…These abnormalities produce breathlessness, orthopnea, weight gain, peripheral edema, early satiety, abdominal distension and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation…

…pain, haemoptysis, syncope and palpitations. Orthopnoea, weight gain and peripheral oedema. Previous hypercapnia, NIV or invasive ventilation. Home oxygen and the patient's usual saturation…

…Definition and pathophysiology Obesity is a chronic, relapsing and biologically complex disease characterized by excessive accumulation of adipose tissue. It is an important cause of…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

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

…before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance; choose a new site if in doubt Cellulitis over the insertion site Change the puncture site…

…completely. Relative contraindications: A high risk of aspiration: a non fasted patient, ileus, third trimester pregnancy, marked reflux. A need for high airway pressures, for…

…effects Excessive sedation. Confusion. Hallucinations. Hypotension. Bradycardia. AV block. Constipation Contra indications Bradycardia. Caution • Clonidine may induce severe hypotension. • Clonidine is not recommended in most…

…to the treated segment, occurred in 10–15% during the first year. The dominant mechanism was excessive intimal hyperplasia within the stent. Restenosis was more…

…include: Diabetes and insulin resistance Thyroid disease Kidney disease Excessive alcohol consumption Diets high in carbohydrate or fat Glucocorticoids Beta blockers Oestrogen therapy Some antiretroviral…

…and class III antiarrhythmic effects. The drug comprises both d and l isomers, which share similar efficacy in prolonging repolarization. However, the l isomer is…

…prolonged, produces multiorgan dysfunction and death. In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction…

…the P wave is positive in lead II. Causes of bradyarrhythmia: sinus bradycardia, SA block, sinus arrest, sick sinus syndrome, second degree or third degree…

…unknown or excessive duration without adequate anticoagulation or exclusion of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic…

…decompensation, whereas acute illness and increased sympathetic drive may promote AF. In DHF, ventricular rate may decrease as dyspnoea improves and sympathetic activation subsides, making…

…pressures. Excessive reduction in diastolic blood pressure may compromise coronary perfusion, particularly in patients with coronary disease. Excessive systolic reduction may be associated with falls…

…denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction…

…Dyspnoea. Reduced exercise tolerance. Excessive fatigue. These non chest pain manifestations are reported more frequently in females, older adults and people with diabetes. Ischaemic heart…

…increase the gain. This amplifies the incoming (reflected) ultrasound waves such that each object appears whiter on the image. Increasing gain excessively results in lower…

…et al). Overall, the HAS BLED score may offer better predictive accuracy for bleeding risk in AF patients undergoing anticoagulation therapy. References 1. Gage BF…

…Myocardial ischemia and infarction Pathological Q waves are evidence of myocardial infarction Myocardial infarction – particularly if extensive in size – typically manifests with pathological Q waves…

…The agent undergoes extensive hepatic metabolism, yielding desethylamiodarone as a major active metabolite. Both the parent drug and its metabolite accumulate extensively in various tissues…

…failure (HF) symptoms may result from several overlapping processes: Recurrent or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction Chronic…

…conditions that favour thrombus formation. Extensive transmural septal infarction may also permit mural thrombi to develop over infarcted myocardium in either ventricle. With contemporary imaging…

…right ventricular necrosis is found in approximately one third of patients with inferior infarction. Extensive involvement is less common in patients with inferoposterior left ventricular…

…to both the left anterior descending (LAD) and left circumflex (LCx) coronary artery territories, resulting in extensive myocardial ischemia or infarction involving the anterior, septal…

…should be avoided in the acute phase. A leg that has recently been operated on, is in a cast or has extensive wounds so that…

…a sacral pressure sore or extensive perineal wounds where urinary leakage prevents healing. Voiding problems in neurogenic bladder dysfunction, in the first instance with clean…

…account for most cases. Variants in APOB that impair apolipoprotein B binding to the LDL receptor. Gain of function variants in PCSK9, which reduce recycling…

…a rate reducing effect in selected circumstances. Ivabradine undergoes extensive first pass hepatic metabolism through CYP3A4. Dose adjustment is required in severe hepatic or renal…

…likely with extensive myocardium at risk, severe baseline stenosis, multivessel coronary artery disease, or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the…

…In obstructive CAD, symptoms may result from extensive or diffuse epicardial disease, chronic total occlusion, incomplete revascularization, or coronary anatomy unsuitable for further intervention. In…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…stress generally indicates previous infarction. Extensive ischaemia may produce a reduction in global LVEF and transient LV cavity dilatation during stress. Stress echocardiography can also…

…syndrome (DI LQTS) [1]. The condition arises in the setting of both modifiable and nonmodifiable risk factors. Modifiable risk factors include electrolyte abnormalities such as…

…in correcting hyponatremia is the prevention of osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis. Excessively rapid correction of sodium can result in…

…focus on the ECG waves in terms of morphology (appearance), durations and intervals. A rather extensive discussion is provided in order to give the reader…

…obstruction): The greater the obstruction the more extensive the ischemia/infarction. The location of the thrombus in the artery: a proximally located thrombus will cut…

…myocardial infarction affecting the papillary muscle or its connected myocardium may also result in mitral prolapse. Extensive myocardial infarction may lead to papillary muscle rupture…

…radiolucent, tolerates moisture better, more expensive and stiffer to mould Elastic bandage Holds the slab in place; wound on without tension Tepid water, plastic gloves…

…of the aorta Previous aortic trauma Pregnancy, particularly the third trimester Weightlifting Cocaine use Deceleration injury Systemic hypertension coexists in approximately 70% of patients with…

…surgery involving atrial tissue, extensive prior radiofrequency ablation, advanced atrial disease, or the use of antiarrhythmic drugs. In such clinical scenarios, an atypical ECG presentation…

…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…

…lesions whose angiographic severity is uncertain. Supporting decisions regarding revascularization and, in selected patients, identifying microvascular or vasomotor coronary disorders. The investigation should be undertaken…

…recovery patterns within the left ventricle, resulting in a widened QRS complex and secondary ST T wave abnormalities [7]. Diagnostic Criteria The diagnostic requirements for…

…revascularization A proximal lesion jeopardizes more myocardium than a distal lesion. In observational data, a lesion proximal to the first septal perforator of the left…

…myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and…

…non invasive evaluation is more appropriate? The presence of extensive comorbidity may alter the balance between procedural risk and benefit. An early invasive strategy is…

ECG Principles of myocardial excitability Myocardium is excitable not only by action potentials originating in the sinus node, but also by external electrical stimuli that…

…complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet…

…Patients with extensive subcutaneous fat require harder pressure. Orientation index marker All ultrasound transducers have an index marker, which is used for orienting in the…