…despite maximally tolerated therapy. It is a prodrug activated predominantly in the liver by very long chain acyl CoA synthetase 1. This activating enzyme is…

Procedurer Spirometry is the only investigation that distinguishes obstructive from restrictive impairment of lung function, and COPD cannot be diagnosed without it . The quality of…

…a patient with an impaired cough reflex, and the first feed then becomes a direct instillation into the lung. No tube may be used before…

…interval. The primary hazard lies in long QTc intervals because they induce a very unstable polymorphic ventricular tachycardia referred to as torsade de pointes . Abnormally…

ECG Please refer to the previous chapter: LQTS (Long QT Syndrome)

…drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS) is presented below. With regards to drugs…

[calc_123lqts] Long QT Syndrome (LQTS) is an inherited cardiac channelopathy characterized by prolonged ventricular repolarization, which predisposes individuals to malignant ventricular arrhythmias, notably torsade…

Procedurer The donation process begins long before any retrieval: it begins when someone in the intensive care unit identifies a possible donor and the deceased…

Echocardiography Pericardial diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis…

5 Year Risk of Life Threatening Ventricular Arrhythmias [calc_123lqts] Long QT Syndrome (LQTS) is an inherited cardiac channelopathy characterized by prolonged ventricular repolarization, which…

Kardiologi Lathundar Three questions determine the management: is the patient unstable, how long has the fibrillation lasted, and does the patient need an anticoagulant? The…

Arrhythmias and arrhythmology Drugs and electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT…

…Three questions come up again and again on call: which dose, how long to interrupt treatment before a procedure, and how to reverse in bleeding…

…and dangerous in a few. The male urethra is about 25 cm long with two curves and a prostate that can grip; the female urethra…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological basis Secondary prevention after myocardial infarction (MI) encompasses long term interventions intended to reduce recurrent infarction…

…than a binary distinction between normotension and hypertension. Its long term relationship with cardiovascular risk is therefore graded, although practical clinical care requires diagnostic and…

…the symptoms began, whether they are continuous or episodic, how long an attack lasts, and whether anything actually triggers it [1,2]. The single most…

…an advanced version of the original SYNTAX Score, designed to improve the prediction of long term outcomes after revascularization. It incorporates both anatomical (from the…

…the prevalence of atrial arrhythmias, ventricular arrhythmias and sudden cardiac arrests, this syndrome appears to be very serious. The ECG is characterized by marked, persistent…

…It is frequently clinically silent, which promotes both patient and clinician inertia and contributes to inadequate long term control. The treatment objective is individualized blood…

…persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes. The central therapeutic objective is…

…wave. Because of the long duration of the plateau phase most contractile cells are in this phase at the same time (more or less). Moreover…

…Management Definition and Clinical Characteristics Torsades de pointes (TdP) represents a multifactorial clinical entity typically associated with drug induced long QT syndrome (DI LQTS) [1]…

…while simultaneously affecting systemic perfusion. Aortic stenosis is a serious condition with poor long term outcomes. Patients with low flow low gradient aortic stenosis (discussed…

…on the coronary arteries. The tumors can be asymptomatic for a long time and be detected randomly when investigating other conditions. More dramatic onset of…

…change in left ventricular diameter during systole. It is measured in parasternal long axis view (PLAX) using M mode. The end systolic and end diastolic…

…may also develop tachycardia induced cardiomyopathy (Gopinnathair et al). Long term prognosis is excellent, with the vast majority of patients recovering completely after restoration of…

…Two dimensional echocardiogram. This view is called parasternal long axis view (PLAX). Structures that are closest to the transducer are placed at the top of…

…effect or about suppression of the HPA axis, where a long half life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient…

…coronary and renal perfusion, particularly in patients with long standing hypertension and a rightward shifted autoregulation [1,3]. The term hypertensive urgency is best avoided…

…few days. Principles Insulin component Function Who needs it : : : Basal insulin (intermediate or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always…

…< 20 kPa (150 mmHg), and permissive hypercapnia as long as the pH stays above about 7.20. Different targets apply when the intracranial pressure…

