…blocker, a calcium channel blocker or digitalis, while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive…

…Comment : : : High sensitivity troponin T < 14 ng/L The decision thresholds are assay specific — follow the local 0/1 hour protocol NT proBNP <…

…adult electrocardiograms. It is crucial to be familiar with normal findings, normal variants, and pathology in neonates, infants and during the childhood years. Below follows…

…a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor neurone disease…

…general (circumferential) or localized to a specific area. The effusion itself may consist of serous fluid (transudate), protein rich fluid (exudate) to pure blood (exudate…

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

…Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the dosing should be 0.05 to…

…extended monitoring exceeding 3 weeks is necessary, an implantable loop recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or syncope…

…myocardial infarction The Fourth Universal Definition separates MI into five principal types. Type Mechanism or setting Type 1 Acute atherothrombotic MI, usually related to plaque…

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

…diagnosis and presents with distinct characteristics compared to transmural ischemia [4, 5]. Acute Pericarditis vs. Acute Myocardial Infarction The ST segment elevation in acute pericarditis…

…the specificity for pathological R wave progression is considerably lower than pathological Q waves and guidelines do not state any ECG criteria specific to R…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

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

…and infarction Definition and Pathophysiology Myocardial injury Myocardial injury is a biochemical diagnosis defined by at least one cardiac troponin value above the assay specific…

…should influence the choice between PCI and CABG. Physical examination findings are not specific to left main disease. The examination should nevertheless assess the consequences…

…and myocardial infarction occur in fewer than 1%, while mortality is generally below 0.1% in contemporary series. Reported risks vary according to the population…

…reperfusion is therefore the central priority of STEMI systems of care. Fibrinolysis promotes thrombus dissolution by converting plasminogen to plasmin. Fibrin specific agents act preferentially…

…basis for intervention. The source material does not provide a distinct symptom profile, physical examination pattern or biomarker signature specific to CTOs. Evaluation and physical…

…autopsy documents thrombosis and the diagnostic criteria used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified…

…Myocardial ischemia and infarction Definition and pathophysiology Fractional flow reserve (FFR) is an invasive, lesion specific physiological index used to estimate the functional significance of…

…unlikely to be the cause of the ST segment depression. The horizontal ST segment depression is more specific than the downsloping depression. Refer to Figure…

…Symptoms may resemble those of obstructive epicardial coronary disease or vasospastic angina. The clinical presentation is not sufficiently specific to identify the underlying mechanism. Microvascular…

…to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide (Narula et al). This chapter discusses the…

…Calcified plaque is generally less likely to rupture than non calcified, lipid rich plaque. CAC nevertheless serves as a marker of the broader atherosclerotic process…

…injury is separate from MI. It refers to cardiac troponin release that does not fulfil the criteria for ischaemic myocardial infarction. It may be acute…

…presenting feature. The source material emphasizes that patients and families should be educated to recognize chest discomfort or dyspnoea as potentially indicating myocardial infarction, particularly…

…after the onset of acute myocardial infarction. The maximum troponin value is observed in 12–48 hours. Troponin may be elevated for up to 2…

…images involves a systematic comparison of rest and stress images to assess myocardial ischemia and infarction. The key steps in this process are outlined below…

…their use is limited by specific adverse effects. Most of these adverse events are related to the suppression of the renin angiotensin aldosterone system (RAAS…

…if more than one hour has elapsed post ingestion unless the ingested substance has the propensity to form bezoars or is a sustained release formulation…

…myocardial infarction, and repeat revascularization. For example, in the SYNTAX trial, patients with high scores had significantly higher mortality and MACE rates compared to those…

…assuming an upright posture. Specific triggers are well recognized and include: Provoked fear, pain, anxiety, intense emotion, the sight of blood, unpleasant sights and odors…

…ECG is to detect ST elevation myocardial infarction (STEMI). Stable patients with ROSC presenting with ST elevations should undergo urgent coronary angiography with the intent…

…withholding specific cardioactive medications during exercise testing (exercise ECG). Indications for exercise stress test Indications have been discussed in Introduction to Exercise ECG. The most…

…ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific marker of myocardial infarction (MI). MI requires both: Acute myocardial injury, demonstrated…

…may also contribute to arrhythmogenesis through diabetic neuropathy and adverse metabolic effects, independently of coexisting CAD, previous myocardial infarction or HF. Nevertheless, the risk of…

…digitalis excess. Biomarkers and Laboratory Findings The source material does not provide information on biomarkers or laboratory findings specific to the evaluation of bradycardia. Treatment…

…the preparations. Relative: Poorly controlled diabetes — expect a raised blood glucose for 2–5 days. Suspected or known tendon rupture. No response to previous injections…

…4. Pulmonary Embolism (PE) Pain Characteristics: While dyspnea is the cardinal symptom, chest pain can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction…

…Chapter 1): Specific clusters of atrial myocardium : There are clusters of atrial myocardium that possess automaticity and thus pacemaker function. The intrinsic rate of depolarization…

…finding is referred to as inferior wall motion abnormality and it may evidence of myocardial infarction, which would have implications for the management of this…

…adults with elevated blood pressure (BP), in whom absolute cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast…

…contraindicated in patients with acute myocardial infarction, unstable angina, severe aortic stenosis, decompensated heart failure, and uncontrolled arrhythmias. Pharmacologic stress agents have specific contraindications: Adenosine…

…and coronary microvascular dysfunction. Women with RA were reported to have approximately twice the myocardial infarction risk of age matched controls. Cardiovascular events occur earlier…

…despite multidrug treatment rather than through specific symptoms. The clinical importance lies in its association with: Increased cardiovascular disease risk; Greater risk of myocardial infarction…

…or peripheral vascular disease. A family history of premature myocardial infarction, vascular disease or marked hypercholesterolaemia. Physical findings related to cholesterol deposition. Untreated or inadequately…

…approximately a 25% reduction in recurrent infarction, stroke, or cardiovascular death. In the cited evidence, this corresponded to 36 fewer events per 1000 treated patients…

…is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard…

…days, compared to the 30 day mortality of STEMI (ST segment elevation infarction) , which is about 6%. Previously, alpha streptococcus was the most common agent…

…but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat, skin, perianal region…

…corticosteroid is to be given: hold the needle still, change the syringe and inject. The injection should go in easily. Resistance means the tip is…

…a repair is determined before the first needle goes in. A wound that has not been irrigated clean, has not been inspected to its depth…

…and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an…

…and preserved orientation 12 to 48 hours Withdrawal seizures, usually generalised tonic clonic and sometimes several within a short period 24 to 72 hours Increasing…

…management. Contraindications Infection, burn or trauma over the insertion site. Insufficient collateral circulation to the hand. Vascular disease in the limb: marked peripheral arterial disease…

…a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in the skin overlying the puncture site. Previous…

…technique is designed to make sure that never happens, and to make sure the catheter does not become the patient's next focus of infection…

…of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a long period, according to the local protocol Psychiatric symptoms Sleep disturbance, hypomania…

…6 + weight in kg Always have one size smaller to hand. The cuff is inflated to 20–30 cmH₂O measured with a manometer — a higher…