…cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL. The hemodynamic and arterial blood…

…Group 3: PH due to chronic lung disease, hypoxia, or sleep disordered breathing Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease…

…is characterised by myocyte necrosis and troponin elevation due to mechanisms other than myocardial ischaemia. Acute myocardial injury may arise from conditions such as sepsis…

…management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms…

…respiratory, metabolic, musculoskeletal and psychological complications. Symptoms and conditions that should prompt assessment include: Hypertension Dyspnoea Exercise intolerance Congestive HF CAD Palpitations or suspected atrial…

…most often chronic, but in some cases, the condition may be transient. Pericardiotomy can be curative, which is why it is important to detect the…

…in stroke volume. Symptomatic bradycardia may present with chronic or acute symptoms, ranging from chronic fatigue and exercise intolerance to sudden cardiac arrest. The most…

…or COPD — diagnosis and follow up. Risk groups: current or former smokers over 40 with respiratory symptoms, and occupational exposure to dust, gas or fumes…

…method and settings Condition Method Starting pressure Escalation Oxygen target : : : : : Cardiogenic pulmonary oedema CPAP 5–7.5 cmH₂O Increase in steps of 2.5 to…

…cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full…

…and upper airway. Due to the risk of airway compromise, it represents a medical emergency. Evaluation and Physical Examination The evaluation of chronic cough in…

…are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin and soft tissue…

…to accumulate eGFR < 30 or dialysis Oxycodone or hydromorphone ; avoid morphine Morphine has an active renally excreted metabolite that causes late sedation and respiratory…

…rise and/or fall. A stable elevation indicates chronic myocardial injury . Myocardial injury is not synonymous with myocardial infarction. Cardiac troponin identifies injury to myocardial…

…alkalosis due to hyperventilation, rhabdomyolysis (particularly the initial phase), sepsis, malignancies with osteoblastic metastases, diminished calcium absorption and/or enhanced calcium excretion, chronic renal failure…

…and therefore the worse the prognosis. This does not always hold true. For example, in cardiac arrest due to pulmonary embolism the initial rhythm is…

…remain stable for prolonged periods, but chronic coronary disease can progress or destabilize abruptly, leading to an acute coronary syndrome (ACS). Clinical manifestations may therefore…

…exercise tolerance Peripheral oedema Symptoms related to fluid retention and worsening congestion The clinical course may be chronic and relatively stable or punctuated by episodes…

…burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure, atrial fibrillation, and other arrhythmias or conduction abnormalities…

Myocardial ischemia and infarction Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for…

Cardiology Coronary Atherosclerosis Coronary atherosclerosis is a chronic, progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental…

…a chronic, inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction, immune cell recruitment, extracellular matrix remodelling, and thrombosis interact to…

…pectoris is a chronic and mostly progressive disease. NSTE ACS (Non ST Elevation Acute Coronary Syndrome) : NSTE ACS is an acute condition that occurs when…

Introduction to Coronary Atherosclerosis, Plaques, Atherothrombosis Coronary atherosclerosis is a chronic, progressive, and highly dynamic inflammatory disease of the arterial wall. It is characterized by…

…pectoris is a chronic and mostly progressive disease. NSTE ACS (Non ST Elevation Acute Coronary Syndrome) : NSTE ACS is an acute condition that occurs when…

…according to blood pressure, heart rate, left ventricular function, comorbidities, concomitant medications, potential drug interactions, the presumed mechanism of ischaemia, patient preferences, local availability, and…

Cardiology Myocardial ischemia and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating…

…comprise chronic or pre existing hypertension, gestational hypertension, and preeclampsia. Collectively, they affect approximately 5–15% of pregnancies worldwide and are major contributors to maternal…

…It is defined by symptoms lasting more than 3 months and attributable to established reversible myocardial ischaemia in either of two settings: Obstructive coronary artery…

…Cardiac etiology Cardiac arrests caused by cardiovascular conditions and events are highly stochastic events. This is due to the fact that the vast majority of…

…Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced…

…on the clinical presentation and symptoms of the underlying conditions for which ACE inhibitors are prescribed. Evaluation and Physical Examination Prior to initiating an ACE…

…include: Symptoms attributable to chronic LV systolic dysfunction and HF Angina, although its absence does not exclude ischemic cardiomyopathy Symptoms related to recurrent ischemia Symptoms…

…the usually modest anatomical regression of coronary atherosclerosis. The magnitude of LDL C reduction varies according to the statin, dose, and individual response. In general…

…is explained by the elevated intrapericardial pressure due to the tamponade. The increased pressure causes compression of the atria and the ventricles (particularly the former…

…for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular function. Levosimendan drug is generally…

…70 mmHg CPP = MAP − ICP RASS −2 to 0 Lightly sedated to awake and calm CAM ICU Negative Screen for delirium every shift BIS…

…in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary antibiotics…

…workload is heavy, or as a substitute for mobilisation and bladder training. Contraindications Type Condition : : Absolute Suspected urethral injury — blood at the meatus, a perineal…

…min). Patients with mild to moderate heart failure, kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function)…

…been instrumental in identifying and staging chronic kidney disease (CKD), facilitating early intervention and management. Standardization: Its widespread adoption has led to standardized reporting of…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

…and specific characteristics such as bifurcations, chronic total occlusions (CTOs), calcification, and thrombus presence. These factors are weighted and summed to produce a total score…

…designed to improve the prediction of long term outcomes after revascularization. It incorporates both anatomical (from the original SYNTAX Score) and clinical variables (e.g…

…and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical presentations…

…MI are to: prevent recurrent MI; reduce ischaemic stroke and cardiovascular mortality; prevent stent thrombosis after PCI; reduce recurrent atherothrombotic events in chronic coronary disease…

…adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast…

…inflammatory effects relevant to coronary disease: Reduction of inflammasome activation. Inhibition of interleukin 1β related inflammatory signalling. Reduction of interleukin 6 and C reactive…

…also influenced by anatomic complexity and comorbidity, which themselves may contribute to progression of native coronary artery disease. The chronic total occlusion is an important…

…patients with an eGFR of 30–44 mL/min/1.73 m2 and up to 17% when eGFR is below 30 mL/min/1.73…

…undergoing PCI for ACS, prasugrel should be considered in preference to ticagrelor, although the comparative evidence between prasugrel and ticagrelor is conflicting. A 12 month…

…a patient is unable to tolerate any statin regimen. The treatment sequence for patients with chronic coronary syndrome is: Lifestyle intervention and a maximally tolerated…

…is consistent with chronic myocardial injury. Non ischaemic conditions, including myocarditis, rapid ventricular rate atrial fibrillation, marked anaemia, hypertensive emergency, heart failure, and end stage…

…segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), myocardial infarction, and repeat target lesion revascularization…

…heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and peripheral artery disease (PAD). Figure 1 (below) shows weight loss effects of novel…

…C by approximately 50–60%, including in patients receiving background statin therapy and in those unable to tolerate statins, provided that hepatic LDL receptor expression…

…or progress to chronic limb threatening ischaemia (CLTI). Clinical presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical…

…A first or anterior infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to VSR. Large infarction, especially for septal or…

…coronary syndrome Reinfarction reduced by approximately 30–40%; death reduced by approximately 35–45% Peripheral artery disease Lower risk of progression to chronic limb threat

…of ACS overall but represents a substantial proportion of ACS presentations in young and middle aged women. The condition is often under recognized or misdiagnosed…