…PCI of chronic total occlusion lesions may improve angina and quality of life, but randomized trials have not demonstrated reductions in mortality or myocardial infarction…

Echocardiography The standard transthoracic echocardiographic examination This chapter presents a sequential series of images that comprise a complete standard echocardiographic examination. The image views are…

…thought it was a decent book with an abundance of illustrations that appeared pedagogical, despite the fact that it had not been updated for decades…

…The ECG shows AV block III (complete heart block). P waves are not related to QRS. PP interval is constant, but independent of RR interval…

…features of third degree AV block On the ECG P waves have no relation to the QRS complexes. The QRS complexes may be normal or…

…complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not…

…does not describe specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics Non invasive assessment of ischaemia and viability Objective evidence of…

…complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R and S wave. However, all three waves may not…

…needed. Intubate for a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation…

…sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis or a…

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…partial occlusion of the artery (i.e. coronary blood flow is not completely obstructed). NSTE ACS typically presents with ST segment depressions and/or T…

…elevations on ECG. ST elevations are the hallmark of STEMI. However, there are situations with transmural ischemia that do not yield ST elevations. It is…

…not wait for a complete diagnosis or for grading. Antihistamines, corticosteroids, inhaled bronchodilators and nebulised adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of…

…and the intubator not being an anaesthetist (1 point). A score of 3 or more indicates a difficult intubation — call for help and get out…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

Procedurer Pericardiocentesis is performed on the basis of the haemodynamics, not the volume of fluid. A litre that has accumulated slowly can be asymptomatic, while…

…QRS complexes; do not delay pacing in order to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine…

…is weak, particularly for intermediate lesions. Even lesions with a visual diameter reduction of 50–70% may or may not produce ischaemia. Conversely, some lesions…

…3] Absence of Q waves in I, V5, and V6 [3] ST T Waves Usually opposite in direction to the QRS complex [3] Not explicitly…

…that improve or resolve after reducing the dose or stopping therapy. It is divided clinically into: Complete intolerance: inability to tolerate any dose of any…

…A complete airway obstruction results in PEA and cardiac arrest within 8 minutes. Cardiac arrest as a result of asphyxia or hypoxia is managed according…

…pregnant adults. The fetus is not harmed by defibrillation, amiodarone, or adrenaline (epinephrine). In the event of a cardiac arrest in a pregnant patient, immediate…

…or sudden cardiac death. The resulting extensive ischemia causes immediate myocardial stunning (akinesia) and electrical instability. Fewer than 1% of patients with ST elevation myocardial…

…a complete blockage of impulse conduction. If such blockage persists for 6 seconds or more, syncope occurs unless an escape rhythm arises. Overview of AV…

…Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater extent of ischemia present in STEMI. In STEMI, a complete coronary artery occlusion leads…

…infarction process is more or less completed. Post ischemic T wave inversions emerge at the earliest 4–6 hours after an episode of ischemia/infarction…

…access, but do not let blood sampling or cannulation delay inhaled treatment. 8. Reassess speech, work of breathing, level of consciousness and air entry repeatedly…

…be well NIHSS A complete score by a physician or nurse experienced in stroke Functional impact A low NIHSS does not exclude a disabling deficit…

…of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound may not…

…Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind…

…passed. An attempt can convert a partial rupture into a complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage…

…a half life of several days and more than a hundred clinically relevant interactions. What determines whether the treatment is safe is not the starting…

…Conversely, a high CAC score indicates substantial atherosclerotic burden but does not, by itself, establish the presence or haemodynamic significance of a specific stenosis. Clinical…

…is present without anatomical or physiological criteria supporting revascularisation. Evaluation and Physical Examination Assessment should establish both clinical risk and the feasibility of complete revascularisation…

…location and complexity of coronary stenoses. Higher scores indicate more diffuse or technically complex disease and are associated with a greater relative advantage for CABG…

…Cardiogenic shock. Complete transection of a papillary muscle may cause immediately overwhelming MR. Partial rupture, often involving the tip or head of the muscle, more…

…separate chapter discusses Long QT syndrome (LQTS). A complete list of drugs causing QT prolongation can be found here. Corrected QT intervals (QTc) can be…

…This evaluation should include a detailed history, thorough questioning of eyewitnesses, and a complete physical and neurologic examination. Blood pressure and heart rate should be…

…or apical window, is generally considered less effective than thoracotomy. This is because it does not ensure complete drainage of the pericardium, and needles or…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…may be partially or completely obstructed. Consequently, the myocardium supplied by the occluded artery becomes ischemic. Ultimately this results in myocardial necrosis (death of myocytes)…

…the T wave in lead aVL will be inverted and in some cases lead I will display a monophasic R wave instead of qR complex…

…second or third degree AV block). A pacemaker is often necessary in individuals with first degree AV block and wide QRS complexes. Treatment of first…

…can determine whether dysfunctional myocardium or myocardium supplied by a diseased vessel, is viable and could benefit from revascularization. Evaluating the success of revascularization : Myocardial…

…of sinus arrest (or any scenario in which atrial impulses do not reach the atrioventricular node), junctional escape rhythm may be life saving. During complete…

…T changes. Such ST T changes may mimic (simulate) or mask ischemia. Simulation of ischemia manifests as ST segment elevations in leads V1–V3, accompanied…

…hallmark of LBBB is the prolonged QRS duration. A QRS duration of 120 ms (0.12 s) or more is required to diagnose a complete…

…acute myocardial infarction, whereas unstable angina is not an infarction . Unstable angina is only diagnosed if there is no evidence of myocardial infarction (necrosis) . However…

…follows: QRS complex with more than 1 R wave and/or notch in the descending limb of the R wave and/or notch in the…

…disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency echocardiography, or any examination without a…

…because of the stronger ventricular contractions caused by the increased filling. Ventricular premature complexes are not preceded by P waves because the ectopic impulse originates…

…is defined by the intermittent failure of atrial impulses to conduct to the ventricles, resulting in some P waves not being followed by QRS complexes…

…STE ACS (ST Elevation Acute Coronary Syndrome) : STE ACS occurs when plaque rupture, and the ensuing atherothrombosis, causes a complete occlusion of the coronary artery…

…and to maximize the likelihood of restoring spontaneous circulation, interventions should be adapted to the current phase. However, current guidelines do not consider this fact …

…ms). Increasing the number of ultrasound lines or image depth will reduce the frame rate since more time is required to complete each frame. Thus…

…seconds). The QRS complex is wide simply because the ectopic impulses that cause these rhythms spread partially or entirely outside of the ventricular conduction system…

…given. Each infusion should be completed, even if the patient reverts to sinus rhythm. Th e infusion must be aborted if hypotension or bradycardia occurs…

…salivation or increasing weakness, and give atropine. 8. Monitor for at least 30 minutes after the test has been completed. Alternatives when edrophonium is not…

…in the nose or the ear canal is an emergency, not a finding that can wait until the next day. Moisture completes a circuit across…