…hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic prophylaxis. Deep…

…without a definite diagnosis. Choice of technique Diagnostic question Method Comment : : : Pigmented lesion, suspected melanoma Excision with a 1–3 mm margin, down into the…

…by the fact that the atria are depolarized sequentially, with the right atrium being depolarized before the left atrium. The first half of the P…

…and symmetric. Their duration is short; they typically disappear within minutes after a total occlusion in a coronary artery occurs (then of course, the ST…

…by the fact that NSTEMI and unstable angina are caused by partial (incomplete) coronary artery occlusions; a partial occlusion results in a reduction of coronary…

…in persons who are otherwise healthy. The majority of those with LAFB, however, have significant heart disease. Myocardial infarction, coronary artery disease, left ventricular hypertrophy…

…water soluble and short acting, not a depot preparation, and gives a shorter duration of effect. Lidocaine 10 mg/mL without adrenaline , 2–5 mL…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…fibrillation, particularly when other therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of digitalis toxicity, which manifests across multiple organ systems…

…system (His Purkinje network), which results in rapid impulse transmission and thus shorter QRS duration (as compared with apical pacing). Because ventricular pacing results in…

…interpretation requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation starts with assessment of the P wave…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

…from dilating adequately during diastole. This leads to increased and equivalent diastolic pressure in all rooms. Because pressure is high in the atria, filling of…

…the fact that the J point is not always isoelectric; this occurs if there are electrical potential differences in the myocardium by the end of…

…limit the filling of the chambers when the volumes become too large. Thus, the pericardium is considered to contribute to the fact that the ventricles…

…90% of males aged 40 years or younger display this). Hence, the authors have confused a completely benign condition (male/female pattern) with a condition…

…K + ) channels open which results in cell repolarization. The cycle then repeats itself ( Figure 1 ). Note that the leakage of sodium during the resting phase…

…QRS duration, delta waves, secondary ST T abnormalities). Click to zoom. Atrioventricular reentrant (reentry) tachycardia (AVRT) Individuals with accessory pathways are at risk of developing…

…the ventricles it will spread partly or entirely outside of the conduction system and thus produce a wide QRS complex (QRS duration ≥0.12 s)…

…that the test failed to identify 27.8% of individuals with poor neurological recovery. The specificity of absent pupillary reflex for predicting a poor neurological…

…lead to ventricular dilation. However, the term dilated cardiomyopathy (DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop…

…help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key Formulas BSA Calculation (Mosteller formula): [ …

…prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or the connected myocardium may cause mitral prolapse, and thus regurgitation. Ischemia manifests with…

…with left ventricular dilation. This type of cardiomyopathy, referred to as tachycardia induced cardiomyopathy , can be caused by any tachyarrhythmia leading to prolonged periods of…

…proximal portion of the pulmonary artery may also be dilated in patients with pulmonary hypertension. Echocardiography in pulmonary regurgitation Echocardiography is the modality of choice…

…the contraction of smooth muscle cells. As compared with nitroprusside, nicardipine induces relatively greater venodilation than arteriolar dilation. Effects Nicardipine causes dilation of the coronary…

…Elderly age ( 65), and Drugs/alcohol. A crucial clinical pitfall is the misapplication of this score. A high HAS BLED score (≥3) indicates a need…

…right heart hypertrophy, dilation and ultimately right heart failure. Echocardiography in mitral stenosis Echocardiographic assessment of mitral stenosis includes visual and 2D imaging, as well…

…heart disease. Endocarditis (common in intravenous drug addicts). Myxomatous degeneration. Rheumatic heart disease. Dilatation of the right ventricle. Dilatation of the right atrium. Pulmonary hypertension…

…because cardiac output diminishes in parallel with increasing myocardial load (and hence oxygen demand). The most common causes of acute aortic regurgitation are aortic dissection…

…ventricle, which is counteracted by dilatation of the ventricle. Dilatation of the right ventricle results in reduced intraventricular pressure and thereby reduced myoardial load. Pulmonary…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain…

…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…

…pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily. Principles of management Medical therapies do not alter disease progression. Diuretics…

…a precaution. Dosage of vernakalant Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg. Normal dilution: 4 mg/ml. Recommended…

…cardiac arrest. High quality compressions with minimal interruptions and early defibrillation are what determine the outcome; drugs are given without pausing the compressions. Anaphylaxis Intramuscular…

…and of ventricular end diastolic and residual volumes. Experimental and clinical observations with a precordial dilution technic. Circulation. Redfield et al: Heart Failure with Preserved…

…a quick reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the mechanism of action, the onset, the duration of effect…

…Choice of agent Situation Choice Reason : : : An opioid naive adult with normal renal function Morphine The reference drug, with the greatest experience eGFR 30–60…

ECG Introduction to ECG interpretation The QRS complex (ventricular complex): normal and abnormal configurations and intervals A complete QRS complex consists of a Q , R…

…From a hemodynamic standpoint, there are two types of enlargement, namely hypertrophy and dilatation. Both hypertrophy and enlargement may reduce atrial and ventricular function as…

…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…

…A duration of 6 months after ACS is generally considered too short for routine use, but it may be considered in selected patients with a…

…flow across the mitral valve. The duration of diastasis is inversely related to heart rate (diastasis is shorter at higher heart rates and vice versa ).

…with time, clarity and respect is also what makes the decision hold afterwards. Organ preserving treatment — treatment given solely for the sake of the donation…

…Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment…

…of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias with…

…VT]). The VF waveform is initially coarse ( i.e fibrillatory waves have large amplitudes) but as the duration of VF is prolonged, the amplitude gradually…

…of serious morbidity or mortality, underscoring the need for a structured and guideline directed approach. This chapter focuses on practical diagnostic and therapeutic considerations, with…

…III and aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation…

…III and aVF (with QRS duration <0.12 seconds), provided that other causes of right axis deviation have been excluded. Causes of left axis deviation…

…requires knowledge of these waves and intervals. The P wave, PR interval and PR segment ECG interpretation traditionally starts with an assessment of the P…

ECG Hypertrophy and dilatation Biventricular hypertrophy Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to…

…The most common serious error is dilating a vessel that turns out to be an artery — everything in the technique is designed to make sure…

…right ventricular hypertrophy. Next chapter Biventricular Hypertrophy Related chapters Overview of Hypertrophy and Dilatation Left Ventricular Hypertrophy Atrial Hypertrophy and Dilatation (P mitrale, P pulmonale…

…onset, prolonged duration of effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute…

…PR interval <120 ms with a delta wave and wide QRS is indicative of 'Ventricular pre excitation', and QRS duration ≥140 ms is considered 'Profound…

…a patient on digoxin treatment 1 ECG signs of left atrial enlargement 3 Left axis deviation 2 QRS duration ≥90 milliseconds 1 Prolonged R wave…