…incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure…

…patients with valve prostheses or other cardiac devices (pacemaker, CRT, ICD). In addition to staphylococcus aureus , hemolytic streptococci and pneumococci cause acute endocarditis. Other microorganisms…

…very difficult. Future efforts may be more successful by focusing on near term prediction using smart devices and emerging technologies ( Marijon et al ). The stochastic…

…Opioids, benzodiazepines and other sedating drugs. Thromboembolic risk, for example immobilisation, cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs…

…neurologically compromised patient. Continuous glucose monitoring reflects interstitial glucose and lags behind the blood glucose during rapid changes. Pressure on the sensor, for example during…

…6. Repeat on the left side. A positive test in the posterior canal is characterised by: A latency of 1–5 seconds before the nystagmus…

…central portion of the chest or the epigastrium and occasionally radiates to the arms. Less common sites of radiation include the abdomen, back, lower jaw…

…presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms or clinical signs, with or without diagnostic electrocardiographic abnormalities and…

…skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A patient who cannot lie…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms or signs, with or without ECG abnormalities and with…

…will differ from the emitted sound waves. The change in frequency is referred to as the Doppler effect . The Doppler effect was first described in…

…also be superimposed on existing bundle branch blocks and alter their appearance. Some patients develop nonspecific intraventricular conduction defects without any change in their QRS…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

…Ménière's disease, TIA and arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate…

…fully interchangeable with an arterial sample [3]. Venous pH is on average slightly lower than arterial pH. Agreement is usually good for pH and reasonable…

Akutsjukvård Psykiatri Lathundar Delirium in older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work…

…damage. Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute…

…independent risk factor [2] . This change reflects robust evidence that female sex alone, in the absence of other comorbidities, does not significantly increase stroke risk…

…with left ventricular systolic function. EAT = v max /time Fractional shortening (FS) Fractional shortening (FS) is calculated by measuring the change (% reduction) in left…

…myocardial infarction. U wave changes New U waves (in absence of bradycardia) may indicate ischemia. If U waves were present on previous recording, the amplitude…

…atherosclerosis) At rest Oxygen supply is adequate and ischemia cannot occur. No changes on resting ECG. Increased myocardial workload (exercise) Oxygen supply increases in parallel…

…and other therapies have failed. Patients with structural heart disease or reduced left ventricular function are not eligible. Effects of propafenone and flecainide on ECG…

…myocarditis and perimyocarditis: ECG changes and clinical features The pericardium is a double walled sac in which the heart and the roots of the great…

…to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…atrial flutter. As compared with several other supraventricular tachyarrhythmias, atrial flutter does not occur among otherwise healthy individuals. Atrial flutter causes characteristic ECG changes, as…

…each other out. However, the ECG may show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest left…

…in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset…

…in patients who remain in sinus rhythm. Several mechanisms may account for apparent ischaemic electrocardiographic changes during rapid AF. ST segment depression or T wave…

…pressure are common in later life. These changes contribute to the complexity of defining an appropriate treatment target, particularly when a lower DBP, orthostatic hypotension…

…modest dietary changes. Mediterranean type diets provide polyphenols from extra virgin olive oil, fruits, vegetables, nuts and legumes; unsaturated fatty acids and other bioactive compounds…

…and disruption of the sarcolemma. These changes may appear within 10–15 minutes of ischaemia. Mitochondrial abnormalities can occur even earlier after coronary occlusion and…

…either symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial…

…and changes in the automaticity of the sinoatrial node. Rhythm Normal rhythm A rhythm is defined as three consecutive beats with identical waveforms on the…

…unit (CCU), regular wards and rehabilitation facilities. Depending on the cause of the arrest, other units may be critical (e.g. trauma unit). Careful and…

…placed proximally on the thighs and arm electrodes are placed proximally on the upper arm. Placement of chest (precordial) electrodes are not changed but additional…

…depressions. In STE ACS, on the other hand, the ST segment depressions are secondary findings and the primary findings are the ST segment elevations. As…

…the chest leads (V1 through V6) are displayed on the ECG paper in their anatomically contiguous order from right anterior (V1) to left lateral (V6)…

…Components of the ATRIA Score The ATRIA score assigns points based on five clinical factors: Anemia: Hemoglobin <13 g/dL in men or <12 g…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…duration , sex , and genetically influenced effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with…

…lipid metabolism and inflammatory signalling. ACLY additionally influences fatty acid synthesis and may affect epigenetic regulation through changes in DNA acetylation. Lipid lowering efficacy Bempedoic…

…temporal pattern. Change in frequency, severity, or exercise threshold. Potential anginal equivalents include: Dyspnoea on exertion. Fatigue. Dizziness during exertion. Discomfort in the arm, jaw…

…or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD…

…MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients presenting with myocardial infarction in other reports…

…and subsequently develop recurrent angina, recurrent ischaemic ECG changes, biomarker evidence of myocardial necrosis, or severe ischaemia on stress testing. Such developments may convert an…

…and stress related haemodynamic changes Diastolic function Pulmonary hypertension Coronary flow velocity reserve (CFVR) Pulmonary congestion detected by B lines on lung ultrasound Myocardial perfusion…

…a more symmetrical T wave, a more distinct transition from ST segment to T wave and lower T wave amplitude. The T wave should be…

…are exceedingly rare precipitants of cardiac arrest. Sodium imbalance Neither hyponatremia nor hypernatremia typically cause discernible ECG changes. Hyponatremia Effective management of hyponatremia requires careful…

…imaging (MPI) is based on principles similar to those used in echocardiography. The 17 segment model of the left ventricle serves as a standardized framework…

…obtained by other imaging methods, namely exercise capacity (and VO2 max , see below). In addition to exercise capacity, stress testing also provides information on electrocardiographic…

…may actually result in LBBB which then masks the ischemic ST T changes on ECG. In summary, left bundle branch block (LBBB) can result from…

…ischemia that only affects the subendocardium). STEMI, on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop…

…lead ECG does not display ST segment elevations during posterolateral transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury…

…supine position. Parasternal Windows PLAX Parasternal Long Axis view The parasternal long axis view (PLAX) is located on the left side of the sternum. It…

…the diagnosis can often be established by examining fewer leads. On the other hand, for the purpose of diagnosing morphological changes (e.g. myocardial ischemia…

…QRS complex). Because the ventricular depolarization is abnormal, the repolarization will also be abnormal (read aboutsecondary ST T changes on ECG). Hence, all beats and…

…T wave inversions in V1–V4, or other ECG changes (see below) should lead to a suspicion of ARVC. The gradual loss of myocardium leads…

…and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion…