Myocardial ischemia and infarction Definition and Pathophysiology No reflow is impaired anterograde myocardial perfusion despite the absence of a flow limiting epicardial coronary stenosis. It…

…more stress, often corticosteroids, often impaired renal function. Prescribe basal insulin, mealtime insulin and the correction dose as three separate entries on the drug chart…

Myocardial ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form…

…contraindicated, for example in asthma Contraindicated in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…particularly early in the disease or after treatment. During exertion, however, the limited diastolic reserve becomes evident, with a rise in left atrial and pulmonary…

…plaque, thrombus, and implanted stents. The principal modalities used in the catheterization laboratory are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Unlike coronary angiography…

…insulin resistance, dyslipidaemia, elevated blood pressure and impaired glucose regulation. Diagnosis is based on the coexistence of defined clinical and laboratory components; the diagnostic criteria…

…localization, hemodynamic effects and possible impact on the coronary arteries. The tumors can be asymptomatic for a long time and be detected randomly when investigating…

…refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family history of…

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

…hypotension, collapse or impaired consciousness Adrenaline, oxygen, intravenous access, fluid and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory…

…before surgery, or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation…

…and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and HHS are dynamic…

…normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent Dose Duration : : : : Pneumonia, non severe…

Procedurer The oesophagus runs directly behind the left atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an…

…a concurrent benzodiazepine or gabapentinoid, marked hypovolaemia, head injury with impaired consciousness, biliary tract disease. There is no contraindication to analgesia in the acute abdomen…

…Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not responded to atropine:…

…and all bites on the hand. These are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis…

…heart failure, kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive…

…score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or liver function, previous stroke, history of bleeding…

…in heart rate, stroke volume, or vascular tone can significantly impact MAP, reflecting the dynamic interplay between cardiac function and vascular resistance. Advantages of measuring…

…History of stroke or transient ischemic attack (TIA). Severely impaired liver function classified as Child Pugh Class C. Dosage Adults Initial dose : A single loading…

…from it. AF has important consequences beyond the arrhythmia itself. It may cause symptoms and impaired quality of life, contribute to heart failure, and increase…

…orthostatic hypotension, or impaired autonomic compensation limits tolerability. Evidence Base and Its Limitations Few adults aged 85 years or older have been included in randomized…

…Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left ventricular (LV) wall thickness [3…

…occurs when intrapericardial pressure equals or exceeds right atrial pressure. The haemodynamic consequences are progressive impairment of right and left sided filling, reduced stroke volume…

…myocardial fibrosis, calcification, vascular remodeling, altered diastolic filling, chronotropic incompetence, and impaired hemodynamic stability commonly coexist. These changes promote hypertension, ischemia, valvular abnormalities, arrhythmias, and…

…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…

…failure, particularly when left ventricular function is impaired Haemodynamic or electrical instability in advanced or acute presentations Left main disease may be clinically silent, and…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…or diffuse disease. No reflow represents impaired antegrade myocardial perfusion in the absence of a flow limiting epicardial stenosis. It is associated particularly with intervention…

…contributors include excess salt intake and salt and water retention, particularly when kidney function is impaired. Inadequate adherence to medication or dietary sodium restriction may…

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

…absence of sounds on the affected side. Ultrasonography can reveal pneumothorax (highlighted by a lack of lung tissue) and its impact on cardiac function. Clinically…

…Figure 1. Components of a pacemaker. The pacemaker is commonly implanted under the clavicle, between the skin and the pectorialis major. The pulse generator has…

…an intuitive basis. Consider the fact that the left ventricle contracts and ejects blood into the aorta roughly 100,000 times daily, each time overcoming…

…that the right ventricle is pressure and/or volume loaded. The load itself leads to impaired right ventricular function, especially if the load becomes prolonged…

…heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early: 1. Assess airway, work of breathing, level…

…a postrenal cause cannot confidently be excluded. 10. Contact nephrology early in severe, progressive or diagnostically unclear AKI. Definition and staging according to KDIGO Acute…

…be well NIHSS A complete score by a physician or nurse experienced in stroke Functional impact A low NIHSS does not exclude a disabling deficit…

…where needed, coagulation expertise at the same time [1]. Activate the local major haemorrhage protocol early. Protocols improve above all the logistics, the communication and…

…and urine can be saved early for later targeted analysis. Initial monitoring and investigations Investigation Comment : : Plasma glucose Taken immediately and repeated in impaired consciousness…

…empirical intravenous antibiotics, fluid, a vasopressor and early source control. Sepsis is a dynamic condition. Investigation and treatment must therefore proceed in parallel and must…

…a rapid transfusion requirement 10 With impaired consciousness, an inability to protect the airway, or ongoing major haematemesis: early anaesthetic assessment before endoscopy Assess the…

…standardized method to evaluate the anatomical complexity of CAD, particularly in patients with multivessel disease or left main coronary artery disease . It integrates multiple variables…

…surgery : No dose adjustments are necessary. Impaired renal function : No dose adjustments are necessary. Impaired liver function : No dose adjustments are necessary. Elderly (≥ 65 years…

…resistant to resolution. Known predictors of cardiac arrest The only risk biomarker in genuinely widespread use is left ventricular ejection fraction (LVEF), measured by echocardiography…

…anticoagulation, and possible reperfusion. The principal pathophysiological determinant of early adverse outcome is acute RV failure. In acute PE, obstruction of pulmonary blood flow increases…

…of hypertension. Hypertension becomes more prevalent in women than men after approximately 65 years of age. Hypertension related left ventricular hypertrophy, concentric remodelling, reduced longitudinal…

…renal disease are bidirectionally related: hypertension accelerates CKD progression, while impaired renal function further increases blood pressure. Non traditional cardiovascular mechanisms include: Uraemia associated inflammation…

…ventricular arrhythmias, impaired left ventricular function, myocardial stunning, and sudden cardiac death. It may also be associated with early death after cardiac transplantation. Myocardial bridging…

…not confined to the ECG. Ischaemia may also produce angina, impaired exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic…

…a clinical syndrome defined by the combination of symptoms and/or signs of heart failure and a left ventricular ejection fraction (LVEF) of 41–49%…

…patient related factors influence interpretation. Natriuretic peptide concentrations generally increase with age and are higher in patients with impaired renal function, reflecting both reduced clearance…

…myocardial necrosis [4]. Clinical Implications and Prognosis Mechanical and Diagnostic Impact LBBB causes extensive reorganization of left ventricular activation [2]. This leads to abnormal LV…

…Structural CMD: resting vascular tone is increased, potentially reflecting capillary rarefaction, fibrosis, or left ventricular hypertrophy. Hypertension, diabetes, and elevated NT proBNP are more frequent…

…the coronary microcirculation. Microvascular angina reflects myocardial ischaemia caused by structural or functional microvascular abnormalities, impaired coronary flow reserve, reduced microcirculatory conductance, or abnormal arteriolar…

…signature specific to CTOs. Evaluation and physical examination Evaluation should establish: The severity and functional impact of angina or anginal equivalent symptoms. The response to…

…Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic claudication. In older adults…