…during central venous catheter insertion) Underlying lung pathologies In cases of benign pneumothorax, positive pressure ventilation can precipitate a tension pneumothorax, leading to circulatory collapse…

…kg. Central venous access: When injected into a central vein, the initial dose should be reduced to 3 mg. Heart transplant patients: Due to denervation…

…Hypersensitivity to adenosine. Administration Normal route : Peripheral intravenous (IV). Alternative route : Central venous administration of adenosine is suitable in the intensive care unit or coronary…

…suspicion of syncope due to an arrhythmia or underlying cardiac disease. Relevant abnormalities include bradyarrhythmias or tachyarrhythmias, AV block, acute myocardial ischemia, old myocardial infarction…

…World Heart Federation (WHF) collaborated to redefine MI using a biochemical and clinical approach. This culminated in the Universal Definition of Myocardial Infarction Consensus Documents…

…are mostly due to acute myocardial ischemia or myocardial infarction, and in these cases, the likelihood of ROSC is higher as compared to other etiologies…

…precapillary pulmonary vascular component. PAWP is used to distinguish pulmonary venous hypertension caused by left heart disease from pulmonary vascular disease. Although a PAWP of…

…on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine release, not allergy…

…This is due to altered tone in the autonomic nervous system, with increased sympathetic input (leading to stimulation of beta adrenergic receptors) and parasympathetic withdrawal…

…elevation myocardial infarction. Due to their clinical presentation, these patients are immediately referred to angiography but no coronary artery occlusion can be identified. Injection of…

…These age variations in heart rate are due to variations in the activity of the autonomic nervous system and changes in the automaticity of the…

…of the QRS complexes vary from one beat to another (in the same lead). This is due to the swinging back and forth of the…

…and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to…

…of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex The…

…may also arise due to extensive subendocardial infarction (NSTEMI). If pathological Q waves occur as a result of myocardial infarction, the infarction may be classified…

…Furthermore, sudden cardiac arrests account for 50% of all years of life lost due to cardiovascular disease ( Myerburg et al ). Sudden unexpected cardiac arrest is…

…resulted in myoardial infarction. An important discovery was reported in 1930 when Buchner and colleages showed that myocardial contractility was closely related to myocardial blood…

…crucial to distinguish Type 2 MI from acute and chronic myocardial injury. Myocardial injury is characterised by myocyte necrosis and troponin elevation due to mechanisms…

…the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are…

…progress to myocardial infarction within 30 days if left untreated. Moreover, the pathophysiology of NSTEMI and unstable angina is very similar: both are due to…

…ischemia is due to a complete and proximal artery occlusion and such occlusions must be managed with immediate PCI (Percutaneous Coronary Angiography). Transmural ischemia (infarction)…

…tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications…

…affected, then the left ventricle is virtually always affected due to the coronary anatomy (refer to the chapter Coronary Arteries and Localization of Infarction & Ischemia)…

…to infarction due to the collaterals. Occasionally, patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to…

…of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2, V3). IIa B In patients with inferior myocardial infarction…

…levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients…

ECG Myocardial ischemia and infarction ST segment depression due to acute myocardial ischemia ST segment depressions caused by ischemia are characterized by a horizontal or…

…thus inhibits venous return to the heart. Pneumothorax can be treated successfully in many instances. Cardiac tamponade : Tamponade in trauma patients is due to blood…

Enalaprilat Enalaprilat is rarely used in hypertensive crisis due to its slow onset, prolonged duration of effect, and significant individual variations in its effect. Drug…

Hydralazine Hydralazine is not preferred for hypertensive emergencies due to the high risk of reflex sympathetic stimulation. Drug Hydralazine Brand names Apresoline ®, Bidil ®…

Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

…versa ( Figure 17 ). Otherwise there is discordance (opposite directions of QRS and T) which might be due to pathology. A negative T wave is also…

…extreme axis deviation Extreme axis deviation is rare. It is most likely due to misplaced limb electrodes. If the rhythm is tachycardia with wide QRS…

…been excluded. Causes of extreme axis deviation Rare. Most likely due to misplaced limb electrodes. If the rhythm is tachycardia with wide QRS complexes, then…

…of the QRS complex. Due to this it is sometimes recommended that ST segment deviation be measured in the J 60 point, or J 80…

…skin and eyes using saline solution (NaCl) if suspected of toxin exposure. Gastrointestinal lavage is infrequently employed due to aspiration risks and inconclusive evidence. However…

Cardiology Indications for pharmacologic agents Pharmacologic stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such…

…health effects of hypertension are devastating. Due to the simplicity of diagnosing hypertension and the effectiveness of antihypertensive treatments, targeting hypertension is the single most…

…tongue, and upper airway. Due to the risk of airway compromise, it represents a medical emergency. Evaluation and Physical Examination The evaluation of chronic cough…

…with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial ischemia…

…sinus node dysfunction Age related degenerative disease (fibrosis) Myocardial ischemia/infarction Lesions due to heart surgery Myocarditis Collagen disease Amyloidosis Risk of supraventricular tachyarrhythmia (tachycardia…

…repeated intravenous bolus injections or as a constant dose infusion. Bolus regime : • 20 mg IV bolus over 2 minutes, followed by 20 to 80 mg…

…severe bleeding. Particular caution is required for: Patients aged ≥ 75 years. Patients with a tendency to bleed (e.g., due to recent trauma, surgery, gastrointestinal…

…often recommended for PCI, while those with high scores (≥33) are typically advised to undergo CABG due to better long term outcomes. Intermediate scores (23…

…the atria and the ventricles (particularly the former). Even small pressure elevations on the right side can compromise venous return to the right ventricle. Therefore…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…a prior inferior infarction. Left posterior fascicular block (LPFB) Left posterior fascicular block is much less common than LAFB. This is due to the fact…

…of aggravating the infarction, as well as inducing ventricular arrhythmias. Unstable angina pectoris in the acute phase (before stabilization of symptoms) – due to the risk…

…The atrial impulse must pass through the atrioventricular node, which delays the impulse due to its slow conduction, before the impulse may reach the ventricles…

…Causes of tricuspid regurgitation The most common causes of tricuspid regurgitation are as follows: Right ventricular dysfunction due to pressure/volume overload. Right ventricular infarction…

…with ECG may reveal atrial fibrillation. Unfortunately, atrial fibrillation is too often discovered first at hospital admission due to its complications (stroke, thromboembolism, heart failure…

…after myocardial infarction), most likely has a parietal thrombus. The presence of ecotdense masses on valves should lead to suspicion of endocarditis (the masses are…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…due to diminished automaticity (pacemaker function) in the sinoatrial node or conduction defects (e.g. second degree AV block) as a result of ischemia/infarction…

…That study spread like a virus through social media and it is likely that it may have resulted in increased mortality due to stopping statins…

…infarction. Hyperkalemia. Treatment of sinoatrial arrest/pause Sinus arrest/pause due to increased vagal tone does not necessitate treatment but it might be wise to…

…fraction (LVEF). Sustained VT: Defined as VT lasting longer than 30 seconds or requiring termination earlier due to hemodynamic collapse [4] . Sustained VT is a…

…with other forms of ventricular tachycardia. Mechanisms of ventricular tachycardia Ventricular tachycardia (VT) may emerge due to increased/abnormal automaticity, re entry or triggered activity…

…of the foci of infection. Vegetations can be found on the flaps and appear as moving masses. Mural vegetations are attached to the endocardium and…

…fluid and a vasopressor according to the sepsis pathway when needed 9 Contact the haematologist or oncologist. Contact an infectious diseases physician early in a…