…cardiovascular event risk. Quantify myocardial blood flow when PET is used. SPECT is recommended in suspected chronic coronary syndrome with moderate or high pre test

…body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source. ATP is produced by metabolizing carbohydrates (glucose), fats or proteins, whichever is available…

…for example aphasia, hemianopia or hand paresis in a person of working age Blood pressure Measure initially in both arms if this does not delay…

…function tests, glucose and lactate. Add a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests…

…unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine, glucose, high sensitivity troponin and, where needed, coagulation tests. Blood…

…equipment for arterial sampling. Urinary catheter with hourly urine output measurement — the treatment cannot be guided without reliable measurement of urine output. Baseline tests: blood…

…blood and urine can be saved early for later targeted analysis. Initial monitoring and investigations Investigation Comment : : Plasma glucose Taken immediately and repeated in impaired…

…glucose loss in approximately a 1:1 stoichiometric relationship. The resulting glucosuria and natriuresis reduce proximal tubular workload, contract plasma volume and modestly lower blood…

…the blood glucose during rapid changes. Pressure on the sensor, for example during sleep, can give falsely low values. When there are symptoms or an…

…insulin resistance, dyslipidaemia, elevated blood pressure and impaired glucose regulation. Diagnosis is based on the coexistence of defined clinical and laboratory components; the diagnostic criteria…

…For decades, the management of type 2 diabetes mellitus (T2DM) and obesity was siloed, with clinicians focusing primarily on hemoglobin A1c (HbA1c) reduction, blood pressure…

…hypersensitivity to the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days. Suspected or known tendon rupture. No response to…

…be adequately inferred from changes in a single intermediate marker such as cholesterol. Dietary composition may influence blood pressure, glucose–insulin homeostasis, lipids and apolipoproteins…

…bicarbonate or blood gas, calcium, phosphate, glucose and a full blood count. 5. Take a urine dipstick and, where the cause is unclear or a…

…hyperglycaemic state, HHS : : : Glucose Plasma glucose ≥ 11.1 mmol/L or previously known diabetes Plasma glucose ≥ 33.3 mmol/L Ketones Blood ketones, beta hydroxybutyrate…

…Cardiac output and blood pressure, rather than ECG, are the strongest predictors of adverse outcomes. Non acute or asymptomatic bradycardia Non acute bradycardia is a…

…or a need for repeated calcium treatment. Urgent investigations As a rule, take: Plasma potassium as a central laboratory sample. A blood gas with pH…

…0 to 5 minutes ABCDE, start timing, glucose, monitoring, intravenous or intraosseous access, a targeted history At 5 minutes A full, adequate dose of a…

…prevent the emergence of risk factors. It includes maintenance of favourable blood pressure, body mass index, cholesterol and glucose levels, together with a low salt…

…a sterile tube and blood culture bottles (aerobic and anaerobic) for culture, and a fluoride tube for glucose and lactate. For injection: the corticosteroid drawn…

…precise ventilation or severe respiratory failure. A peripheral venous blood gas is easier to obtain and can often be used for an initial assessment of…

…preferably confirmation by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of office blood pressure Category…

…selected electronically against the blood group Standard for planned transfusion in a patient without irregular red cell antibodies Serological crossmatch (MG test) Serological crossmatching between…

…or limited life expectancy. Available randomized evidence has not demonstrated that frailty weakens the cardiovascular benefits of blood pressure lowering among the frailer participants enrolled…

…oscillometric measurement becomes unreliable), lymphoedema or a dialysis fistula in both arms, an arm circumference too large for the available cuffs, and in a patient…

…raise the blood pressure. Serotonin syndrome can also cause autonomic instability and hypertension [4]. Step 2: look systematically for acute organ damage Organ or condition…

…that leads to the stress test (if that was the reason for conducting the test). Chest pain rated as 6 or above (according to the…

…regions with reduced blood flow. Radiotracers for SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a six hour half life allowing high doses for better image…

…Reference values for coronary blood flow Normal coronary blood flow at rest: 0.6 to 1.3 mL/min/g of myocardial tissue During hyperemia…

…below the hypertension threshold but hypertensive home or ambulatory pressure. Office measurements provide only a limited representation of usual blood pressure and may be biased…

Cardiology Emergency medicine Definition and Pathophysiology A hypertensive emergency is severe blood pressure elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European…

