…supply results in diminished ATP production and subsequently disruption of cellular metabolism. In case of ischemia, cardiac myocytes protect themselves by switching to anaerobic metabolism…

…It lies instead in patient selection. Because implantation entails appreciable cost and procedural risk, the risk benefit balance depends almost entirely on the capacity to…

…which in the case of left bundle branch block should lead the clinician to activate the catheterization laboratory (discussed in Left bundle branch block and…

…As mentioned before, the subendocardium of the left ventricle has the poorest prerequisites in case of ischemia. The infarction process starts in the subendocardium from…

…workload leads to increased oxygen demand but the stenosis limits the volume that can be delivered to the heart muscle supplied by the atherosclerotic artery…

…for now, it is sufficient to note that the more myocardium supplied by an artery, the greater the ischemic area in case of occlusion. Ischemic…

Procedurer A cast should hold the fracture still and do nothing else. The two ways in which casting harms the patient are that it is…

…has recently been operated on, is in a cast or has extensive wounds so that the cuff cannot be applied. Place the cuff over a…

CPR Each recording presents two leads recorded simultaneously. Sex : Female Age : 72 years History : heart failure Medications : digoxin, quinidine ECG 1 . The initial beats are…

…Each recording presents two leads recorded simultaneously. Sex : Male Age : 43 years History : None Medications : None ECG 1 . Sinus rhythm interrupted by rapid ventricular tachycardia…

CPR Sex : Male Age : 62 years History : Coronary bypass grafting; history of arrhythmias. Medications : beta blockers ECG 1 . Sinus rhythm interrupted by ventricular tachycardia (VT…

…complexes with similar morphology as ECG 1, likely presenting a supraventricular rhythm. Three short bursts of ventricular tachycardia occur. ECG 3. Repeated bursts of VT…

…The management is the opposite in each case. Equivalent doses Agent Equivalent glucocorticoid dose Mineralocorticoid effect Biological half life : : : : Hydrocortisone (cortisol) 20 mg Marked Short…

…else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive…

…thickness unmeasurable and staging therefore impossible; a superficial punch in a case of bullous dermatosis misses the subepidermal split. Choose the technique according to the…

…in meters. BMI is relevant for medical prognostication as it serves as a quick, low cost, and reliable screening tool for body composition, risk of…

…patient preferences, local availability, and cost. The pathophysiological substrate of angina may differ between patients. Myocardial ischaemia may result predominantly from obstructive epicardial coronary disease…

…features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest left ventricular hypertrophy (LVH), one should suspect concomitant right…

…congenital malformations leading to an incomplete or absent pericardium. In case of suspicion of pericardial disease, it is important to conduct a careful investigation as…

…1. Sinoatrial arrest. Also note the ST segment elevations (which in this case have no relation to the sinoatrial arrest). As discussed in Chapter 1…

…lack documentation or have only weak evidence. Venous thromboembolism when a DOAC cannot be used (interactions, cost, adherence, pregnancy after the first trimester under specialist…

…or a dressing alone. Contraindications Primary closure must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on…

…contrast, within selected high risk populations, prevalence may be sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of at least 70%…

…against interleukin 1β, provided proof of concept but was not developed for routine coronary prevention because of fatal infections and high cost. Low dose…

…Consequently, posterior infarction should not be regarded as an isolated electrocardiographic pattern in every case; it may represent the posterior component of a broader infarct…

…their capital letters (Q, R, S), and small waves are referred to by their lower case letters (q, r, s). Figure 5 shows examples of…

…long cycles (i.e. long RR intervals) are associated with long refractory periods and short RR intervals have shorter refractory periods. Aberrant conduction occurs when…

…a short lasting second or third degree AV block which may be unpleasant to the patient. This side effect lasts a few seconds. Case reports…

…in case of known allergy, when exposed to potent allergens (e.g. wasp stings, peanuts, etc.) and in case of swollen airways or dermatological symptoms…

