…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…

…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…

…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…

…cured on the spot, in three minutes, without drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other…

…a recent change in symptoms or signs, with or without electrocardiographic changes, and with or without acute elevations in cardiac troponin concentrations. Based on the…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position is necessary. After previous punctures: change side…

…organ damage. Isolated malignant retinopathy without other acute organ damage can often be treated more cautiously with oral drugs under careful observation [3,4]. A…

…distinction between UA and NSTEMI has become increasingly dependent on the use of highly sensitive cardiac troponin assays. As detection of myocardial necrosis has improved…

…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…

…in which the large necrotic area may cause nonspecific conduction disturbances. Such conduction disturbances may also be superimposed on existing bundle branch blocks and alter…

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…

…deviates most. What matters is which change can explain the pH, and whether the other variable lies within the expected range of compensation. Sample type…

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…

…may need active treatment and prompt follow up, but not necessarily acute normalisation in the emergency department [1,3]. Step 1: confirm the blood pressure…

…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…

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

…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…

…elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions (such as bundle branch blocks)…

…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…

…P waves typically have a notch on the apex. Please note that for most clinicians it is not necessary to be able to determine the…

…multiple leads P pulmonale Figure 1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left…

…the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema…

…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…

…or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular disease, including heart failure and…

…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…

…These changes may appear within 10–15 minutes of ischaemia. Mitochondrial abnormalities can occur even earlier after coronary occlusion and progress over time. Experimentally, necrosis…

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

…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…

…lead ECG Numerous conditions that can be diagnosed using the 12 lead ECG require that ECG changes occur in two or more anatomically contiguous leads…

…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…

…contribute: Direct toxic effects on cardiomyocytes Disruption of intracellular signalling and protein synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol…

…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…

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

…recurrent symptoms, myocardial infarction, or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular…

…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…

…to pathology. A negative T wave is also called an inverted T wave. T wave changes are notoriously misinterpreted, particularly inverted T waves. Below follows…

…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…

…Perfusion defects are further classified based on the intensity of tracer uptake and associated myocardial changes: Mild defects : Characterized by decreased tracer counts while preserving…

…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…

…which usually prevents other ST T changes (such as those arising from ischemia) to come to expression on ECG. Therefore, ischemic ST T changes (ST…

…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…

…plane, the transducer changes orientation either toward or away from the orientation marker. Angle : The transducer is kept at the same location on the chest…

…arrhythmias) it is not always necessary to analyze all leads, as the diagnosis can often be established by examining fewer leads. On the other hand…

…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…