…serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not…

…an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment…

…early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute kidney injury is present when at least one of the…

…treatment is oxygen in hypoxaemia, repeated doses of an inhaled short acting β2 agonist, ipratropium in more severe attacks, and a systemic steroid given early…

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

…most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal routine neurological examination…

…use Deceleration injury Systemic hypertension coexists in approximately 70% of patients with aortic dissection. PAU is particularly associated with advanced age, smoking, coronary artery disease…

…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…

…distal to the suspected obstruction Arterial and venous Doppler signals Evidence of systemic disease or a potential embolic source Neurological assessment is central to triage…

…hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical status Comorbid cardiopulmonary disease…

…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…

…of oral morphine per day, and 25 micrograms/hour to approximately 40–50 mg of oral morphine per day. Patches have no place in acute…

…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…

…difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease…

…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…

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

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…the concurrent use of beta blockers. The vasodilating effect reduces preload and afterload, further reducing myocardial workload. Levosimendan is used in severe 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…

…noted in both North American and European guidelines. However, a concave ST segment does not rule out ischemia, it merely reduces the probability of ischemia…

…of bupropion, among others, can raise the blood pressure. Serotonin syndrome can also cause autonomic instability and hypertension [4]. Step 2: look systematically for acute…

…as possible in the acute phase but should not delay reperfusion treatment. I C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial…

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…

…combined use of aspirin and an oral P2Y12 receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome…

…including demand related events in the presence of fixed coronary disease. More than one mechanism may operate simultaneously. Some acute coronary events occur without an…

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…

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

…structural heart disease, fibrosis of the conduction system and acute myocardial infarction (particularly anterior STEMI). Hence, an acute myocardial infarction may actually result in LBBB…

…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…

…Prophylaxis against recurrence of cerebrovascular disease: 75–80 mg tablet once daily. Warnings and precautions Use Aspirin with caution in the following cases: Concurrent anticoagulant…

…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…

…This chapter discusses typical and atypical changes in the ST segment and the T wave during myocardial ischemia. A thorough discussion of the electrophysiological principles…

…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…

…90% of the cases. As compared with the right ventricle, the left ventricle contracts against much greater resistance (i.e. the pressure in the systemic…

…populations The evidence for anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary syndrome…

…electrocardiographic changes, and with or without acute elevations in cardiac troponin concentrations. Based on the presenting electrocardiogram (ECG) and the presence of troponin elevation, ACS…

…with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial ischemia…

…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…

…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…

…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…

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…

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

…The central clinical danger is progressive aortic wall disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic…

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…

…through formation of an intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome…

…recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms or signs, with or…

…of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being the most common. The figure 80% occurs in…

…influenced effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute stroke requires attention…

…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…

…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…

…of significant LMCA disease, including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy of…

…the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart…

…the incidence of coronary heart disease and acute myocardial infarction has been reduced by approximately 50% during the past few decades, the incidence of heart…

…g. malignancy, amyloidosis). In case of suspicion of pericardial disease, in the first place, an echocardiographic examination is done. With echocardiography, good conditions are obtained…

…metoprolol) First choice in most cases The IV dose is titrated slowly. Caution in acute heart failure and in obstructive airways disease Verapamil or diltiazem…