…haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels, by contrast, are no obstacle. Untreated hypokalaemia or marked electrolyte disturbance; correct…

…syndrome lipid lowering recommendations. Acute coronary syndrome The period immediately following ACS is associated with particularly high risk of recurrent cardiovascular events. Intensive LDL C…

…presenting symptoms of NSTEMI. It does identify several clinical manifestations that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing…

…and the magnitude of LDL C reduction. Thus, even a modest absolute reduction may be clinically important in individuals at high or very high risk…

…from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies…

…compromise or skin tenting — reduce promptly, before radiography. The longer a joint remains dislocated, the harder the reduction becomes and the greater the risk of…

… and A reduction of at least 50% from baseline. In patients who experience a recurrent atherothrombotic or cardiovascular event within 2 years while receiving maximally…

…risk of thrombosis related to the intravascular foreign body. First generation DES, particularly sirolimus and paclitaxel eluting devices, were associated with increased late and very…

…Strong risk factors serve as useful predictors in prediction models. Targeting risk factors has been very successful in the primary and secondary prevention of atherosclerotic…

…refractory to guideline directed medical therapy, occur at a low level of exertion, or are associated with high event risk. The apparent differences between thresholds…

…when triglycerides are elevated, LDL C is very low, or cardiometabolic abnormalities make LDL C an incomplete representation of atherogenic burden. Clinical Presentation and Symptoms…

…10 year risk of fatal or non fatal CVD Low <2% Moderate ≥2% to <10% High ≥10% to <20% Very high ≥20% The risk categories…

…with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with chronic kidney disease, particularly diabetic kidney…

…defined by an increased concentration of circulating triglycerides. Both fasting and non fasting measurements provide prognostic information regarding cardiovascular risk. Thresholds vary among guideline systems:…

…syndromes, or heart failure have preexisting hypertension. The relationship between blood pressure and outcome in older adults is not linear at very low pressures. Excessive…

…the risk of hypercapnia has been assessed. 3. Take an arterial blood gas in respiratory compromise, low saturation, suspected carbon dioxide retention, reduced consciousness, or…

…recommended as the initial study in patients with low to moderate risk of CAD. In patients with a high to very high risk of CAD…

…in the same order every time, reduces the risk of missing abnormalities. The eight steps below go through the rhythm and then the waveforms one…

…disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and a consequent excess risk of premature atherosclerotic cardiovascular disease …

…double blind, placebo controlled study of 13,970 patients at high cardiovascular risk who were unable or unwilling to take statins. Approximately 70% were in…

…in very small and very large people. Acute kidney injury (KDIGO) Stage Creatinine Urine output : : : 1 A rise ≥ 26 µmol/L in 48 h, or…

…is symptomatic or at risk of developing symptoms. The most common non reversible causes of sinus bradycardia are sinus node dysfunction, side effects of medications…

…a large change in TSH. During acute illness the TSH can be falsely low or high in the absence of thyroid disease; repeat it once…

…1 hypertension, pharmacological treatment has demonstrated cardiovascular benefit, although in younger individuals with low short term risk, lifetime benefit should be considered and discussed. Where…

…lower or otherwise modified in some populations. Cardiometabolic mechanisms Visceral and ectopic fat are particularly relevant to cardiovascular risk. Excess adipose tissue promotes: Chronic, low…

…presumably explained by a higher incidence of malignant ventricular arrhythmias. It has been suggested that the high risk of ventricular arrhythmias is due to the…

…and the balance of risk and benefit determine whether treatment is initiated. High 3 9 As above. Very high Oral anticoagulation (warfarin or NOAC) is…

…has very good prognosis and may even occur in otherwise healthy individuals. However, if the QRS complexes are wide there is a risk of distal…

…of idiopathic ventricular fibrillation and sudden cardiac arrest. This is a rather large increase in relative risk , but the absolute risk is still very low…

…The risk of ventricular fibrillation is very high during torsade de pointes . ECG showing an episode of sinus rhythm (with multiple ventricular premature beats) spontaneously…

