…HINTS is not a test for BPPV. It is used in the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus, nausea and difficulty walking that…

…onset, continuous dizziness lasting hours to days, often with nausea, nystagmus, motion intolerance and difficulty walking Vestibular neuritis, cerebellar or brainstem infarction, haemorrhage, drug toxicity…

…reliable in the hypoglycaemic range. Poor peripheral circulation, cold fingers, sampling errors and contamination can give erroneous values. If the measured value does not fit…

…However, randomized evidence has not shown a reduction in mortality or myocardial infarction with routine CTO PCI compared with medical therapy. Clinical presentation and symptoms…

…arrest, agonal breathing or cardiac arrest — intubate. Inability to protect the airway: a reduced level of consciousness not attributable to hypercapnia, marked swallowing difficulty, vomiting…

…diagnostic difficulty in a patient recently treated for AMI. Dyspnoea may occur, particularly when the effusion is substantial or when haemodynamic consequences develop. In patients…

…Loss of confidence in resuming normal activity Difficulty returning to work or recreational exercise Frailty or loss of muscle mass, particularly in older adults Patients…

…HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting…

Cardiology Indications for pharmacologic agents Pharmacologic stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such…

…common and occur in a wide range of conditions. Unfortunately, many clinicians tend to misinterpret the T wave and some find it difficult to put…

…branch block is more common in individuals with structural and ischemic heart disease. Assessment of ischemia on ECG is difficult in the presence of left…

…is difficult or inadequate. The primary airway in cardiac arrest when the person ventilating is not experienced in intubation. Planned anaesthesia for short procedures in…

…therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new…

…an elevated cardiac troponin concentration and new ST segment depression in new onset AF should not automatically be labelled type 2 myocardial infarction without further…

…Behçet disease can cause both arterial and venous thrombosis. In SLE, renal artery involvement may contribute to difficult to control hypertension. The cardiovascular consequences of

…cause of pericardial effusion is pericarditis. Because it is difficult to determine if there is also myocarditis (which is frequent), it is common to use…

…of skin color is not necessary to confirm cardiac arrest. Skin color is pale or cyanotic, but this may be difficult to discern depending on…

…again, in its final third. The right bundle branch does not give off any Purkinje fibers during its course through the interventricular septum. It starts…

…is rarely the difficult part — it is the confirmation of the position that determines whether the tube is safe. A misplaced tube in the airway…

…printed on the catheter , usually 10 mL in adults. Do not use saline — the salt can crystallise and block the valve. The material determines how…

…it may be difficult to acquire images in the left lateral decubitus position. This affects images obtained in apical windows (refer to Standard Transthoracic Echocardiogram…

…time is typically prolonged (35 to 55 milliseconds) in V1–V2. Hence, the QRS duration is slightly prolonged (but it does not reach 120 milliseconds…

…measuring dimensions. In order to obtain representative measurements, it is pivotal to align the M mode line such that it does not overestimate distances; e…

…nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI…

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

…are not ischemic! However, T wave inversions that are accompanied by ST segment deviation (either depression or elevation) is representative of ischemia (but in that…

…atrial impulses to conduct to the ventricles, resulting in some P waves not being followed by QRS complexes. This condition is further categorized into two…

…displayed on the ECG paper in their anatomically contiguous order from right anterior (V1) to left lateral (V6), but regrettably, the limb leads are not…

…of Cardiac Amyloidosis Demographic and Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left…

…infarction Procedurer Definition and scope Coronary angiography is an invasive fluoroscopic procedure in which contrast media are injected selectively into the epicardial coronary arteries through…

…should not be confused with hypertrophy caused by increased loading conditions. Increased ventricular load is mostly caused by systemic hypertension or aortic stenosis. In hypertension…

…is often difficult to differentiate pericarditis and myocarditis, and they tend to accompany each other. Therefore, the term perimyocarditis is often used in clinical practice…

…artery — everything in the technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's…

…of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias…

…not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult…

…intubation. A difficult airway is anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the right course, not RSI. Assess…

…exploring electrode (in the 12 lead ECG) that can present the ST segment elevations ( Figure 1 ). Thus, the 12 lead ECG does not display ST…

…resulting in fewer cardiac arrests caused by these conditions ( Jerkeman et al ). It is often difficult to determine the cause of an out of hospital…

…difficult for the immune system to reach the bacteria. Endocarditis can lead to the destruction of the valvular apparatus, as well as to embolization in…

…the right ventricle with echocardiography The right ventricle is relatively difficult to examine, which is due to the location of the ventricle in the thorax…

…This is not a new experience for either the pathologist or the internist. That there is something lacking in our understanding of this problem is…

…20 G in an adult; a smaller size in children. A set with an integrated guidewire (Seldinger technique) helps when the vessel is difficult to…

…level risk estimation, but it does not characterize body composition, fat distribution, skeletal muscle mass, physical fitness or individual health status. In particular, it cannot…

…procedural injury in patients undergoing either procedure, and postprocedural cTnI elevation correlates with evidence of injury on cardiac magnetic resonance. Interpretation is more difficult when…

…which typically occurs in leads V2–V3. How to measure the QT interval Measurement of the QT interval may be difficult due to T wave…

…professionals with the skills and equipment required. Although ACLS is more advanced and costly than the interventions available in BLS, the number needed to treat …

…including in the left ventricle, left atrium, aorta and coronary arteries. As the valve area becomes smaller, the transvalvular resistance increases, making it more difficult…

…ECG in moderate hyperkalaemia Previously mentioned ECG changes becomes more pronounced. P waves become wider. P wave amplitude decreases. The P wave may be difficult…

…wave in lead II, but the heart rate exceeds 100 beats per minute. Although sinus tachycardia is the most common tachyarrhythmia, it may not always…

…arise in an ectopic focus (located distal to the block). Third degree AV block is a very serious condition because escape rhythms may (1) not…

…anaesthesia. Placenta praevia or ruptured membranes in pregnancy — a speculum may be used, but not digital examination until the position of the placenta is known…

…been started a continuing transfusion requirement. A normal haemoglobin early on does not exclude major bleeding. In acute blood loss, plasma and red cells are…

…constitutes a major clinical problem. It can manifest as an increase in the frequency of a pre existing arrhythmia, the sustenance of a previously non…

…burden of nonviable or scarred myocardium is associated with less improvement in LVEF. Nevertheless, improvement in LVEF is not the only possible objective of revascularization…

…makes it difficult for blood to flow from the ventricle to the aorta). Hypertension and aortic stenosis result in increased afterload. ECG changes in hypertrophy…

…cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter is not capable of persisting…

…fitness and exercise capacity . In clinical practice, however, it is difficult to achieve peak oxygen uptake because it requires maximal exertion, which patients rarely achieve…

…previously, this part of the left ventricle is difficult to capture with the conventional leads in the 12 lead ECG. In 10% of individuals, the…