…on four or more drugs or “refractory hypertension” for blood pressure above target despite five or more drugs. Screening for primary aldosteronism Screening for primary…

…when related to one another. A low blood pressure may be due to low flow, low vascular tone or both, and the appropriate action differs…

…that the aortic valve leaks during diastole, such that blood regurgitates back from the aorta into the left ventricle. This results in volume overload in…

CPR Hypoxia and asphyxiation Hypoxia refers to a reduced partial pressure of oxygen in the blood. Asphyxia is characterized by insufficient ventilation, leading to hypoxia…

…volumes, and pressure conditions in the heart. These techniques allow for the calculation of all clinically relevant hemodynamic parameters, with few exceptions. Prior to the…

…conventional exercise test. Preparation and equipment Cycle ergometer with a braked, workload controlled resistance; 12 lead ECG with continuous recording; automated or manual blood pressure…

…nitroglycerin regularly may have developed tolerance and require higher doses, alternatively nitroprusside to achieve desirable blood pressure lowring effect. Drug Nitroglycerin Brand names Gonitro ®…

…perfusion. • Dose dependent elevation of intracranial pressure (ICP) and reduction in cerebral blood flow. Caution • Used cautiously in patients with high intracranial pressure or azotemia…

…crisis. Mechanism of action Phentolamine is a non selective alpha adrenergic blocker. Phentolamine reduces blood pressure while increasing catecholamine activity. Effects Primarily causes afterload reduction…

…early disease or after effective treatment. HFrEF is commonly associated with structural and functional ventricular abnormalities and progressive neurohormonal activation. The therapeutic rationale for disease…

…blood at a rate appropriate to tissue requirements unless filling pressures are elevated. The syndrome is therefore defined by symptoms and signs of congestion or…

…should be reserved for patients in whom the diagnosis has been carefully confirmed. Apparent resistant hypertension may result from: Inaccurate or inconsistent blood pressure measurement…

…In some of these patients, microvascular obstruction or epicardial spasm may account for the ischaemia. STEMI usually results from rapid thrombotic occlusion of a previously…

Echocardiography Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also…

…and peripheral oedema. Previous hypercapnia, NIV or invasive ventilation. Home oxygen and the patient's usual saturation. Previous exacerbations and hospital admissions. Current inhaled treatment…

…criteria for intermediate care or intensive care. Time course after the last intake The times given are approximate. Symptoms can begin before the blood alcohol…

…heart failure and in obstructive airways disease Verapamil or diltiazem When a beta blocker is contraindicated, for example in asthma Contraindicated in impaired left ventricular…

…allows frequent blood pressure measurement and continuous monitoring. An arterial line is often appropriate when very rapid or precise control is required, for example in…

…do not delay transfusion or control of the bleeding in order to obtain a central venous catheter. 4. Take samples for blood grouping and cross…

…defects from incidental findings. Guidance for Intervention : A Qp/Qs 1.5 often warrants surgical or percutaneous closure in ASD/VSD. Serial measurements track shunt…

…required to up to 900 μg/day. Transdermal (one patch lasts for a week): • Catapress TTS 1 (0.1 mg/24hrs). • Catapress TTS 2 …

…an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure by inhibiting ACE. Effects • The hypotensive effect of enalaprilat depends on plasma volume and plasma…

…beta adrenergic receptor blocker. • Esmolol lowers blood pressure immediately (within 1 minute) • Esmolol may also be used to control supraventricular tachycardia (rate control). • Esmolol may…

…receptor agonist. • Lowers blood pressure while maintaining or increasing kidney perfusion. Effects Dopamine 1 receptor agonists lower systemic blood pressure and increase renal perfusion. Time…

…provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is defined as significantly elevated blood…

…or vascular tone can significantly impact MAP, reflecting the dynamic interplay between cardiac function and vascular resistance. Advantages of measuring MAP over systolic blood pressure…

…blocker. Effects Lowers blood pressure, reduces heart rate, myocardial oxygen consumption and myocardial contractility. Less pronounced blood pressure lowering effect than esmolol and labetalol. Time…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…no imaging evidence of RV dysfunction. Catastrophic or “supermassive” PE refers to refractory cardiogenic shock or the need for ongoing cardiopulmonary resuscitation. Mechanical circulatory support…