…in asystole and sudden death. In echocardiography, tumour should be suspected in case of detection of ecotdense tissue masses. However, the majority of all ecotate…

…to the assessment of exercise capacity. Metabolic equivalents (METs) can be used to estimate the energy cost of physical activity. One metabolic equivalent (1 MET…

…seen in certain causes of cardiac arrest (e.g. pulmonary embolism) or in case of long no flow or low flow periods. Under such circumstances…

…the muscle layer closest to the endocardium. The subendocardium has the poorest prerequisites in the case of myocardial ischemia. All myocardial infarctions affect the subendocardium…

…only be used if the flow (Q) is constant, which is not the case in the heart. Blood flow is pulsatile during the cardiac cycle…

…medical system (EMS), as well as the hospital cardiac arrest team (CAT) and intensive care units and other units caring for resuscitated patients. Figure 1…

…common cause. Ebstein's anomaly The prevalence of Ebstein's anomaly is approximately 1 case per 200.000 live births (Atthenhofer et al) . Figure 1…

…ECG Case 1: Ventricular tachycardia progressing to ventricular fibrillation Below are sequential ECG recordings during a sudden cardiac arrest in a 43 year old male…

…applies where you work. They assume normal renal and hepatic function, a non pregnant adult of normal weight, and individual assessment. See the separate quick…

…salicylate into the central nervous system. Discuss the case early with the poison control centre and with anaesthesia or intensive care. If intubation is necessary…

…5 µg/mL, though greater arrhythmia suppression may occur up to 3.5 µg/mL at the cost of increased toxicity risk. In routine clinical…

…which the heart cannot provide blood flow commensurate with the body’s requirements or can do so only at the cost of elevated filling pressures…

…7]. Etiology and Mechanisms LBBB may result from lesser degrees of conduction delay within the left bundle system in the case of incomplete LBBB [7]…

…misses a substantial proportion of cases. The cardiorenal and cerebrovascular consequences of unrecognized PA make early case detection clinically important. Current European recommendations advise screening…

…either before or after the QRS complex. In either case it will be retrograde (in lead II, III and aVF) because of the direction of…

…NNT to save 1 person Reference Early detection of cardiac arrest Yes 11 Berdowski et al Bystander CPR Yes 15 Hasselqvist et al Early defibrillation…

…Asphyxi Hanging ning Case Traumas Drowning Road accident Drug overdose/drugs Number of individuals (n=2670) (n=1999) (n=1300 1062) (n=1062) (n=765) (n=187) Pre Hospital ROSC (%) 17…

…are depolarized normally; this can only be the case if the impulse (which depolarizes the ventricles) passes through the bundle of His, and hence it…

…miscellaneous conditions The early repolarization pattern and syndrome: from ECG criteria to management Although the early repolarization pattern has been recognized for almost 50 years…

…be fatal. Approximately 500 Swedes are affected annually by endocarditis and the median age of 70 years at the onset of the disease. Approximately 12…

…90 mm Hg). The discordance between optimal blood pressure and the definition of hypertension is explained by a cost benefit equation. The benefits of interventions…

…60 beats per minute. In case of sinus arrest (or any scenario in which atrial impulses do not reach the atrioventricular node), junctional escape rhythm…

…Binds to digoxin. Digitalis antidote (anti digoxin, Fab fragment). Given in case of suspected digoxin intoxication. Table 4. Pharmacological treatment of acute bradycardia. Atropine Evidence…

…the R wave and/or notch in the descending limb of the S wave In case of complete/incomplete bundle branch block or pacemaker rhythm…

…of any physiological index; lesion specific and largely independent of resting hemodynamics; guideline reference standard. Requires pressure wire + vasodilator (cost, time, patient discomfort); falsely normal…

…that PISA can be used to quantify regurgitation volume. In the case of mitral regurgitation (MR), the regurgitant area can be calculated using the following…

…a complicated anatomy. In cross section (SAX, short axis view), the the ventricle is rather a crescent shaped appendage of the left ventricle. On longitudinal…