…80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation—predominant right…

…several hours of awakening has been described. Atypical and painless presentations Pain is not universal. Painless STEMI is more frequent in people with diabetes and…

…In patients with pericarditis complicated by constriction, symptoms and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are…

…Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as…

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

…preferably with sips of water if swallowing is safe. Advance the tube in time with the swallows. 6. Stop immediately in the event of coughing…

…of acute or chronic heart failure are often better categorised as myocardial injury. Clinical Presentation and Symptoms Patients with Type 2 MI frequently present with…

…requires elevated levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms or ECG changes consistent with myocardial infarction/ischemia…

…disease. Alcohol also increases the rise in myocardial oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although…

…excludes myocardial ischemia as the cause of the pain. Refer to The ischemic cascade for details. History taking in patients with chest pain (chest discomfort…

…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…

…With regards to drugs, the risk of QT prolongation and TdP varies markedly across the list but tends to be rather similar within a drug…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

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

…Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular…

…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…

…Choose a point with at least 15 mm depth of fluid throughout the respiratory cycle and where the lung does not come up against the…

…role of sensitized sensory nerve endings and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This syndrome presents with a…

…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…

…Additional features associated with greater difficulty include a previously failed attempt, a blunt proximal stump, vessel bending, calcification and an occlusion length of at least…

…90% of renal glucose reabsorption. The remaining glucose is reabsorbed by SGLT1 in the S3 segment. SGLT2 also mediates proximal tubular sodium reabsorption, with chloride…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…branch block morphology is more common (regardless of heart rate) among persons with heart disease. Alternating block (right and left bundle branch block alternating from…

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

…94%. Provide an intravenous or intraosseous fluid bolus, beginning with 500 ml of normal saline over 5 10 minutes, adjusting based on response. If hypotension…

…and cardiac arrest, with hyperkalemia being the most prevalent electrolyte disturbance observed in cardiac arrest scenarios. Hypocalcemia, although capable of causing cardiac arrest, is an…

…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…

…artery stenosis. Stress can be induced pharmacologically with coronary vasodilatory agents or simulated hemodynamically through exercise or the use of chronotropic and inotropic agents. Radiotracers…

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

…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…

…unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach…

…atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…context of cancer therapy, patients may develop new cardiac symptoms such as syncope, pre syncope, or rapid palpitations. These symptoms often accompany QTc prolongation with…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…

…the anticipated benefit–risk balance of revascularization. Coronary angiography remains primarily an anatomical examination, whereas contemporary decision making increasingly combines anatomical imaging with functional assessment…

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

…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…

…AF causing acute haemodynamic instability requires prompt treatment, with electrical cardioversion preferred. Evaluation and risk assessment The evaluation of a patient with AF who may…

…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…

…the reason for which remains elusive. Gene mutations can be confirmed in roughly 60% of individuals with ARVC. Mutations in the desmosomal gene PKP2 is…

…to myocardial excitability. This is done by repeatedly stimulating with gradually decreasing amounts of energy until the stimulus no longer yields an activation. The pacemaker…

…from that of atrial fibrillation. Acute and paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial…

…the size and localization of the mass are indicative in diagnostics. A patient who exhibits an ecotdense mass entrenched in the endocardium with impaired mobility …

…from the Swedish Cardiac Arrest Registry, which has recorded causes of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes…

…Careful electrocardiographic and hemodynamic monitoring with ECG, central vein catheter and intra arterial catheter (A line) is warranted. Overview of vasopressors and inotropes Inotropes and…

…LCX or the right coronary artery (RCA). For details, refer to chapter The Coronary Arteries. Mitral valve disease A wide range of conditions may cause…

…parallel with increased oxygen consumption during exercise. Thus, supply and demand are balanced and no ischemia occurs. (Some individuals display a benign form of ischemia…

…coronary vasodilation. This selectivity minimizes activation of A1, A2B, and A3 receptors, which are associated with adverse effects such as bronchoconstriction and atrioventricular block. Adenosine…

…gamma cameras to create tomographic images of the left ventricle. In PET (Positron Emission Tomography), radiotracers emit positrons. When a positron collides with an electron…