…factor activation stimulates the coagulation cascade, generating thrombin and fibrin and enlarging the occlusive thrombus. The severity of myocardial injury depends on the size of…

…compression, exacerbating myocardial injury. Clinical Presentation and Symptoms In up to one half of STEMI cases, a precipitating factor such as vigorous physical exercise, emotional…

…environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial injury is determined not only…

…pulse, and active movement of every tendon crossing the wound. A tendon injury can be painless and gives normal passive movement — test actively against resistance…

…of skull fracture or a marked midfacial fracture — the tube can pass through a fracture in the cribriform plate into the cranium Absolute Corrosive injury…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…platelets and coagulation factors, which results in thrombus formation (Figure 1). Disruption of an atherosclerotic plaque may also release atherosclerotic debris downstream, causing microvascular embolization…

…traditionally termed Dressler syndrome , which is a manifestation of post cardiac injury syndrome (PCIS). PCIS is an umbrella term that also includes post pericardiotomy syndrome…

…g daily in females as capable of causing cardiomyopathy. Several mechanisms contribute: Direct toxic effects on cardiomyocytes Disruption of intracellular signalling and protein synthesis Electrical…

…of the pain. Refer to The ischemic cascade for details. History taking in patients with chest pain (chest discomfort) HISTORY PARAMETER QUESTIONS COMMENTS Risk factors…

…income countries for more than half a century, causing approximately 20% of all deaths in these regions. Mortality rates and case fatality in coronary artery…

Info A comprehensive list of conditions and drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS…

…cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops acutely or subacutely…

…disrupt, resulting in the activation of thrombocytes and coagulation factors causing the formation of a thrombus. Such a thrombus can cause occlusion of the artery…

…Ventricular fibrillation is the result of numerous re entry circuits , causing rapid and chaotic ventricular depolarizations, rendering the left ventricle incapable of generating effective contractions…

…symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications Infection of the…

…the drainage is stopped for coughing, chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause…

…inhibitor therapy occurs in approximately 1% of patients. It manifests as localized, transient swelling of the subcutaneous or submucosal tissues, most frequently involving the face…

…lesions causing ischaemia have been treated. Conversely, angiographically satisfactory stenting may leave clinically relevant residual ischaemia, particularly after complex coronary intervention. The clinical importance of…

…ejection fraction, procedural factors and anticipated outcomes. The supplied material does not describe specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics…

…and pharmacological basis Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus …

…occlusion causing transmural ischemia and requiring urgent reperfusion, even in the absence of classic ST elevation. Multiple studies have demonstrated the superior sensitivity of OMI…

Arrhythmias and arrhythmology ECG Aberrant ventricular conduction (aberrancy, aberration) Aberrant conduction is not a mechanism of arrhythmia; it is a ventricular conduction disturbance . It is…

…gallstone. Figure 1. Gallstone causing acoustic shadowing. Reverberations artifacts Ultrasound waves can be reflected multiple times between dense structures ( i.e structures with high echogenicity)…

…or coughing before cardiac arrest also speak for anaphylaxis (airway obstruction caused by a foreign body is an important differential). Treatment of anaphylaxis and cardiac…

…Hypocalcemia, although capable of causing cardiac arrest, is an infrequent occurrence. Hypercalcemia, hyponatremia, hypernatremia, hypomagnesemia, and hypermagnesemia are exceedingly rare precipitants of cardiac arrest. Sodium…

…Bradycardia causing hemodynamic instability is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions…

…absolute quantification. The resting myocardium rarely reveals evidence of significant coronary artery stenosis unless the stenosis is severely critical, potentially causing angina during rest. Patients…

…Noonan syndrome : 60% of all individuals with Noonan syndrome have pulmonic stenosis. The stenosis is subvalvular, causing a narrowing of the RVOT (right ventricular outflow…

…restoration of sinus rhythm (or any other rhythm with normal ventricular rate and activation). Recovery may, however, take several months. Table 1. Arrhythmias causing tachycardia…

…crossing. Exact times are needed for continued management and quality follow up. STEMI: time targets and choice of reperfusion Primary PCI is the method of…

…the ECG machine. Lidocaine spray for the pharynx and lidocaine gel for the electrode. A glass of water with a straw, a vomit bowl, tissues…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…of SCA cases, though determining the exact underlying cause and its reversibility is often difficult. Physical examination and clinical evaluation should focus on identifying factors…

Cardiology Genetic and miscellaneous conditions Clinical Red Flags Raising Suspicion of Cardiac Amyloidosis Demographic and Clinical Context Cardiac amyloidosis should be suspected in patients older…

…Lesions causing only mild obstruction may rupture, thrombose and occlude. Many acute myocardial infarctions arise from lesions that previously obstructed less than 50% of the…

…chest discomfort; symptoms suggestive of myocardial ischaemia despite normal or non obstructive coronary arteries; dyspnoea; fatigue; and recurrent symptoms causing impaired quality of life. Women…

…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…

…drugs predisposing to bleeding and alcohol use. A high bleeding risk score should prompt correction of modifiable risk factors and closer surveillance; it does not…

…and bundle branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for…

…at any age. Exercise, or any other activity causing adrenergic stimulation, increase the risk of syncope, ventricular arrhythmias and sudden cardiac arrest. ARVC can cause…

ECG Pacemaker malfunction, troubleshooting and ECG Conventional surface ECG can reveal the following types of pacemaker dysfunction: Failure to capture (FTC) , which means that the…

…atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial flutter is caused by a…

…Hemodynamic effects of cardiac tumors The hemodynamic effect of the tumor depends on its size and location. Tumors can reduce cardiac output by causing obstruction…

…highly stochastic events. This is due to the fact that the vast majority of these arrests are caused by ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation…

…with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual…

…a significantly increased risk of atrial fibrillation. The increase in left atrial pressure may also propagate backward to the pulmonary circulation, causing pulmonary hypertension (PH…

…and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine…

…causing vasodilation. Dobutamine Dobutamine is a chronotropic and inotropic agent. It increases heart rate, myocardial contractility, and blood pressure, thereby simulating the effects of exercise…

…causing minimal radiation exposure. It is metabolically inert and diffuses freely across cell membranes, allowing for precise quantification of myocardial blood flow and assessment of…