…Typical angina or dyspnoea at a low level of exertion. Left ventricular dysfunction suggesting extensive obstructive CAD. A high risk result on non invasive testing…

…emergency or urgent procedures, chronic kidney disease, ST segment elevation myocardial infarction, and cardiogenic shock. Patient related and procedural risk factors The risk of adverse…

…glucose has become very low [4]. Sampling and measurement error A capillary glucose is sufficient to start emergency treatment, but abnormal or unexpected values should…

…risk factor for death [15]. For patients with LBBB and a left ventricular ejection fraction (LVEF) $< 35%$, the implantation of a defibrillator or…

…Clinical assessment History that affects the level of risk Ask briefly and to the point: When did the deterioration begin, suddenly or over several days…

…the cause of cardiac arrest, cardiopulmonary resuscitation (CPR) should be performed per standard guidelines. Cardiac arrests due to trauma are characterized by very low survival…

…treatment, with a very low number needed to treat (NNT), indicating high effectiveness. Although BLS is primarily developed for out of hospital cardiac arrest (OHCA)…

…the descending aorta and vena cava inferior . The pressure in the vena cava inferior is very low, such that the vein can be fully compressed…

…Severe coagulopathy or ongoing anticoagulation — correct this first . Thrombocytopenia, by contrast, is not a contraindication; the specimen may be taken even at very low platelet…

…Chest pain rated as 6 or above (according to the 10 point scale) should prompt termination of the stress test (refer to Termination criteria during…

…test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD Characteristics suggesting that good quality imaging is achievable…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

…of 60%. 4 points make LVH probable. 5 points make LVH very likely. Romhilt Este's score system Points Any of the following: R or…

…to the ventricles. Conduction through the AV node is intentionally slow (due to the low concentration of gap junctions in AV nodal cells), which allows…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

…is of paramount importance. In cardiac arrest due to asphyxia, the probability of return of spontaneous circulation (ROSC) is high but survival is very low…

…with or without shivering 28 31°C Severe hypothermia Unconscious, with signs of life <28 °C Very severe hypothermia No signs of life <24 °C Actions…

…whereas norepinephrine and/or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion is clinical euvolemia rather…

…of primary prevention trials involving individuals with an estimated 10 year cardiovascular risk of 10%. Approximately 12% reduction in non fatal myocardial infarction with low…

…A narrow pulse pressure suggests a low stroke volume Capillary refill < 3 s A simple and validated marker of perfusion Lactate < 1.6…

…rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular disease or…

…and dilatation Biventricular hypertrophy Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to detecting biventricular…

…abnormality be used instead of enlargement. Atrial enlargement/abnormality often accompanies ventricular enlargement. The ECG has, as one could expect, low sensitivity but high specificity…

…and impaired ventricular relaxation [10]. There is also an increased risk of intracardiac thrombus and stroke or systemic embolization, even in patients in sinus rhythm…

…Exercise induced arrhythmia or exercise induced syncope. Assessment of chronotropic function and pacemaker settings. Preoperative functional assessment before major surgery. At a low pre test…

…than a routine referral being made. Two or more magnets constitute the same kind of urgency by a different mechanism. They attract one another through…

…result. Overview of vasopressors and inotropes Vasoconstriction Vasodilatation Positive inotropy Phenylephrine Vasopressin Midodrine Noradrenaline Adrenaline, high dose Dopamine, high dose Adrenaline, low dose Dopamine, intermediate…

…or an intracranial aneurysm Contact the responsible specialist An aortic aneurysm 6 cm Relative — avoid forced manoeuvres An ongoing respiratory infection with a risk of…

…to moderate heart failure, kidney or liver disease, especially when combined with diuretics (risk of fluid retention and impaired kidney function). Patients with bronchial asthma…

…as a quick, low cost, and reliable screening tool for body composition, risk of type 2 diabetes, metabolic syndrome and specific cancers. BMI and cardiovascular…