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…

…myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local…

…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…

…are elevated. The syndrome is therefore defined by symptoms and signs of congestion or impaired cardiac performance rather than by ejection fraction alone. Heart failure…

…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…

…of one or both ventricles. Dilation of the left ventricle is virtually always accompanied by impaired left ventricular systolic function. It should be noted that…

…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…

…atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and…

…effect varies tenfold between individuals, and the only way to find the right level is to give a small dose, wait until it has worked…

…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:…

…contaminated wounds where a long time has passed since the injury (see below). Be particularly cautious with impaired healing: peripheral vascular disease, diabetes with neuropathy…

…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…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…

…absent or markedly reduced y descent. The clinical impact depends not only on effusion volume but also on the rate of fluid accumulation, pericardial distensibility…

…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…

…output or impaired renal perfusion. Many patients have preserved cardiac output; increased venous and intra abdominal pressures, impaired renal venous outflow and persistent right sided…

…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…

…During the acute infarction phase, endocardial inflammation and impaired regional contraction create conditions that favour thrombus formation. Extensive transmural septal infarction may also permit mural…

…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…

…impaired right ventricular contraction and reduced forward flow through the pulmonary circulation. Consequently, left ventricular filling falls and cardiac output may become markedly depressed. Right…

…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…

…to the right atrial and ventricular myocardium via a vein (Figure 1). Figure 1. Components of a pacemaker. The pacemaker is commonly implanted under the…

…of ventricular function. Impaired diastolic function (i.e diastolic dysfunction ) may lead to diastolic heart failure (i.e heart failure with preserved ejection fraction, HFPEF …

…right ventricle is primarily a function of the following parameters: Contractility of the myocardium : all causes of reduced contractility, globally or regionally, lead to impaired…

…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…

…diabetes, and renal function, which significantly impact outcomes. Inconsistent Predictive Value : While effective in PCI treated patients, its predictive ability is less robust in CABG…

…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…

…At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false positive burden is substantial…

…PE) is classified according to haemodynamic status, clinical severity, evidence of right ventricular (RV) dysfunction, and myocardial injury. This classification is central to determining the…

…in women than in men. Smoking, obesity and psychosocial factors are associated with a greater cardiovascular impact in women. Obesity, physical inactivity and depression are…

…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…

…prognosis. Pathophysiology The defining physiological abnormality is heart failure occurring with mildly impaired LV systolic function. The syndrome remains fundamentally one of impaired cardiac performance…

…Ischaemic heart disease Atrial arrhythmias Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic…

…leads, and narrow r waves followed by broad, deep S waves in the right precordial leads [7]. Septal q waves are usually absent [7]. Stricter…

…not establish a benign diagnosis. ANOCA/INOCA is associated with recurrent symptoms, impaired quality of life, repeated hospital presentations and angiography, and increased short and…

…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…