…anyone interested in ECG interpretation. Also includes vast amounts of clinically relevant discussions and articles in emergency medicine. AnaesthesiaUK is a comprehensive e resource and…

…C Anxiety Tranquillizer (e.g benzodiazepine) is considered. IIa C Cardiac arrest Management Recommendation Level of evidence Urgent angiography is indicated in patients exhibiting ST…

…tachycardia is endless loop tachycardia, which also depends on the ventricular stimulation being triggered by atrial activity. In endless loop tachycardia, the ventricular impulse manages…

…6 minutes (Lipton et al). Survival in cardiac arrest is highly dependent on the initial rhythm (first recorded rhythm). The initial rhythm is a marker…

…the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy. Its purpose is to guide clinicians in balancing estimating the risks…

…restrictive filling (grade 3 dysfunction) Irreversible restrictive filling (grade 4 dysfunction) E/A ratio 1–2 1–2 <1 1–1.5 (not reversed with…

…confidence intervals (the mean is presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit)…

…clinical variables (e.g., age, sex, renal function, left ventricular ejection fraction) to provide a more personalized risk assessment. Key Variables in SYNTAX Score II…

…de Lemos JA, Giugliano RP, McCabe CH, Braunwald E. TIMI risk score for ST elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment…

…is sinus rhythm (i.e under normal circumstances) the P wave vector is directed downwards and to the left in the frontal plane and this…

…characteristics, clinical features, family history and genetic testing are important clues in the investigation. Additional examinations (e.g coronary angiography, cardiac MRI) are frequently necessary…

…in increased wavelength and decreased frequency. The same principles can be applied to blood flow and tissue motions. The sound source in echocardiography (i.e…

…e. contraction). The significance of this will depend on the severity of the conduction defect and the affected ventricle. In general, a conduction defect in…

…it is still used in clinical practice. M mode provides a one dimensional view of all reflectors (i.e structures reflecting ultrasound waves) along one…

…is the number of wave cycles per second. The unit of frequency, which is denoted by the letter f , is Hertz (Hz) . In Figure 2…

…can be fixed or dynamic, depending on the underlying etiology. Pulmonary stenosis can be valvular (i.e stenosis localized in the valve), subvalvular (stenosis proximal…

…confidence intervals (the mean is presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit)…

…tachyarrhythmia (tachycardia). Sinus tachycardia is the result of an increased rate of depolarization (i.e increased automaticity) in the sinoatrial node. This simply means that…

…through the heart and vessels. The velocity of erythrocytes ( i.e blood) can be used to estimate pressure gradients (pressure differences) between the atria, ventricles…

…in this sequence, before mechanical dysfunction ( i.e. left ventricular systolic or diastolic dysfunction) or electrical changes (ST T changes on ECG) become apparent. In…

…and the appropriate action differs fundamentally between these cases. Pressures in the heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure…

…whether the difficulties were anticipated, whether the position and the equipment are in order, and whether there is an explicit plan for what happens when…

…reduce the antiplatelet effect of acetylsalicylic acid. Use with caution in patients on low dose acetylsalicylic acid for cardioprotection. Pharmacokinetic interactions Methotrexate: NSAIDs inhibit tubular…

…complex in V1–V2 resembles a left bundle branch block (i.e negative QRS) V1 : The initial portion of the QRS complex is smooth in…

…troke B leeding history or predisposition L abile INR (International Normalized Ratio) E lderly (age 65 years) D rugs/alcohol concomitantly Each component is assigned…

…Gonzalo; Baumgartner, Helmut et al. (2012): Guidelines on the management of valvular heart disease (version 2012). In European heart journal 33 (19), pp. 2451–2496…

…heart rate 50–100 beats per minute; (2) P wave precedes every QRS complex; (3) the P wave is positive in lead II and (4…

…administration of ticagrelor with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir) can lead to a significant increase in exposure to ticagrelor…

…use of validated risk models to estimate the risk of acute myocardial infarction, 30 day and 1 year mortality in patients with NSTE ACS. TIMI…

