…Grade Blood ketones pH or bicarbonate Consciousness : : : : Mild DKA 3 to 6 mmol/L pH 7.25 but < 7.30, or bicarbonate 15 to…

…Question Appropriate sample : : Metabolic acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂…

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

…a separate identity check each time Always, once per patient if no valid result exists Type and screen (BAS test) Blood group confirmation and antibody…

…preferably using validated clinical tests Ability to perform activities of daily living Cognitive status Risk of falls Symptoms or history suggesting orthostatic hypotension Multimorbidity Polypharmacy…

…Measure the blood pressure in both arms when fitting the device. Use the arm with the higher pressure, or the non dominant arm if the…

…rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular disease or scleroderma…

…rate response Blood pressure reaction ECG reaction: ST changes, T wave changes, arrhythmias, conduction defects Cause of termination This article will discuss each of these…

…areas of the myocardium by highlighting regions with reduced blood flow. Radiotracers for SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a six hour half life…

…insights into myocardial blood flow under rest and stress conditions. MPI uses radiotracers in combination with single photon emission computed tomography (SPECT) or positron emission…

…clinical assessment must determine whether immediate blood pressure lowering treatment is required. Patients with suggestive symptoms, signs or a medical history indicating possible secondary hypertension…

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…

…hypertension is elevated blood pressure attributable to a specific, identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension…

…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…

…the Doppler effect is provided here. The Doppler effect is used to assess the velocity and direction of blood flow. This is possible because sound…

…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…

…risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation, chest movement and a blood gas. Ventilate by…

…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…

…clinical syndrome in which the heart cannot provide blood flow commensurate with the body’s requirements, or can do so only at the expense of…

…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…

…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…

…dietary sodium and volume overload; Concomitant drugs or conditions that increase blood pressure; or An undiagnosed secondary cause of hypertension. White coat hypertension must be…

…pool, numerous macrophages or foam cells, and a thin fibrous cap. Disruption of the cap exposes the lipid core and extracellular matrix to circulating blood…

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…

…assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation, suspected carbon dioxide retention, reduced consciousness, or when NIV is being considered. 4…

…full blood count, electrolytes, creatinine, coagulation tests and troponin are taken in parallel but must not delay treatment in a patient without suspected coagulopathy or…

…begin before the blood alcohol concentration has reached zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake…

…without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and…

…important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination with new or progressive acute target organ damage. Common manifestations…

…instability, for example a systolic blood pressure below 90 mmHg, a narrow pulse pressure, peripheral vasoconstriction, impaired consciousness, a rising lactate or a worsening acidosis…

…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…

…the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). This measurement is pivotal in diagnosing and managing congenital or acquired cardiac shunts…

…induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable. The benefit of…

…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…

…vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces mean arterial blood pressure (MAP) by decreasing systemic…

…the volume of blood the heart pumps and the resistance encountered in the systemic circulation. Therefore, alterations in heart rate, stroke volume, or vascular tone…

…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…

…on: Blood pressure and evidence of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or…

…Long acting nitrates or ranolazine may be added when symptoms persist or when heart rate, blood pressure, left ventricular dysfunction, contraindications, or intolerance limit escalation…

…accumulation of pericardial fluid, blood, or, less commonly, a mass. Tamponade occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are…

…and/or the coronary microcirculation. These abnormalities may produce a transient mismatch between myocardial oxygen demand and coronary blood supply, resulting in myocardial hypoperfusion or…

…elimination of LDL cholesterol from the blood. Individuals with familial hypercholesterolemia may have either one defect gene copy (heterozygous FH) or two defect gene copies …

…compartments. Heart failure is defined physiologically by the inability of the heart to provide blood flow appropriate to tissue requirements unless filling pressures are elevated…

…rate and blood pressure are monitored. The test is generally symptom limited and is stopped when limiting symptoms, significant electrocardiographic changes, arrhythmias or an abnormal…

…combinations generally lower blood pressure more effectively than simply increasing the dose of a single drug. They may also permit lower doses of each component…

…media. Blood then propagates along the wall, creating a true lumen and a false lumen separated by an intimal flap. Propagation may be antegrade or…

…T2DM) and obesity was siloed, with clinicians focusing primarily on hemoglobin A1c (HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely…

…review on this topic [1]. References [1] G Heusch. Myocardial Ischemia: Lack of Coronary Blood Flow or Myocardial Oxygen Supply/Demand Imbalance? Circ Res. 2016…

…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

…that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS), myocardial infarction (MI), or, rarely…

…segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow…

…persistent ST segment elevation or an accepted equivalent in the setting of ischaemic symptoms. The immediate pathophysiological objective is restoration of blood flow to the…

…etiologies when promptly and appropriately addressed. Both venous and arterial blood gases can be utilized for the analysis of electrolyte levels. Electrocardiography (ECG) serves as…