…not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the arrhythmia first. Known stricture or tumour of the nose, pharynx or…

…are provoked by a change of position — turning over in bed, lying down, standing up, tilting the head backwards. A symptom free interval between attacks…

…or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder, elbow, finger, patella, jaw or hip prosthesis. A dislocation with neurovascular…

…This interval includes: The time from symptom onset to recognition and seeking medical assistance. Prehospital assessment, treatment and transport. Diagnostic assessment and initiation of reperfusion…

…sinus rate. In the AV node, adenosine produces a transient, rate dependent prolongation of the A H interval, frequently manifesting as transient first , second , or…

…presenting more than 12 hours after symptom onset, PPCI is recommended when there are: ongoing symptoms suggestive of ischaemia; haemodynamic instability; or life threatening arrhythmias…

…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…

…both are predictable. Indications Inability to protect the airway: reduced level of consciousness, loss of pharyngeal reflexes, vomiting with a risk of aspiration. Inadequate oxygenation…

…bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock…

…from symptom onset is 12 h, a primary PCI strategy is indicated in the presence of ongoing ischemic symptoms, haemodynamic instability, or life threatening arrhythmias…

…resulting extensive ischemia causes immediate myocardial stunning (akinesia) and electrical instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the…

…status Haemodynamic instability, cardiogenic shock, acute heart failure related to ongoing ischaemia, life threatening arrhythmias, and cardiac arrest after presentation are markers of very high…

…Bradycardia causing hemodynamic instability is a potentially life threatening condition and should be managed urgently. The risk of cardiogenic shock is high and pharmacological interventions…

…Marked agitation or inability to cooperate. Copious secretions without an effective cough. Choice of method and settings Condition Method Starting pressure Escalation Oxygen target : : : : : Cardiogenic…

…or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion is clinical euvolemia rather than an isolated…

…also termed massive PE, is defined by haemodynamic instability and represents approximately 5–10% of cases. Intermediate high risk PE occurs in haemodynamically stable patients…

…treatment and the expected continued bleeding matters more than an exact estimate of blood loss [1]. Strong indications for activation Ongoing bleeding with haemodynamic instability…

…or haemodynamic instability, and cardiogenic shock. ACS is distinct from myocardial infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting of acute myocardial…

…a risk of perforation Anterior packing: Suspected base of skull fracture or a significant midfacial or nasal fracture (absolute). An unsecured airway or haemodynamic instability …

…emergency. Infection can progress rapidly, while the typical local signs of inflammation may be faint or absent. Take cultures immediately, but never let sampling, imaging…

…a lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than a more distal…

…in ventricular function Hemodynamic instability Periprocedural myocardial infarction Cardiogenic shock Cardiac arrest The severity may be disproportionate to the angiographic appearance of the treated epicardial…

…and Pathophysiology Posterior myocardial infarction is myocardial necrosis involving the posterior region of the left ventricle, usually as part of an inferoposterior or posterolateral infarction…

…cause of the arrhythmia already affects cellular function. This results in electrical instability which explains why ventricular tachycardia may progress to ventricular fibrillation. Left untreated…

…coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological stress. The physiological basis is an…

…ischaemia, heart failure, electrical instability or a large area of myocardium at risk. Over 48 hours: urgent PCI is still indicated with continuing ischaemia, shock…

…be confused with a venous access. Indications Continuous blood pressure monitoring in haemodynamic instability or during ongoing vasoactive treatment. Conditions in which blood pressure must…

…protection. Asthma and other marked obstructive airways disease — relative; the risk of bronchospasm is real. Hypotension and haemodynamic instability. Respiratory compromise during an ongoing crisis…

…or exclusion of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory…

…the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first. CT before the puncture Swedish…

…primarily for instability. Evaluation and physical examination Initial assessment should establish whether AF is associated with acute haemodynamic compromise, pulmonary oedema, or evidence of coronary…

…dysfunction may therefore reflect a combination of: direct tubular toxicity; renal haemodynamic disturbance and ischaemia; pre existing or concurrent hypovolaemia; cardiac dysfunction or haemodynamic instability…

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…

…ventricular necrosis is found in approximately one third of patients with inferior infarction. Extensive involvement is less common in patients with inferoposterior left ventricular infarction…

…management of ventricular rate. However, AF causing acute haemodynamic instability requires prompt treatment, with electrical cardioversion preferred. Evaluation and risk assessment The evaluation of a…

…electrical or haemodynamic instability, or cardiogenic shock. UA itself is defined by a recent change in the pattern of myocardial ischaemia rather than by a…

…of raised intracranial pressure or impending herniation Moderately severe symptoms New confusion Severe headache Persistent nausea Moderately reduced consciousness Marked gait instability The specificity of…

…objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic…

…interactions, while venlafaxine and higher doses of bupropion, among others, can raise the blood pressure. Serotonin syndrome can also cause autonomic instability and hypertension [4]…

…In these conditions, involvement of the AVN and the conduction system occurs more often than sinus node involvement, and atrioventricular block (AVB) may indicate septal…

Arrhythmias and arrhythmology ECG Chronotropic incompetence: inability to adequately increase heart rate Chronotropic incompetence is an independent predictor of overall and cardiovascular mortality. The condition…

…the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory…

…Physical inability to perform the test safely. Relative: Condition Comment : : Left main stenosis Known — perform the test only on a clear indication and with full…

…a risk of transmission Until symptom free Haemoptysis of unclear cause Until investigated Relative obstacles also include dementia, marked hearing loss and an inability to…

…uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to attend for sampling and follow up — relative, but in…

…Our inability to predict cardiac arrest is evident in many ways. Some examples follow: Modern ICDs are capable of successfully defibrillating 99% of ventricular tachyarrhythmias…

…question): A fracture of the bone to be punctured, or a major injury proximal to the puncture site. A joint prosthesis or orthopaedic metalwork in…

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…

…utility is frequently limited by its inability to distinguish between muscle mass and various fat depots, or to identify the precise location of excess adiposity…

…means that the automaticity is diminished). Chronotropic incompetence (inability of the sinoatrial node to adequately increase its automaticity during physical activity). Sinus arrest & sinus pause…

…an inability to protect the airway, or ongoing major haematemesis: early anaesthetic assessment before endoscopy Assess the severity of the bleeding clinically Signs of major…

…is divided clinically into: Complete intolerance: inability to tolerate any dose of any statin. Partial intolerance: inability to tolerate the dose required to achieve the…

…addressing some of the SYNTAX Score's shortcomings, such as its inability to account for coronary dominance variability and its reliance on subjective lesion weighting…

…and severity) which may compensate for the inability to reach their maximal heart rate. Ultimately, the specificity of exercise stress testing is lower in the…

…Where functional impairment is accompanied by inability to perform activities of daily living, treatment goals should be individualized and discontinuation of medication may become appropriate…