of acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute…

…failure. The rapid advances in the 1970s and 1980s were followed by almost two decades without any major breakthrough in the management of heart failure…

…failure. The rapid advances in the 1970s and 1980s were followed by almost two decades without any major breakthrough in the management of heart failure…