…pull the skin and subcutaneous tissue 2–3 cm to one side, inject, wait 10 seconds, withdraw the needle and release the skin. The displaced…

…that is the posterior superior iliac spine. Mark it. 3. Clean the skin and apply the drape. Anaesthetise skin, subcutaneous tissue and then the periosteum…

…an inflammatory dermatosis: the active edge , not the burnt out centre. 2. Clean the skin and infiltrate the anaesthetic intradermally and subcutaneously until a weal…

…the first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and…

…if the temperature criterion is not met. The first hour Step Action : : 1 ABCDE, full vital signs, level of consciousness, and repeated assessment of the…

…the standard. Dark skin: a risk of permanent hypopigmentation. Areas with poor circulation, above all the lower leg in a patient with peripheral arterial disease…

…and consider referral in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the…

…are the strongest predictors of adverse outcomes. Non acute or asymptomatic bradycardia Non acute bradycardia is a common finding in both healthy and diseased individuals…

…venous Doppler signals Evidence of systemic disease or a potential embolic source Neurological assessment is central to triage. Sensory loss extending beyond the toes and…

…negligible, and doses do not require reduction in patients with renal disease; neither amiodarone nor desethylamiodarone is dialyzable. The volume of distribution is large, averaging…

…recorder Contraindications None. Practical obstacles are skin disease or allergy to the electrode gel, and marked body hair that cannot be shaved. Set up 1…

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…

…of rebound. The referring physician should have made this decision; document which applies. Nitroglycerin is continued; note it in the report. Shaving and careful skin…

…at normal concentrations; be cautious nonetheless in known peripheral vascular disease and follow local practice. Inject through the wound edge , not through intact skin — it

…risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right internal jugular vein is the first choice in most situations. The…

…related joint disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint…

…into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral epicondylitis the effect is…

…are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin and soft tissue…

…the first choice : superficial, easy to compress, with a dual collateral supply to the hand through the palmar arches and the lowest complication rate. The…

…quoted as the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first…

…risk of myocarditis, given the similarities between COVID 19 and MERS (Middle East Respiratory Syndrome, coronavirus). Recent studies on COVID 19 and cardiovascular disease Cardiovascular…

…may affect hemodynamics and the underlying cause is often serious (e. g. malignancy, amyloidosis). In case of suspicion of pericardial disease, in the first place…

…must have knowledge of age related variations in the ECG, as well as cardiac diseases that may affect infants and children. Physiological and anatomical development…

…arrest is the mechanism of death for most diseases and conditions, including non cardiovascular conditions. A cardiac arrest can be expected or unexpected. The most…

…must have knowledge of age related variations in the ECG, as well as cardiac diseases that may affect infants and children. Physiological and anatomical development…

…of hospital cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL. The hemodynamic and…

…diabetes and obesity become increasingly prevalent after the menopausal transition. Women with type 2 diabetes also have a higher prevalence of cardiovascular complications and death…

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

…does not invariably result in clinical disease. Penetrance is incomplete and age dependent, and the severity and manifestations of disease may differ substantially among carriers…

…scores and may be the first clinically important manifestation of an otherwise unrecognized inflammatory disease. Epidemiology and disease specific patterns Patients with inflammatory rheumatic disease…

…in the autonomic nervous system, with increased sympathetic input (leading to stimulation of beta adrenergic receptors) and parasympathetic withdrawal. Sinus tachycardia secondary to disease and…

…systolic blood pressure alone. Predictive Value : Elevated MAP has been associated with an increased risk of cardiovascular diseases, such as stroke, and mortality. Stability : MAP…

…not be regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to…

…total and cardiovascular mortality ( Curtis et al ). Among patients with coronary heart disease, left ventricular function is actually a stronger predictor of death than the…

…angiography, and, occasionally, pathological examination. Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia. The first cellular abnormalities of ischaemia include depletion of glycogen…

…stenoses must be graded in order to optimize management according to disease severity. The most important parameter, for grading of stenoses, is the opening area

…diffuse, leading to underestimation of the overall disease burden. Angiography also provides limited information about plaque composition, vulnerability and the risk of future plaque rupture…

…assessment of peripheral arterial and aortic disease; planned surgery, especially carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), or major non cardiac surgery. The vascular…

…etc ) accelerate the atherosclerotic process and increase the number and size of atherosclerotic plaques. Typically, the first manifestation of coronary artery disease is stable angina…

…Borg Rating of Perceived Exertion Scale There is a strong correlation between a person's perceived exertion rating times 10 and the actual heart rate…

…etc ) accelerate the atherosclerotic process and increase the number and size of atherosclerotic plaques. Typically, the first manifestation of coronary artery disease is stable angina…

…Its incidence and prevalence rise steeply with age, reflecting accumulated risk factors, age related reduction in cardiovascular reserve, and the increasing burden of comorbid disease…

Cardiology Clinical medicine Definition and Scope Primary prevention aims to prevent the clinical manifestation of cardiovascular disease (CVD) in individuals without established clinical CVD. It…

…While dyspnea is the cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation…

…the presence of arrhythmogenic substrates. A substrate is defined as a physiological or anatomical factor that can trigger or sustain arrhythmias, such as necrotic tissue…

…large outcome trials have clarified, and in some cases substantially narrowed, the role of revascularization itself in stable coronary artery disease, while a distinct evidence…

…known coronary artery disease: Achieving 85% of age adjusted MHR resulted in myocardial perfusion defects in all patients,, anginal symptoms in 83%, and ECG changes…

…risk of hypercapnia and a normal blood gas Usually 94 to 98 percent An individually documented target prescription, for example in chronic hypercapnia Follow the…

…defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when appropriate, immediate percutaneous coronary intervention (PCI). Complications…

…complexity and completeness of possible revascularization A proximal lesion jeopardizes more myocardium than a distal lesion. In observational data, a lesion proximal to the first…

…over 40 years of age, atherosclerosis is the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma…

…within the plaque and tissue factor bearing microparticles contribute to activation of coagulation. Plaque rupture is typically associated with a fibrin rich, red thrombus. The…

…function declines and as albuminuria increases. When eGFR falls below approximately 60–75 mL/min/1.73 m², the probability of coronary artery disease (CAD…

…provides the clinical context, the diagnosis requires evidence of new myocardial ischaemia, which may manifest through symptoms, ECG changes, or angiographic complications. Evaluation and Physical…

…sensitive and specific in evaluating perfusion and also play a role in determining the viability of compromised myocardial tissue, aiding revascularization decisions when the potential…

…aggressive lowering of blood lipids with statins and sophisticated treatments for hypertension. However, coronary artery disease remains the number one killer in most regions worldwide…

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

…concentrations and first order kinetics at higher concentrations. Ethanol is water soluble and readily crosses cell membranes, allowing distribution throughout water containing tissues, including the…

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

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