…or is judged futile. Children in an emergency, where peripheral venous access often takes too long. Intraosseous access accepts all drugs, fluids and blood products…

…after pituitary surgery or radiotherapy, or with suspected suppression of the HPA axis after long term glucocorticoid treatment. A basal morning cortisol in the grey…

… the long term outcome is worse Medial epicondylitis At the flexor origin Avoid the ulnar nerve Carpal tunnel syndrome The carpal tunnel An acceptable bridge…

…target value that must never be exceeded, during the first 72 hours for as long as the patient remains unconscious. The evidence Trial Question Result …

…2. Marked sinus bradycardia, sinus arrest, sick sinus syndrome with long pauses. Bradycardia in poisoning with a beta blocker, a calcium channel blocker or digitalis…

…A clinically infected wound. Heavily contaminated wounds where a long time has passed since the injury (see below). Be particularly cautious with impaired healing: peripheral…

…2. Aortic Valve Velocity Time Integral (AV VTI) Optimal View : Deep transgastric or transgastric aortic valve long axis (AVLAX) view. Method : Use continuous wave Doppler…

…often recommended for PCI, while those with high scores (≥33) are typically advised to undergo CABG due to better long term outcomes. Intermediate scores (23…

…in the United States alone, yet no reliable model currently exists for the long term prediction of sudden cardiac arrest. The constraint does not lie…

…normal accessory pathways. However, conduction may be blocked in unusual accessory pathways that possess long conduction times or decremental conduction properties. Furthermore, adenosine binds to…

…and combinations are frequently required. The central therapeutic aim is symptom control rather than modification of long term cardiovascular outcomes. With the important exception of…

…complications than patients without AF; both short and long term prognosis are worse than in patients who remain in sinus rhythm. Several mechanisms may account…

…Long term prognosis is influenced particularly by: Resting left ventricular function The amount of residual viable myocardium exposed to ischaemic risk Susceptibility to serious ventricular…

…Small reference vessel diameter A small post procedural lumen Substantial residual stenosis Long lesions Diabetes mellitus Untreated edge dissection Components and mechanisms of DES A…

…heart failure with reduced ejection fraction (HFrEF) in developed countries. New ischemic events are major determinants of subsequent LV deterioration and long term survival. Viable…

…not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical therapy and secondary prevention. Clinical Presentation and…

…protocols. Note that while cardioversion restores sinus rhythm in up to 95% of patients, long term maintenance (particularly in persistent AF) remains the greater challenge.

…Thus, Ashman's phenomenon requires a long RR interval followed by a short RR interval ( Figure 2 ). These aberrantly conducted beats typically have right bundle…

…larger, present with more severe neurological deficits, and carry higher rates of mortality and long term disability compared to non cardioembolic ischemic strokes. Consequently, the…

…cardiomyopathy Takotsubo cardiomyopathy Tachycardia induced cardiomyopathy Non compaction cardiomyopathy Peripartum cardiomyopathy Cardiomyopathy secondary to valvular heart disease Long term prognosis varies markedly across these conditions…

…Figure 1 A ). The plateau phase has a long duration which enables the majority of the ventricular myocardium to contract simultaneously. Since the membrane potential…

…in some instances, persist for extended durations. As for any long standing tachycardia, there is a risk of developing tachycardia induced cardiomyopathy. In pediatric populations…

…seen in certain causes of cardiac arrest (e.g. pulmonary embolism) or in case of long no flow or low flow periods. Under such circumstances…

…studies (Edwards et al), the left ventricle is divided into three equal parts along the long axis of the ventricle. This creates three circular sections…

…time). Since M mode only analyzes a single ultrasound line, its temporal and axial resolution is very high, as compared with 2D echocardiography. M mode…

…Both methods may be used in the acute setting, whereas long term management only includes pacemaker therapy. Treatment of AV block in the acute setting…

…et al and Marijon et al , long term prevention of cardiac arrest at the population level is very difficult. Future efforts may be more successful…