…non pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent Dose…

…accumulation of these peptides irritates afferent neural pathways in the respiratory tract. This process is not dose dependent. Similarly, angioedema occurring in the setting of…

…or upper gastrointestinal tract, ileus and ongoing upper gastrointestinal bleeding. Marked agitation or inability to cooperate. Copious secretions without an effective cough. Choice of method…

…respiratory symptoms, and occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease…

…left heart disease from pulmonary vascular disease. Although a PAWP of 12 mmHg represents the upper limit of normal in some assessments, a threshold of …

…investigations. The emergency differential also reflects distinct mechanisms of acute cardiopulmonary disease: Pulmonary embolism and spontaneous pneumothorax may produce abrupt chest pain and respiratory distress…

…the 99th percentile upper reference limit; and Clinical evidence of acute myocardial ischaemia. At least one of the following provides the required evidence of ischaemia:…

…For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery disease (i.e CCS). The new…

…updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with suspected coronary artery disease (i.e. CCS). The…

…with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw, upper back…

…disease. Calf symptoms are typical of femoropopliteal disease. More distal disease may cause foot symptoms, although lower extremity symptoms are much more common than upper…

…atherothrombosis. It is usually precipitated by disruption of an atherosclerotic plaque through rupture or erosion. The relative contributions of plaque disease and thrombus vary considerably…

…above the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values…

…suggests vascular disease, and the arm with the higher reading is used thereafter Two to three measurements one minute apart, taking the mean of the…

Procedurer The ankle brachial index is the cheapest and most accessible method of objectively demonstrating peripheral arterial disease, and it is needed more often than…

…limb ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood…

…typical rise and/or fall of high sensitivity cardiac troponin (hs cTn), with at least one value above the 99th percentile upper reference limit (URL…

…Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the epicardial coronary arteries and/or the coronary microcirculation…

…The upper reference limit is currently the 99th percentile in a healthy population. Troponin levels higher than the 99th percentile of a normal population are…

…others normal Gilbert's syndrome, haemolysis The R value = (ALT / upper limit of normal) / (ALP / upper limit of normal). An R 5 indicates hepatocellular…

…mitral valve disease is a common cause ( Figure 25, P mitrale ). If the atria are depolarized by impulses generated by cells outside of the sinoatrial…

…failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn concentration rises. Early…

…may represent a more favorable profile, as the upper limit of the "healthy" range can still harbor significant metabolic risk. 3 For patients with a…

…disease, postoperatively after cardiac surgery 80 g/L Acute coronary syndrome 80 g/L; a higher threshold may be considered individually in ongoing ischaemia Upper…

…intake redistributes blood to the gastrointestinal tract which reduces blood availability in the heart. Symptoms of ischemic heart disease are generally not related to body…

…The upper 99% limits of normal for corrected QT (QTc) values in the general population are 450 ms for men and 460 ms for women…

…risk increasing particularly after 70 years Male sex Previous upper gastrointestinal disease Hepatic or renal disease Multiple cardiovascular risk factors Concomitant nonsteroidal anti inflammatory drugs…

…mitrale, because mitral valve disease is a common cause (Figure 1). The duration of the P wave will exceed 120 milliseconds in lead II. Biatrial…

…in diseased atria—most frequently following surgery or extensive ablation, or under the influence of antiarrhythmic drugs—can produce atypical ECG patterns. Conversely, upper loop…

…should be distinguished from severe muscle injury. Myopathy is characterized by muscle symptoms accompanied by CK greater than 10 times the upper limit of no

…stenosis, multivessel coronary artery disease, or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the absence of a flow limiting epicardial stenosis. It…

…pediatric and neonatal care must have knowledge of age related variations in the ECG, as well as cardiac diseases that may affect infants and children…

…pediatric and neonatal care must have knowledge of age related variations in the ECG, as well as cardiac diseases that may affect infants and children…

…19 and MERS (Middle East Respiratory Syndrome, coronavirus). Recent studies on COVID 19 and cardiovascular disease Cardiovascular implications of COVID 19 have been elucidated in…

…reduce stroke risk, and detection may lead to inappropriate anxiety and invasive procedures. Symptomatic disease Symptoms of carotid disease include: TIA; ischaemic stroke; focal neurological…

CPR It is commonly stated that approximately 80% of all cardiac arrests are caused by acute or chronic coronary artery disease, with the latter being…

Cardiology Principles of myocardial perfusion imaging Myocardial perfusion imaging (MPI) is a non invasive technique for detecting and quantifying coronary artery disease (CAD). It offers…

Cardiology Nephrology Definition and pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…disease (CAD), atherosclerosis, heart failure (HF), atrial fibrillation and cardiovascular events. In clinical practice, obesity is conventionally defined by a body mass index (BMI) of…

…significant coronary artery disease, potentially resulting in false negative findings. Radiotracers in myocardial perfusion imaging Radiotracers are designed to identify ischemic areas of the myocardium…

…cardiovascular disease. It has been the number one killer in Western and high income countries for more than half a century, causing approximately 20% of…

…cardiomyopathies and channelopathies. Nevertheless, apparently sporadic disease may result from: Incomplete penetrance of a variant inherited from a parent. A de novo variant. Less commonly…

…most persuasive when the initial probability is high enough that the result meaningfully increases the likelihood of disease and can justify further investigation or treatment…

…and cardiac catheterization. Principles of management of congenital heart disease and GUCH Complex malformations often require intervention (surgical or catheter based intervention). In addition to…

…Figure 1. Flowchart showing the natural course of coronary artery disease and classification of acute coronary syndromes into STEMI, NSTEMI and unstable angina using ECG…

…scale) should prompt termination of the stress test (refer to Termination criteria during stress testing). Dyspnea (dyspnoea) Exercise does lead to tachypnea (increased respiratory rate)…

…Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia, cold agglutinin disease…

…associated with hypertension, coronary artery disease, arrhythmias, heart failure and alcohol related cardiomyopathy. The cardiovascular implications of lower alcohol intake remain controversial. Epidemiological studies have…

…of significant LMCA disease, including acute occlusions, subtotal stenoses, and discusses associated clinical presentations, prognostic implications, and management strategies. In the GRACE ECG substudy of…

…explain the marked differences in characteristics and outcomes across the data sources for out of hospital cardiac arrest (OHCA) and in hospital cardiac arrest (IHCA…

…mean transit time — isolates microvascular resistance. Only indices that detect microvascular disease as an independent cause of ischemia, including with non obstructive epicardial arteries (ANOCA…

…stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose colchicine as…

…the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing acute coronary syndromes are: Plaque rupture with exposure of thrombogenic material…

…cardiac disease Oxygen targets Patient Initial target saturation : : Known COPD or another clear risk of hypercapnic respiratory failure 88 to 92 percent No risk of…

…central clinical danger is progressive aortic wall disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation…

…choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease, etc .) are warranted. Management of…

…with inflammatory rheumatic disease have a higher cardiovascular risk than the general population. This excess risk has been documented across a broad range of conditions…