…does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting appropriate for cardioversion. Administration of vernakalant Vernakalant (Brinavess)…

…Recent studies on COVID 19 and cardiovascular disease Cardiovascular implications of COVID 19 have been elucidated in recent studies from China and Italy (1–5…

…is flat and isoelectric (i.e in level with the baseline). Displacement of the ST segment is of fundamental importance, particularly in acute myocardial ischemia…

…relative to the cardiac cycle, since a shock delivered asynchronously on the T wave during ventricular tachycardia can precipitate ventricular fibrillation, whereas a synchronized shock…

…of how changes in the length of the cardiac cycle causes aberration. Figure 1. The figure shows a supraventricular extrasystole (i.e a premature atrial…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…on the image. Structures with low echogenicity reflect less ultrasound and become darker in the image. Acoustic shadowing Some structures have very high echogenicity (e…

…of the end diastolic volume (EDV, i.e blood volume in the ventricle at the end of diastole) that is pumped out during systole. Currently…

…now be discussed in detail. E/A ratio: Blood flow across the mitral valve Flow velocity across the mitral valve is examined in the apical…

…the mainstay of this therapy). Rate control does not affect the rhythm per se . Rhythm control, on the other hand, attempts to restore sinus rhythm…

…Phenylephrine Eliminate the causative allergen : discontinue any suspected medications and remove any remnants of allergens (e.g., insect residues). For patients on beta blocker therapy…

…Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of haemorrhageinduced traumatic cardiac arrest. Resuscitation 2019; 140:37 42…

CPR Poisoning and drug toxicity In adolescents and young adults, intoxication events leading to cardiac arrest are notably prevalent, primarily due to the misuse of…

…to the ICU or CCU depends on the system of care and patient status. The absolute majority of patients should be managed in the ICU…

…80% (i.e less than 80% diagnoses chronotropic incompetence) Management of chronotropic incompetence Treatment of chronotropic incompetence and other bradyarrhythmias are discussed in the chapter…

…category includes all acute coronary syndromes without significant ST segment elevations on ECG. NSTE ACS is caused by partial occlusion of the artery (i.e…

…ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due…

…Consequently, unipolar pacemakers yield larger stimulation artifacts on ECG (Figure 4). In bipolar pacing, the anode and cathode are both located within the heart and…

…with suspected coronary artery disease (i.e CCS). The new guidelines are based on data derived from studies conducted mainly in North America and Europe…

…A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in peripheral blood is mandatory to establish…

…first line therapies. Digoxin is also used frequently in the emergency setting to control ventricular rate during supraventricular tachycardias (e.g.atrial fibrillation). Because digoxin…

…of normal findings , normal variants (i.e less common variants of what is considered normal) and pathological variants . Thus, in this chapter, you will learn…

…one" – is used to denote the occluded coronary artery. In the majority of cases, it is only possible to determine the ischemic/infarct area (and…

…fraction is highly dependent on preload and afterload. A rapid increase in preload (e.g by increasing venous return to the heart in supine position)…

…causes hemodynamic effects. Electrical alternans – i.e the beat to beat variation i electrical amplitude – is the ECG hallmark of cardiac tamponade. Causes of pericardial…

…Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the other hand, appears to be…

…in a significant number of cases, the rhythm is non shockable, as seen in certain causes of cardiac arrest (e.g. pulmonary embolism) or in…

…thrombus (i.e the degree of artery obstruction): The greater the obstruction the more extensive the ischemia/infarction. The location of the thrombus in the…

…underlying hypertrophic cardiomyopathy are complicated and some gene variants may only cause hypertrophy under certain loading conditions (i.e in the presence of increased load)…

…actually reduce conduction through the AV node, resulting in increased AV block. Sinus node dysfunction can be caused by supraventricular tachyarrhythmias (e.g. atrial fibrillation)…

…in the chapter ST elevations in ischemia and differential diagnoses. In cardiac arrest caused by acute total occlusion of an epicardial coronary artery (i.e…