…not treated away. Incision and drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy…

…cardiac transplantation or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke, and initiation of renal replacement therapy. The study found no significant…

…6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV…

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…

…tachycardia is always considered pathological and the underlying cause must be investigated. Pain, infections, medications, fever, hypovolemia, dehydration, anemia, hyperthyroidism and myocarditis are common etiologies…

…or extrapolation from other fields (e.g. sepsis research) or physiological reasoning. Cardiac arrest care is advanced and should preferably only be conducted in specialized…

…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…

…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…

…Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period the cells die and…

…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…

…NSTE ACS/NSTEMI are almost invariably accompanied by ST segment depressions in other leads (particularly V5) and that is not consistent with posterior transmural ischemia…

…a stent thrombosis or restenosis. Type 1 myocardial infarction Definition and pathophysiology Type 1 MI results from acute coronary atherothrombosis. It is usually precipitated by…

…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…

…infarction) Lead Definition of pathological Q wave Normal variants V2–V3 ≥0,02 s or QS complex None All other leads ≥0,03 s and…

…on the other hand, is caused by a complete coronary artery occlusion, which results in the complete stop of blood flow and thus more extensive…

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…

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…

…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…

…of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms…

…Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the effect of anticoagulants, increasing bleeding risk. Monitor coagulation…

…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)…

…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…

…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…

…impulses spreading from other parts of the ventricle (where the fascicle is intact). Figure 1. Left anterior fascicular block (anterior hemiblock) and left posterior fascicular…

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

…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…

…can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with a pleural friction rub…

…pulmonary hypertension, pulmonary valve stenosis). Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior…

…pulmonary hypertension, pulmonary valve stenosis). Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior…

…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) …

…heart rate, ECG. References Narula et al: Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiology.

…ischemia or myocardial infarction, and in these cases, the likelihood of ROSC is higher as compared to other etiologies and presentations. Asystole and pulseless electrical…

…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) …

…reaches hospital early. The benefit of both methods falls steeply with the time since ingestion, and both can harm the patient through aspiration. Contact your…

…Smooth muscle cells (SMCs) migrate from the tunica media into the intima, driven by platelet derived growth factor (PDGF) and other cytokines. Within the intima…

…in whom total brain infarction is not expected to occur within a reasonable time, and in whom death is judged likely within 180 minutes of…

…In impaired consciousness or DKA: remove the pump and change to an infusion or injections Drugs for type 2 diabetes in inpatients Agent The acutely…

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…

…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…

… and At least one of the following: New ischemic ECG changes New pathological Q waves Imaging evidence of new loss of viable myocardium or a…

…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…

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…

…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…

…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…

…and class III) within 4 hours prior to, as well as in the first 4 hours after, vernakalant administration. Acute coronary syndrome (including myocardial infarction…

…acute myocardial ischemia, old myocardial infarction, long QT, and bundle branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia…

…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…

CPR Tamponade and cardiac arrest Cardiac arrest associated with tamponade has an exceptionally poor prognosis. In the vast majority of these cases, the tamponade develops…

…et al, Twerenbold et al) Kinetics Troponin T (cTnT) and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The…

…Class IA, IC and III antiarrhythmics. Tricyclic antidepressants . Lithium. Cholinesterase inhibitors. Methyldopa. Reserpine. Clonidine. Conditions Myocardial ischemia, myocardial infarction (can cause permanent bradycardia, particularly anterior…

…dysfunction (SND) Perimyocarditis Acute myocardial infarction (or ischemia) Drug side effects (procainamide, digitalis) Well trained athletes display sinoatrial block as a physiological and normal finding…

…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…

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

…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…

…ATP concentration after induction of ventricular fibrillation (cardiac arrest). As ATP concentration declines, critical cell functions cease. Membrane potential, action potential, excitability, and contractile function…

…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…

…materials pose a high risk of infection. Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular…

…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…