…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…

…Contraindications and when to involve a surgeon The following locations must not be handled routinely in primary care or in the emergency department without contacting…

…Indirect criteria after circulatory arrest, following a five minute no touch period The circulation at retrieval Maintained up to retrieval Ceased; warm ischaemic time is…

…failure The insulin requirement falls . Reduce the dose and measure more frequently Acute illness and infection The insulin requirement rises, often despite a reduced food…

Myocardial ischemia and infarction Procedurer Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after…

…in order to minimize the probability of missing significant abnormalities. The following parameters must be assessed, in chronological order: Heart rate Rhythm P wave PR…

…injuries, hemodynamic and respiratory instability, multiorgan failure, infections, seizures and temperature management. The ICU is the preferred level of care for the absolute majority. The…

…ECG changes. Significant pericardial effusion may bring about the following ECG changes.: Low voltage: large amounts of pericardial effusion will diminish the QRS amplitudes. Electrical…

…affecting cardiac function or hemodynamics. The following functions are attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction…

Clinical chemistry & laboratory medicine Myocardial ischemia and infarction Definition and Pathophysiology Myocardial injury Myocardial injury is a biochemical diagnosis defined by at least one cardiac…

…is based on the following three components: Cardiac troponins – Elevation of cardiac troponins in peripheral blood is mandatory to establish a diagnosis of myocardial infarction…

…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…

…following PCI. Both type 4b and 4c MIs meet the clinical criteria for a type 1 MI. Type 5 MI: Represents a periprocedural myocardial infarction…

…This distinction is clinically important because cardiac troponin elevation after revascularization is common and may reflect procedural myocardial injury rather than a clinically significant infarction…

…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…

…For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia following an acute gastrointestinal bleed or a sustained tachyarrhythmia. Symptoms…

…ECG criteria for pathological Q waves (Q wave infarction) Lead Definition of pathological Q wave Normal variants V2–V3 ≥0,02 s or QS complex…

…is permeated by the mantra time is myocardium, which refers to the progressive loss of myocytes following the occlusion of a coronary artery. The size…

…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…

…pathological examination. Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia. The first cellular abnormalities of ischaemia include depletion of glycogen, relaxation of myofibrils…

…first year after stenting, although the risk is higher after treatment of ST segment elevation myocardial infarction (STEMI) and following complex PCI. Stent thrombosis remains…

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 ischemia and infarction Definition and Pathophysiology Unstable angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal…

Myocardial ischemia and infarction Definition and therapeutic rationale Multivessel coronary artery disease (CAD) refers to clinically significant atherosclerotic disease affecting two or more major epicardial…

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…

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…

…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)…

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

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…

…level, producing atrioventricular (AV) or intraventricular blocks. Isolated sinus bradycardia in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic…

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

…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…

…first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following substances…

…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…

…a disorder of autonomic reflexes. It typically occurs after attaining an upright posture or following painful stimuli and emotional stress. By the age of 60…

…episodes Iatrogenic events (e.g., during central venous catheter insertion) Underlying lung pathologies In cases of benign pneumothorax, positive pressure ventilation can precipitate a tension…

…result in hemorrhage within the pericardium. Ventricular rupture : A transmural infarction can cause a rupture in the left ventricular free wall. Mediastinal trauma : Penetrating injuries…

…cells ( Parmacek et al ). Cardiac troponin levels rise within a few hours after the onset of myocardial infarction. This is utilized in clinical practice by…

…latter term has been deprecated. The left bundle branch is subdivided into the following two fascicles: (1) the anterior (anterosuperior) fascicle , which delivers the electrical…

…Intermittent bradycardia The following conditions may cause intermittent bradycardia: Extrasystoles (premature ventricular beats or premature atrial supraventricular beats) can cause transient AV blocks by affecting…

…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…

…limb lead II. Normal (physiological) causes of sinus bradycardia Sinus bradycardia (SB) is considered a normal finding in the following circumstances: During sleep . Well trained…

…most common causes of tricuspid regurgitation are as follows: Right ventricular dysfunction due to pressure/volume overload. Right ventricular infarction. Ebstein's anomaly (Figure 1)…

…with the following: Myocardial Infarction : LBBB can develop as a complication of myocardial infarction (MI) [5]. It is more frequently associated with anterior infarction than…

…shoulders, and arms, sometimes following the trapezius ridge [2]. Distinguishing Features: Recognition may be aided by the pain not being relieved by rest or nitroglycerin…

…the S3 segment. SGLT2 also mediates proximal tubular sodium reabsorption, with chloride following passively down the resulting electrochemical gradient. By inhibiting SGLT2, these drugs produce…

…complex in leads I and II. The following rules apply: Normal axis : Net positive QRS complex in leads I and II. Right axis deviation : Net…

…complex in leads I and II. The following rules apply: Normal axis: Net positive QRS complex in leads I and II. Right axis deviation: Net…

…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…

…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) …

…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…

…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…

…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) …

…determining what phase the patient is in. The three phases following a sudden cardiac arrest were described by Weisfeldt and Becker (2002). Drawing on physiology…

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

…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…

…Hence, heart rate and blood pressure must also be noted. In summary, the following variables should be included in the survey: personal identification, age, sex…

…fundamental pathophysiological substrate for acute coronary syndromes (ACS), including ST Elevation Myocardial Infarction (STEMI) [1] . Historically viewed as a simple plumbing problem characterized by the…

…Infections are difficult to heal because the heart valves are not vascularized and therefore it is difficult for the immune system to reach the bacteria…

…Lathundar Key message Fever in a neutropenic patient is an emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint…