…whereas clinical restenosis refers to recurrent angina caused by disease in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary…

…instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several concurrent causes. In older patients delirium is often multifactorial…

…toxins, thrombosis (coronary or pulmonary), tension pneumothorax. No drug has been shown to improve the neurological outcome in cardiac arrest. High quality compressions with minimal…

…is incomplete: reduce the calculated equianalgesic dose by 25–50 per cent and titrate. At a high dose, in old age or in renal failure…

…materially different by age or sex in the overall trial analyses. Some data from a study of healthy women suggested a reduction in ischaemic stroke…

…independent of baseline HbA1c or the magnitude of HbA1c reduction. 7 Instead, these agents exert multifaceted effects through direct activation of receptors in target tissues…

…reflect virtually all sound waves, leaving too few waves to explore the area behind the reflector. This results in dark areas, which are referred to…

…highly sensitive to brainstem integrity and cerebral perfusion. During cardiac arrest, circulation to the brain is severely compromised or absent, leading to rapid brainstem hypoxia…

…Any of the following: R or S in any limb lead ≥20 mm S V1 or S V2 ≥30 mm R V5 or R V6…

…This chapter discusses typical and atypical changes in the ST segment and the T wave during myocardial ischemia. A thorough discussion of the electrophysiological principles…

…implies that the myocardium is structurally and functionally altered, and the pathological changes are not explained by coronary heart disease, hypertension, valvular disease or congenital…

…of the blood gas A normal or rising pCO₂ during an ongoing severe asthma attack is an alarm sign. Early in a severe attack the…

…73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the critically ill patient. Intravenous antibiotics…

…and magnets A button battery in the nose or the ear canal is an emergency, not a finding that can wait until the next day…

…small adjustments impossible. Procedure Intravenous titration in acute severe pain Practical points during titration: Give the injection slowly over at least a minute; a rapid…

…QRS complexes generated in the ventricles at 100 bpm (cycle length: <600 ms). Classification according to duration: Sustained VT : VT 30 seconds, or VT <30…

…bleeding. Long term antiplatelet therapy after STEMI is associated with approximately a 25% reduction in recurrent infarction, stroke, or cardiovascular death. In the cited evidence…

…ischaemic electrocardiographic changes during rapid AF. ST segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material…

…in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic arrest and asystole represent severe manifestations of impulse generation or…

…common in later life. These changes contribute to the complexity of defining an appropriate treatment target, particularly when a lower DBP, orthostatic hypotension, or impaired…

…syndromes, or heart failure have preexisting hypertension. The relationship between blood pressure and outcome in older adults is not linear at very low pressures. Excessive…

…or large vessel arteritis Pulmonary arterial vasculopathy and pulmonary hypertension Arterial and venous thrombosis Valvular heart disease Cardiac dysrhythmias Arterial stiffness and endothelial dysfunction The…

…Despite the effectiveness of preventive interventions in both sexes, women are less likely to receive statins, aspirin or referral to cardiac rehabilitation and are less…

…faintness, or belching. Radiation to both arms or shoulders has a particularly strong association with myocardial infarction in the cited clinical data, although right arm…

…change in weight. Assessment should integrate the history, physical examination, laboratory data and diagnostic testing. Examination for congestion Useful bedside indicators of persistent or improving…

…I status with Level B evidence in the chronic coronary syndrome lipid lowering recommendations. Acute coronary syndrome The period immediately following ACS is associated with…

…and the severity and manifestations of disease may differ substantially among carriers. Consequently, a normal examination or cardiac investigation at one point in time does…

…resting period is advised. 4. Which of the following describes a 'Black athlete repolarization variant' considered a normal ECG finding? A: T wave inversion in…

…whereas others have brief or asymptomatic episodes that are not detected during routine clinical assessment. The clinical burden of AF does not reliably predict stroke…

…QRS complexes generated in the ventricles at 100 bpm (cycle length: <600 ms). Classification according to duration: Sustained VT : VT 30 seconds, or VT <30…

…low flow velocities during the loss of organized atrial systole. Transesophageal echocardiography and surgical pathology demonstrate that over 90% of thrombi in non valvular AF…

…Confirm cardiac arrest In case of a collapse (out of hospital or in hospital) the first task is to determine if a cardiac arrest has…

…as MDMA (ecstasy) or amphetamines. In either scenario, there is sustained muscle activation, leading to marked heat generation, acidosis, and the subsequent development of hyperkalemia…

…Echocardiography bedside. Heating is optimally achieved using extracorporeal membrane oxygenation (ECMO). In the absence of ECMO, both non invasive and invasive rewarming techniques should be…

…However, in cases of iron, lithium, or potassium intoxication where lavage might prove beneficial, the procedure should be conducted post intubation. Avoid lavage if gastrointestinal…

…or Additional leads in acute myocardial infarction). Importance of performing ECG during ongoing chest pain It is of paramount importance to record the ECG during…

…increased intrapericardial pressure, which in turn affects ventricular relaxation (and thus ventricular filling). This may even lead to compression of the ventricles during diastole; cardiac…

…Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges…

…or more frequently, as individually appropriate. 3 Important study: Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock (N Engl J Med 2021…

…complex The definition of fragmented QRS complexes ( Figure 2 ) are as follows: QRS complex with more than 1 R wave and/or notch in the…

…in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or…

…physiological) ST segment depressions occur during physical exercise. These ST segment depressions have an upsloping ST segment. The depression in the J 60 point is…

…presents the entire electrocardiographic (ECG) development in STE ACS/STEMI. Note that a patient with STEMI may present during any of the phases illustrated in…

…head in opposite directions, the T wave is said to be discordant which is abnormal. Because most ECG leads have net positive QRS complexes (during…

…bystanders), the emergency dispatcher, first responders (police, fire brigade, emergency services, security guards, etc .), paramedics, EMTs, nurses and physicians in the emergency medical system (EMS)…

…on the ECG are assessed: Normalization (return) of ST segment elevations Rapid T wave inversion Normalization (return) of ST segment elevations Successful reperfusion results in…

…myocardial infarctions affect the left ventricle. Right ventricular infarction is uncommon but may occur if there is a proximal occlusion in the right coronary artery…

…clear echocardiographic windows during active compressions is challenging; however, subcostal windows might be feasible, particularly during brief pauses. An enlargement of the right ventricle is…

…the ATRIA Score The ATRIA score assigns points based on five clinical factors: Anemia: Hemoglobin <13 g/dL in men or <12 g/dL in…

…than LDL C in many studies, although the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large…

…patient populations The evidence for anti inflammatory treatment in coronary disease has principally involved two populations: Patients recently recovering from myocardial infarction or acute coronary…

…pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the infarct related artery (IRA), or it…

…particularly in middle age. Conversely, a high CAC score indicates substantial atherosclerotic burden but does not, by itself, establish the presence or haemodynamic significance of…

…important differences in ischemic events or stent thrombosis. Stable coronary disease and elective PCI For chronic coronary syndromes treated with elective PCI, the standard DAPT…