…thick fibrous cap but suffer from endothelial denudation. The local microenvironment is rich in hyaluronan, toll like receptor 2 (TLR2), and neutrophil extracellular traps (NETs…

…a documented rise and/or fall of cTn values. However, myocardial injury alone is an entity in itself and may arise from non ischaemic cardiac…

…produces an exaggerated inspiratory fall in systemic systolic blood pressure, termed pulsus paradoxus. Tamponade is therefore characterized haemodynamically by elevation and near equalization of diastolic…

…rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia. Non ischaemic…

…the toe instead. Marked pain that prevents the patient from tolerating compression. Preparation and equipment Equipment: a handheld Doppler probe 5–10 MHz, ultrasound gel…

…of myocytes that form the slow conducting isthmuses critical for re entry [6] . Non ischemic dilated cardiomyopathy (NICM), hypertrophic cardiomyopathy (HCM), and arrhythmogenic right ventricular…

…the arms. Orthostatic hypotension: a fall of ≥20 mmHg in SBP and/or ≥10 mmHg in DBP at 1 or 3 minutes after standing, following…

…Step 1: confirm the course and assess severity Establish the baseline Look for previous creatinine values in the record, preferably from before the current illness.

…artery dissection (SCAD) Standard angiography may fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal…

…with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage…

…falls within five years of stopping but may remain elevated thereafter. The overall health benefit is greater still when reductions in non cardiovascular morbidity and…

…done without losing time. 7. Perform urgent CT of the brain and CT angiography from the aortic arch to the vertex. 8. Contact the thrombectomy…

…are introduced, although the effect on 24 hour mortality is uncertain and the evidence for non traumatic bleeding is weaker [2,3,4]. Do the…

…Non traditional cardiovascular mechanisms include: Uraemia associated inflammation Oxidative stress Vascular dysfunction Promotion of vascular calcification Albuminuria and proteinuria Neurohormonal activation Plasma volume expansion Myocardial…

…of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability. HFmrEF may therefore represent…

…as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle. It is caused by an impulse discharged from an ectopic…

…As per data from the registry, only suicide attempts have lower survival outcomes. Nonetheless, prompt interventions can reverse cardiac arrest and survivors of traumatic cardiac…

…Check the mask, remove air from the cuff so that it is flat with a slightly upturned leading edge, and lubricate the dorsal surface. 2…

…and practice of resuscitation medicine. Kitamura T, Kiyohara K, Sakai T, et al. Epidemiology and outcome of adult out of hospital cardiac arrest of non…

…in twenty falls outside them . Order twelve tests in a healthy person and the probability is around 46 % that at least one will fall outside…

…specific 99th percentile upper reference limit. It is classified as acute when serial measurements demonstrate a rise and/or fall. A stable elevation indicates chronic…

…universities, and medical institutions around the world: What is the best ECG book? This question is far from trivial and the stakes are high; mastering…

…lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed when…

…The principal acute complications fall into two broad categories: Electrical complications , particularly ventricular arrhythmias. Mechanical or pump failure complications , including heart failure and cardiogenic shock…

…is evident from the fact that the vast majority of all myocardial infarctions and episodes of myocardial ischemia, do not cause ventricular arrhythmias and cardiac…

…hypoglycaemia No defined threshold The patient has cognitive or physical impairment and needs help from another person Level 3 can occur even when the glucose…

…from a central line if one is present 4 Take a full blood count with a differential, CRP, creatinine, electrolytes, liver function tests, glucose and…

…and 21 G needles. An 18 G puncture needle, 7–9 cm (a spinal needle or the needle from a pericardiocentesis set), 10 mL and…

…CYP2C9 variants) (1 point) E xcessive fall risk (1 point) S troke (1 point) HEMORR₂HAGES Score Risk category Incidence of major bleeding (per 100 patient…

…112 mmol/L may be relatively unaffected, while a rapid fall from 140 to 125 mmol/L can cause marked symptoms [4]. Grade Plasma sodium : …

