…a head lamp, bayonet forceps, a tongue depressor, a vomit bowl. Local anaesthesia and vasoconstriction: lidocaine 4 % with oxymetazoline 0.5 % (or xylometazoline) on cotton…

…equipment A chair with a head rest, preferably an ENT chair; raise the chair to your eye level. A head lamp or another directable light…

…temperature water or saline ( 36–37 °C ), a kidney dish, a towel, suction. Manual technique: an operating otoscope or a head lamp with a loupe…

…delayed — may justify charcoal later, in some cases up to 6 hours or more. Discuss this with the poison control centre. Gastric lavage is considered…

Echocardiography Pulmonary (pulmonic) stenosis Pulmonary stenosis is virtually always a consequence of congenital heart disease. The stenosis can be fixed or dynamic, depending on the…

…LAP and LVEDP. Cardiogenic shock develops if the cardiac output is insufficient. Aortic regurgitation may cause myocardial ischemia because cardiac output diminishes in parallel with…

…with connective tissue disorders (Marfan syndrome, Ehlers Danlos syndrome), osteogenesis imperfecta typically causes prolapse of P2 (Figure 1). Myocardial ischemia affecting the papillary muscles or…

…leading to right heart hypertrophy, dilation and ultimately right heart failure. Echocardiography in mitral stenosis Echocardiographic assessment of mitral stenosis includes visual and 2D imaging…

…As an idiosyncratic response to substances such as MDMA (ecstasy) or amphetamines. In either scenario, there is sustained muscle activation, leading to marked heat generation…

…the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or reduced fracture to be…

…activity or environmental stresses such as heat, humidity, altitude or wind. A gradual progression is particularly important in previously sedentary individuals and those with chronic…

…Heated and moistened oxygen. Warm covers. Heat fan. Remove any cold or damp textiles. Administer cardiopulmonary resuscitation (CPR) following standard protocols, emphasizing concurrent rapid rewarming…

Info Heart rate (bpm) = 60000 / cycle length Cycle length (ms) = 60000 / heart rate Heart rate (BPM) Cycle length (ms) Heart rate (BPM) Cycle…

…in which the heart cannot provide blood flow commensurate with the body’s requirements or can do so only at the cost of elevated filling…

…congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure with preserved ejection fraction (HFpEF) is characterized by: Symptoms and/or signs…

…the Get With The Guidelines Heart Failure (GWTG HF) and the SWEDEHEART registries, demonstrate that while the incidence of HFrEF has stabilized or slightly declined…

…by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within this spectrum, Heart Failure with Reduced Ejection Fraction (HFrEF…

…Hjalmarsson, and Swedberg proposed using beta blockers – which have negative inotropic and negative chronotropic effects – to treat heart failure, they were met with skepticism. Their…

…Hjalmarsson, and Swedberg proposed using beta blockers – which have negative inotropic and negative chronotropic effects – to treat heart failure, they were met with skepticism. Their…

…fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical signs, and an LVEF below…

…treatment repertoire includes surgery, catheter interventions, and medical therapies. Adults with congenital heart disease are mostly managed in GUCH clinics (Grown Up Congenital Heart disease…

…defined population includes: LVEF ≤35%; sinus rhythm; resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with an ACE inhibitor or ARNI…

…typically discrete and not on a par with the degree of left ventricular impairment. Pathophysiology of takotsubo cardiomyopathy (broken heart syndrome) This topic is still…

Overview of diagnosis, classification and management of heart failure

…ascites Older patients may present atypically, with fatigue, depression, sleep disturbance or altered mental status rather than prominent breathlessness. Hemodynamic phenotypes Initial assessment should distinguish…

ECG Introduction to ECG interpretation The electrical axis of the heart Although often ignored, assessment of the electrical axis is an integral part of ECG…

…I and II. Heart axis deviation: right axis deviation (RAD) and left axis deviation (LAD) Causes of right axis deviation Normal in newborns. Right ventricular…

…negative chronotropic effect. Among persons who do not suffer from heart failure, chronotropic incompetence may be caused by beta blockers, amiodarone or digitalis. Sinus node…

…is accompanied with a sensation, which threatens instant death if the motion is persisted in; and, that on stopping, the distress immediately abates, or altogether…

…or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be available or…

ECG Video lecture: Assessment of the electrical axis of the heart

…with normal ventilatory capacity and cardiac output), diminished ventilatory capacity, diminished cardiac output or an angina equivalent. Note that women, diabetics and older individuals with…

…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…

Referensvärden A child's ECG changes continuously with age: the heart rate, the electrical axis and the waveform in the newborn differ markedly from adult…

Info The ECG shows AV block III (complete heart block). P waves are not related to QRS. PP interval is constant, but independent of RR…

…from the oral cavity and affect heart valves that have some kind of damage, change or degeneration. Endocarditis with alpha streptococcus is most often subacute…

…increase in, for example, pulmonary hypertension or pulmonic stenosis. Heart rate . Synchronicity : Optimal contraction requires the majority of all ventricular myocardium to contract simultaneously. For…

…and arrhythmology ECG Sinus rhythm: the normal rhythm of the heart A rhythm is defined as three consecutive heartbeats with identical waveforms on the ECG…

…is measured in apical four chamber view (4C) or five chamber view (5C) using pulsed wave doppler with sample volume located in the valve orifice…

…Corrected QT Interval. QTc Calculator Heart Rate QT Interval (in msec) Calculate QTc Values $(document).ready(function() { $(" qtc form").on('submit', function(event…

…cautiously in patients with high intracranial pressure or azotemia. • Should not be given to pregnant women. • Should not be given to patients with Leber optic…

…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…

Myocardial ischemia and infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the…

Echocardiography Cardiac tumors Cardiac tumors are rare. They can occur anywhere in the heart or surrounding tissue. Tumors can be localized in the myocardium, pericardium…

CPR Each recording presents two leads recorded simultaneously. Sex : Female Age : 72 years History : heart failure Medications : digoxin, quinidine ECG 1 . The initial beats are…

…heart failure, and chronic kidney disease (CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion…

…arrest. Evaluation and Physical Examination The source material does not provide specific details regarding the physical examination or general evaluation of patients with bradycardia. Diagnostics…

…and muffled heart sounds are important when present but are relatively insensitive findings. Some patients with subacute tamponade may initially remain normotensive or even hypertensive…

…initiated the Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery…

…RAD) RAD holds significant diagnostic weight in the evaluation of pulmonary vascular and right heart pathology. In adults with clinical suspicion of pulmonary hypertension (PH)…

Drugs and electrolyte imbalance ECG Digoxin ECG changes: arrhythmias, conduction defects and waveform changes Digoxin may be used in patients with heart failure, atrial fibrillation…

…Commonly, patients with bradycardia have a strong indication for drugs that aggravate or cause bradycardia (e.g. beta blockers in heart failure). In such scenarios…

…rare condition that may be caused by rheumatic valvular disease, congenital heart disease, Whipple’s disease, or tumors. Rheumatic disease is the most common cause…

…time, exacerbation is a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism…

…by heart is that an arterial line must never be confused with a venous access. Indications Continuous blood pressure monitoring in haemodynamic instability or during…

…sinus rhythm without spontaneous breathing, passive leg raising with an increase in stroke volume 10%, or inferior vena cava variability . In the absence of responsiveness…

…Preparation and equipment A device capable of both CPAP and bilevel ventilation, or alternatively flow generated CPAP with a PEEP valve. Masks in several sizes…

…Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and…