…by Direct criteria: clinical neurological examination and, where needed, four vessel angiography Indirect criteria after circulatory arrest, following a five minute no touch period The…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic…

…Denotes myocardial infarction related to stent thrombosis following PCI. Type 4c MI: Denotes myocardial infarction related to restenosis following PCI. Both type 4b and 4c…

…elevation after revascularization is common and may reflect procedural myocardial injury rather than a clinically significant infarction. Mechanisms of injury Procedural injury may result from…

…of patients. Evaluation and clinical assessment Clinical factors influencing treatment selection The following characteristics favour CABG when clinically and anatomically appropriate: Diabetes mellitus, particularly with…

…measure in decontamination, and gastric lavage is today a rare procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit…

…intubation, and prolonged ICU admissions. Pending the correct level of care, the following actions can be performed. CPR Initiate CPR in adherence to standard guidelines…

…99th percentile URL; and Clinical evidence of acute myocardial ischaemia , demonstrated by at least one of the following: Symptoms of myocardial ischaemia. New ischaemic ECG…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Refractory angina is a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options…

…testing in women Exercise ECG has lower sensitivity and specificity in women. This may be due to the following: Atherosclerosis is generally less severe in…

…injuries to the mediastinum can cause tamponade. Post operative Complications : Post surgical complications following thoracic procedures can cause tamponade. Tamponade with swinging heart of the…

…segment elevation myocardial infarction (STEMI) and following complex PCI. Stent thrombosis remains multifactorial, reflecting interactions between patient related, lesion related, device related, and procedural factors…

…post procedural luminal diameter A high degree of residual stenosis Long lesion length Diabetes Untreated edge dissection DES have reduced restenosis compared with BMS, and…

…parallel, otherwise hypoglycaemia will follow. Discharge without a plan. Document what has been changed, who is following it up and when. Sources American Diabetes Association…

…dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following early…

…The following functions are attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction between the ventricles and surrounding…

…pericardial effusion and cardiac tamponade Small amounts of pericardial effusion may not cause any ECG changes. Significant pericardial effusion may bring about the following ECG…

…all pediatric patients. Sinus rhythm is defined by the following criteria: Regular rhythm with a ventricular rate within the age specific normal interval. P wave…

…from hemodynamic failure and multiorgan dysfunction. 10% die from recurrent arrhythmias. To monitor and evaluate the victim after ROSC, the following modalities and investigations are…

… and Clinical evidence of acute myocardial ischaemia. At least one of the following provides the required evidence of ischaemia: Symptoms compatible with myocardial ischaemia New…

…Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…indicated in patients with symptoms suggestive of acute myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent…

…2]. Summary of Pain Characteristics The following table synthesizes the key differential diagnoses and their characteristic pain patterns based on the provided context. Condition Typical…

…Other Differential Diagnoses ST segment elevations simulating acute ischemia or infarction may also occur in the following conditions [15]: Myocarditis Early repolarization patterns Left bundle…

…develop earlier. Standard textbooks have traditionally taught that the pathological Q wave is a permanent ECG manifestation and that it represents transmural infarction (STEMI). However…

…refers to the progressive loss of myocytes following the occlusion of a coronary artery. The size, location, and duration of the occlusion are of prime…

…necrosis and cardiac troponin release meeting the criteria of the universal definition of MI. Clinically, UA is defined by one or more of the following…

…80 mg tablet once daily. Warnings and precautions Use Aspirin with caution in the following cases: Concurrent anticoagulant therapy (e.g., coumarin derivatives or heparin…

…myocardial infarction. cTnI and cTnT have different molecular structures, which may affect their release into the blood as well as their clearance. cTnI has a…

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

…exclude or verify the following potentially life threatening causes of chest pain: Ischemic heart disease : stable angina pectoris, unstable angina pectoris, acute myocardial infarction (AMI)…

…an episode of ischemia/infarction, but no later than 24 hours. However, T wave inversions following reperfusion develop within 4 hours and such T waves…

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…

…is in. The three phases following a sudden cardiac arrest were described by Weisfeldt and Becker (2002). Drawing on physiology, observational and experimental studies, they…

…pathophysiology and prognosis differ for these entities. Note that the terms bradyarrhythmia and bradycardia are used interchangeably throughout this chapter. Intermittent bradycardia The following conditions…

…syncope (NMS), a disorder of autonomic reflexes. It typically occurs after attaining an upright posture or following painful stimuli and emotional stress. By the age…

…abnormal, and the following differential diagnoses are at hand: Sinus node dysfunction. Side effects of drugs (diltiazem, verapamil, beta blockers, digitalis). Hypoxia. Myocardial ischemia/infarction…

…The following table summarizes the common diagnostic criteria for complete and incomplete LBBB: Feature Complete LBBB Incomplete LBBB QRS Duration $\ge 120$ msec [3…

…myocardial infarction (STEMI) This applies to patients undergoing either primary or delayed percutaneous coronary intervention (PCI). Contraindications Prasugrel should not be used in the following…

…onset atrial fibrillation to sinus rhythm. Vernakalant is used in the following settings: Non surgery patients: atrial fibrillation ≤7 days duration. Post cardiac surgery: atrial…

…with chloride following passively down the resulting electrochemical gradient. By inhibiting SGLT2, these drugs produce coupled sodium and glucose loss in approximately a 1:1…

…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…

…Causes of sinoatrial (SA) block The following conditions cause sinoatrial block: Sinus node dysfunction (SND) Perimyocarditis Acute myocardial infarction (or ischemia) Drug side effects (procainamide…

…as a result of ischemia/infarction. Sinus Node Dysfunction (SND) – Sinus node dysfunction implies that the cells of the sinoatrial node are defective and fail…

…in partial (incomplete) occlusion of the coronary artery. NSTE ACS results in one of the following diagnoses: Non ST Elevation Myocardial Infarction (NSTEMI, non STEMI) …

…fascicular block (LAFB) LAFB may imitate anteroseptal infarction. rS complexes in leads II, III and aVF may mask Q waves from a prior inferior infarction…

…in partial (incomplete) occlusion of the coronary artery. NSTE ACS results in one of the following diagnoses: Non ST Elevation Myocardial Infarction (NSTEMI, non STEMI) …

…Ebstein's anomaly is characterized by the following malformations: The septal and posterior leaflets of the tricuspid valve adhere to the ventricular myocardium (failure of…

…measure ST segment deviation. The following must be noted regarding the ST segment: The normal ST segment is flat and isoelectric. The transition from ST…

…These estimates should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of no flow ( Rawshani…

…effects for up to 2 weeks. The peak vasodilatory effect is observed between 2 4 days following the infusion. This delayed onset is attributable to…

…with an increasing number of methods to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide (Narula…

…types I and III, elastin, and proteoglycans [6] . This matrix forms a fibrous cap that sequesters the highly thrombogenic lipid core from the flowing blood…

…hypertrophy). The following rules will distinguish the two conditions in the vast majority of cases: Right ventricular hypertrophy shifts the electrical axis to the right…

…direction of the QRS complex in leads I and II. The following rules apply: Normal axis : Net positive QRS complex in leads I and II…

…direction of the QRS complex in leads I and II. The following rules apply: Normal axis: Net positive QRS complex in leads I and II…

…As a rule, some kind of damage to native (own) valves is required to become vulnerable and contaminated by bacteria . Infections are difficult to heal…

…only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ dysfunction must…