…stomach has gone from routine to exception. Activated charcoal — in Sweden usually called medicinal charcoal — is the first line measure in decontamination, and gastric lavage…

…within 10 seconds (Fell et al, Houtkooper et al). The majority of ATP produced is utilized to fuel the contractile machinery and maintain ion channel…

…things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas determines the need…

…different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal insulin, mealtime insulin and the correction dose…

Arrhythmias and arrhythmology ECG Premature atrial contraction (premature atrial beat / complex) A premature atrial contraction is produced by an impulse discharged from an ectopic focus…

…are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both…

…Scars, hernia or visible abdominal wall collaterals (caput medusae) Puncture at least a few centimetres away from them Full bladder Have the patient void, or…

…the limiting factor The time critical element The diagnosis and the donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive…

…At 5 minutes A full, adequate dose of a benzodiazepine About 10 minutes Repeat the benzodiazepine once if the seizure persists, and prepare step 2…

…haemodynamic disturbance results from impaired right ventricular contraction and reduced forward flow through the pulmonary circulation. Consequently, left ventricular filling falls and cardiac output may…

…is regular, typically ranging from 100 to 250 beats per minute in atrial tachycardia and less than 100 beats per minute in atrial rhythm. Refer…

…the patient. Before the examination: let the patient empty her bladder — a full bladder makes bimanual palpation difficult and causes prolapse to be underestimated. Offer…

…start treatment that eliminates potassium from the body. 6. Check the plasma potassium after about 1 hour and follow the plasma glucose closely for at…

…of the saturation Carbon monoxide poisoning. The pulse oximeter does not distinguish carboxyhaemoglobin from oxyhaemoglobin and shows a falsely normal value. Give 100 % oxygen on…

…3.0 Thereafter usually an antiplatelet drug or nothing Preparation and equipment INR, full blood count, creatinine with eGFR and liver function tests before starting…

…Preservation of mobility, cognition, independence, functional capacity, and quality of life may be equally important therapeutic objectives. Evidence from randomized trials is often less applicable…

…repolarization and provoke ventricular tachycardia or ventricular fibrillation. The likelihood of clinically significant EMI is generally low, particularly with bipolar electrocautery performed away from the…

…exist during the first few minutes from collapse. Table 1 shows the number needed to treat (NNT) for various interventions involved in BLS and ACLS…

…mechanism. Sequential activation implies that the atria are activated first and they fill the ventricles with adequate volumes of blood before ventricular contraction commences. To…

…differs pathophysiologically from cardiac arrest. In stroke, neuronal cell death begins in the central ischemic zone, where the ischemia is most pronounced and extends towards…

…radial, and circumferential contraction. Thus, methods such as ejection fraction may provide easily obtained parameters, but fail to provide important insights into left ventricular mechanics…

…ventricle. Studies from the US and Japan has estimated that up to 2% of patients referred to PCI with a suspicion of STE ACS/STEMI…

…is inadequate and closer monitoring is required. Dabigatran is contraindicated at an eGFR < 30 mL/min. Check the full blood count and creatinine when…

…and abdominal organs is large. The sternum may be used for aspiration when the iliac crest is inaccessible, but biopsy must never be taken from…

…falls, and functional deterioration may have greater consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age…

…An unsynchronised shock that happens to fall in the T wave can precipitate ventricular fibrillation, and cardioversion of fibrillation of unknown duration without anticoagulation can…

…stenosis Known — perform the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy…

…with the same risk as manifest hypertension. Non dipping: a nocturnal fall in pressure of < 10% of the daytime value; an independent risk marker…

…the higher pressure, or the non dominant arm if the values are equal. Check against a manual measurement and document the difference. Programme measurements every…

…α1 stimulation and thereby vasoconstriction with a marked rise in SVR. As for the intermediate dose, together with marked hypertension (caution during non selective beta…