…therapy. In this setting, the risk of sudden death and end stage heart failure is high, and assessment for advanced therapies may be required. Evaluation…

…glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart failure armamentarium. Its use has declined over time due…

…rest due to high vagal tone. These individuals have developed a highly efficient left ventricle, capable of generating sufficient cardiac output at low heart rates…

…since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease…

…ECG monitoring D Disability AVPU: Alert Voice responsive Pain responsive Unresponsive Limb movements Pupillary light reflexes Blood glucose E Exposure Identify signs of heart failure…

…attention. The ventricular rate is typically very high (100–250 beats per minute) and cardiac output is affected (i.e reduced) in virtually all cases…

…pressure and evidence of hypotension Heart rate and tachycardia Respiratory rate and oxygenation Evidence of systemic congestion or acute RV failure Syncope or altered clinical…

…denervation can be performed to mechanically reduce sympathetic output [4]. Evaluation of Treatment and Alternatives for Drug Failure The provided context does not contain specific…

…forward. Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant…

…which is not the case in the heart. Blood flow is pulsatile during the cardiac cycle; flow is high during systole and ceases during diastole…

…the physical activity. It is based on the subjective physical sensations experienced during exercise, including increased heart rate, increased respiratory rate and depth, increased sweating…

…Mitral regurgitation Causes of mitral regurgitation The most common cause of mitral regurgitation in high income countries is age related degeneration of the valvular apparatus…

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…

…Sudden onset of palpitations followed by syncope Severe coronary artery or structural heart disease High risk features on examination include: Unexplained systolic blood pressure <…

…volume (SV) and heart rate (HR). CO = HR · SV Cardiac Index (CI) Cardiac Index (CI) is the ratio between cardiac output (CO) and body…

…low cardiac output and sensitivity to drugs that reduce preload. Posterolateral (posterior, inferobasal) STEMI (STE ACS) The heart is rotated 30° to the left in…

…a predefined target heart rate is reached. Its principal outputs are: Functional capacity and exercise tolerance Reproduction and characterization of symptoms Heart rate and blood…

…disease Stage eGFR Description : : : G1 ≥ 90 Normal or high G2 60–89 Mildly reduced G3a 45–59 Mildly to moderately reduced G3b 30–44 Moderately…

…impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer procedures…

…a high risk even if the plasma potassium is below 6.5 mmol/L. Conversely, patients with chronic renal failure may have very high values…

…output, respiration, chest findings, MAP and the response to every intervention Within 60 min Contact intensive care in shock, rapidly progressive organ dysfunction, respiratory failure…

…dysfunction and renders the defibrillation ineffective. The likelihood of successful defibrillation is high in coarse VF (the early phase), but diminishes rapidly as the waveform…

…start of CPR to ROSC or end of resuscitation attempts. Efficient CPR generates approximately 25% of normal cardiac output, which postpones or mitigates cerebral injuries…

…rapid ventricular rate atrial fibrillation, marked anaemia, hypertensive emergency, heart failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI…

…therefore requires individualized balancing of ischemic and bleeding hazards. High bleeding risk (HBR) should be assessed in a structured manner. Within the ARC HBR framework…

Initial Focus: High potency statin therapy is foundational unless contraindicated. Combination Therapy: Ezetimibe is the next step if LDL C targets are not met with…

…hour. Adverse effects Tachycardia. Flushing. Headache. Angina pectoris. Caution Heart failure. Angina pectoris (ischemic heart disease). Hydralazine doses and administration in hypertension (hypertensive crisis/emergency).

…chemistry & laboratory medicine Definition and Pathophysiology Apolipoprotein B (apoB) and non high density lipoprotein cholesterol (non HDL C) are complementary measures of atherogenic lipoprotein burden…

…cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance…

…circumference — a cuff that is too narrow gives a falsely high reading The cuff at heart level Measure in both arms at the first visit…

…ongoing unstable angina. Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis, pericarditis or endocarditis…

…1. Expose the whole shoulder; rolling up a sleeve creates a constriction that distorts the anatomy and tempts the operator to inject too high. 2…

…a high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in…

…The basic analgesic; always give it in parallel unless contraindicated NSAID PO According to the preparation Avoid in renal failure, heart failure, a history of…

…of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of developing an atherothrombotic event…

…of patients should undergo angiography within 24 hours, but high risk patients should be evaluated with angiography earlier. Guidelines recommend the use of validated risk…

…cardiac death: what the new Nature study shows Low risk (blue) versus high risk (red) ECG morphs in lead aVL (adapted from Obermeyer et al…

…since the 1960s. In 1948 the NHLBI initiated the Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk…

…that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to…

…practice guidelines for emergency medicine (and prehospital medicine). This is high quality medical education simply. Life in the Fast Lane Australian site with one of…

…disease or high cardiovascular risk T2DM with chronic kidney disease Heart failure with reduced ejection fraction (HFrEF), with or without diabetes Heart failure across the…

…world: What is the best ECG book? This question is far from trivial and the stakes are high; mastering ECG interpretation will frequently be a…

…the image. Acoustic shadowing Some structures have very high echogenicity (e.g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too…

…treatment, with a very low number needed to treat (NNT), indicating high effectiveness. Although BLS is primarily developed for out of hospital cardiac arrest (OHCA)…

…Respiratory conditions : Tension pneumothorax Drowning Airway obstruction Hanging Pneumonia High altitude sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes…

…and hypoperfusion manifesting as hypotension. The high mortality associated with sepsis underscores the critical importance of timely and appropriate interventions. In patients presenting with concurrent…

…Constrictive pericarditis also leads to right sided heart failure, which is explained by the fact that high pressure in the right atrium leads to a…

…in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine, Dipyridamole…

…with ischemic heart disease, is the most common form of cardiovascular disease. It has been the number one killer in Western and high income countries…

…relaxation should proceed rapidly and the ventricle should expand substantially. This requires that the myocardium has high compliance , a term used to describe myocardial elasticity…

…even if symptoms have subsided, particularly with continuing ischaemia, heart failure, electrical instability or a large area of myocardium at risk. Over 48 hours: urgent…

…masked hypertension: normal office blood pressure but organ damage or high risk. Treatment resistant hypertension. Suspected nocturnal hypertension or absent nocturnal dipping (diabetes, renal failure…

…in venous thromboembolism Treatment doses in deep vein thrombosis and pulmonary embolism differ from the atrial fibrillation doses and include an initial high dose phase…

…develops over hours to days [1,2]. Six steps Step Question Practical interpretation : : : 1 Is the pH low or high? pH <7.35 is acidaemia…

…Atelectasis and postoperative hypoxaemia. Hypoxaemic failure where high flow nasal oxygen is insufficient and the carbon dioxide is normal. Bilevel NIV: Acute exacerbation of COPD…

…marked distress. Delirium is an acute neuropsychiatric syndrome and a clinical diagnosis, often described as acute brain failure. It is precipitated by somatic illness, drugs…

…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…

…present). High voltage (excessive amplitudes) is present if the S wave in V1 or V2 + the R wave in V5 is 35 mm. Q waves…

…the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked obstructive airways disease — relative; the…

…Ventricular arrhythmias. Myocardial ischaemia. Tissue ischaemia (high doses or extravasation). Dopamine — high dose Cardiogenic shock. Vasodilatory shock. Heart failure, acute or chronic. Bradycardia (second line…