…or when the volume limit is reached. Indications Diagnostic aspiration: a new pleural effusion of unclear cause. An effusion not confidently explained by heart failure…

…important. Cardiorenal syndrome may develop during acute decompensated heart failure, but worsening renal function does not necessarily indicate reduced cardiac output or impaired renal perfusion…

…in the Treatment of Cardiogenic Shock. N Engl J Med 2021; 385:516 525 Indications Severe left ventricular failure, acute or chronic. Severe biventricular failure…

…or only mildly elevated, particularly early in the disease or after treatment. During exertion, however, the limited diastolic reserve becomes evident, with a rise in…

…HFrEF. Advanced or refractory heart failure should be considered when there is recurrent clinical deterioration despite careful follow up and appropriate therapy. In this setting…

…among the common opioids in renal failure Ketobemidone IV 2.5–5 mg Oral bioavailability about 35 per cent Paracetamol PO or IV 1 g…

…use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and a clinical diagnosis, often described as acute brain failure…

…hypertension, valvular disease or congenital heart disease. Cardiomyopathy leads to impaired cardiac function and heart failure. There are six main types of cardiomyopathy: Hypertrophic cardiomyopathy…

…heart failure with mid range ejection fraction) are relatively new entities and there are currently no effective treatments that modify the natural course in these…

…heart failure with mid range ejection fraction) are relatively new entities and there are currently no effective treatments that modify the natural course in these…

…in decompensated heart failure (DHF). In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during…

…of heart failure (HF) in the presence of a left ventricular ejection fraction (LVEF) of ≥50%, accompanied by objective evidence of structural and/or functional…

…Despite the effectiveness of preventive interventions in both sexes, women are less likely to receive statins, aspirin or referral to cardiac rehabilitation and are less…

…arising after percutaneous coronary intervention (PCI). In contemporary practice, ISR remains the most frequent cause of PCI failure, despite its substantially lower incidence with drug…

…lowering alone. Meta analyses have shown that the risk reduction in MACE is largely independent of baseline HbA1c or the magnitude of HbA1c reduction. 7…

…in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or…

…IV, repeated to a maximum of 15 mg 0.1 mg/kg slowly Avoid in decompensated heart failure Digoxin 0.25–0.5 mg IV…

…or in headache. A failure to improve function is a reason to taper off, not to increase the dose. Contraindications Ongoing respiratory depression, or untreated…

…More broadly, bradyarrhythmic arrest and asystole represent severe manifestations of impulse generation or conduction failure. The pathophysiology of these events may stem from reversible causes…

…between treatment benefit and harm. Prevention in the very elderly therefore extends beyond reducing myocardial infarction, stroke, heart failure, or cardiovascular death. Preservation of mobility…

…be detected for the first time, or develop during acute management. AF is often haemodynamically tolerated and may require no specific acute therapy beyond appropriate…

…low flow velocities during the loss of organized atrial systole. Transesophageal echocardiography and surgical pathology demonstrate that over 90% of thrombi in non valvular AF…

…of Heart Failure, endorsed by major global cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or objective evidence…

…or hepatic disease may produce a similar symptom complex; in the absence of cardiac dysfunction, these conditions do not fulfil the definition of heart failure…

…predominantly by atrial tissue; its midregional pro ANP assay may provide information comparable to BNP and NT proBNP in heart failure (HF). The biologically active…

…improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is frequent in patients with cardiovascular disease, including heart failure…

…tolerated statin plus ezetimibe. Consider bempedoic acid in selected patients, particularly those with statin intolerance or persistent failure to reach goal. For statin intolerant patients…

…increased intrapericardial pressure, which in turn affects ventricular relaxation (and thus ventricular filling). This may even lead to compression of the ventricles during diastole; cardiac…

…the blood gas A normal or rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe attack the patient…

…or an initial medical strategy. In haemodynamically unstable patients, evaluation must also consider acute severe mitral regurgitation, mechanical complications, and ischaemia related ventricular failure as…

…ECG, and normal initial troponin may be observed in a chest pain unit or another non intensive care setting while serial testing is completed. Diagnostic…

…muscle damage or inflammation may result in elevated cTnT levels. Although both troponin T and I may be chronically elevated in patients with renal failure…

…failure, structural heart disease, fibrosis of the conduction system and acute myocardial infarction (particularly anterior STEMI). Hence, an acute myocardial infarction may actually result in…

…multivessel CAD varies from stable angina or exertional limitation to acute coronary syndrome (ACS), ventricular arrhythmia, heart failure or cardiogenic shock. In chronic coronary disease…

…access in a patient at risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or…

…rate parameters. Clinical Presentation and Symptoms Acute heart failure necessitating inotropic or vasopressor support typically manifests in patients with left ventricular systolic dysfunction, low cardiac…

…renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to…

…effect, and significant individual variations in its effect. Drug Enalaprilat Brand names Vasotec IV ® Indications Hypertension and hypertensive emergency. Acute left ventricular failure. Mechanism…

…particularly in an acute rise, renal failure, symptoms or continued potassium administration Severe At least 6.5 mmol/L, or hyperkalaemic ECG changes at any…

…Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency). ACE…

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

…Dizziness. Caution Should be used cautiously in patients with myocardial ischemia and/or heart failure. Nicardipine doses and administration in hypertension (hypertensive crisis/emergency). ACE…

…imaging, or electrophysiology in relation to ACE inhibitor therapy. Biomarkers and Laboratory Findings Monitoring renal function and potassium is a critical component of ACE inhibitor…

…hypertension or absent nocturnal dipping (diabetes, renal failure, sleep apnoea). Suspected hypotension: dizziness, syncope, autonomic dysfunction, adverse drug effects. Wide variability between measurements. Hypertension in…

…AV block is defined by the intermittent failure of atrial impulses to conduct to the ventricles, resulting in some P waves not being followed by…

…aldosterone levels. Clinical Presentation and Symptoms In the management of heart failure, digoxin improves hemodynamics without increasing heart rate or decreasing blood pressure, making it…

…in bed, lying down, standing up, tilting the head backwards. A symptom free interval between attacks, with possible residual unsteadiness. No hearing loss, tinnitus or…

…blood pressure in both arms. Procedure 1. Exercise protocol: start at 25–50 W and increase by 10–25 W every minute, or by 25…

…drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The…

…marrow failure and certain targeted cancer treatments. Fever is not obligatory Hypothermia, new confusion, tachypnoea, hypotension, rigors, abdominal pain or a rapid deterioration in general…

…If oral anticoagulation is indicated, NOACs should be chosen except in patients with moderate to severe mitral stenosis or mechanical heart valves; for these patients…

…a risk factor for heart failure and arrhythmias. Family History of Sudden Cardiac Death (FHSCD) : A history of SCD in close relatives suggests a genetic…

…pressure or azotemia. • Should not be given to pregnant women. • Should not be given to patients with Leber optic atrophy. Nitroprusside doses and administration in…

…cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in the throat. In recent years, the concept of a distinct…

…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…

…conditions in which CPR should be withheld in order to avoid futile attempts or subjecting the individual (and the relatives) to unwanted interventions. Unfortunately, during…

…arrhythmia or cardiac involvement is suspected. Transient apnoea, hypoxaemia, a rising lactate, acidosis, hypertension and tachycardia are common during a generalised seizure. In prolonged status…

…acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂ in suspected ventilatory failure…

…• In patients with pheochromocytoma, cocaine or methamphetamine overdose, prior treatment with alpha blockade is necessary before administering labetalol (risk of elevating blood pressure in these…