…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]…

…persists a biopsy instead. 2. Photograph the lesion — it will disappear, and the documentation is all that remains. 3. Pare down any hyperkeratosis with a…

…Since 2022 the z score with a lower limit of normal at z = −1.64 (the fifth percentile) has been recommended in preference to…

…abdominal surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic disease…

…airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first feed then becomes a direct instillation into the lung…

…lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification must integrate haemodynamics with…

…the transducer is greater and more lung tissue obscures the heart. Therefore, most images in adult TTE are obtained with the patient positioned in the…

…departments — follow local protocol. Severe lung disease or a contralateral pneumothorax: avoid the subclavian and jugular routes on the healthy side, since a pneumothorax there…

…tazobactam 4 g × 4 IV plus gentamicin 5–7 mg/kg IV as a single dose Urosepsis with shock and suspected ESBL meropenem 1 g…

…and incompletely absorbed after oral administration, with systemic bioavailability ranging from 25% to 65% and minimal hepatic first pass extraction. Following a single oral dose…

…wall motion abnormality (RWMA) during stress. A fixed abnormality that remains unchanged with stress generally indicates previous infarction. Extensive ischaemia may produce a reduction in…

…to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma. Irregular wide complex tachycardia (absolute…

…Gallstone causing acoustic shadowing. Reverberations artifacts Ultrasound waves can be reflected multiple times between dense structures ( i.e structures with high echogenicity). For each reflection…

…pneumothorax (highlighted by a lack of lung tissue) and its impact on cardiac function. Clinically, patients may present with: Absent breath sounds on the affected…

…myocardial infarction. Rupture of the free ventricular wall. Neoplasms (particularly breast and lung cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and…

…of the atrial conduction system. Individuals with atrial fibrillation and bradycardia have bradycardia–tachycardia syndrome. Careful management is warranted in patients with bradycardia–tachycardia syndrome…

…coronary blood flow by relaxing vascular smooth muscle. They are contraindicated in patients with bronchospastic lung disease, or a history of significant reactive airway disease…

…with respect to RVH, because the right ventricle is difficult to visualize clearly with trans thoracic echocardiography. Causes of right ventricular hypertrophy Lung disease (with…

…This is due to altered tone in the autonomic nervous system, with increased sympathetic input (leading to stimulation of beta adrenergic receptors) and parasympathetic withdrawal…

…part of the target range. Paraquat poisoning — oxygen worsens the lung injury. Discuss with your national or regional poison control centre. An open flame or…

…three way tap. A Seldinger set with a guidewire, a dilator and a 5–8 F pigtail catheter , plus a drainage bag. Sample tubes for…

…lung and the fluid level. 2. Choose a point with at least 15 mm depth of fluid throughout the respiratory cycle and where the lung…

…Otherwise the echocardiographic findings plus the clinical picture are sufficient for a treatment decision. Systemic thrombolysis is the first line treatment in high risk embolism…

…AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age rather than sex alone. Consequently…

…therapeutic options cannot be pursued. Patients receiving digoxin may present with symptoms of digitalis toxicity, which manifests across multiple organ systems. Non cardiac symptoms include…

…cardiac tissue, the latent interval of several weeks, improvement with anti inflammatory treatment, and the tendency to recur all support an immunopathological mechanism. The precise…

…instead as an ectopic atrial rhythm (EAR) . Ectopic atrial tachycardia (EAT) most commonly occurs in individuals with underlying structural or electrical heart disease. Less frequently…

…correlates strongly with the risk of potentially life threatening ventricular arrhythmias. Therefore, the QT interval must always be assessed when interpreting the ECG. Long QT…

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

…should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of no flow ( Rawshani et al…

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

[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…

…that drive coronary and cerebral perfusion, and ventilation of the lungs during cardiopulmonary resuscitation (CPR) differ substantially from normal circumstances. The purpose of CPR is…

…heparin is rarely needed with DOACs. Reversal in major bleeding Drug Reversal : : Warfarin Prothrombin complex concentrate (dose by INR and weight) plus vitamin K 10…

…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…

…MI) encompasses long term interventions intended to reduce recurrent infarction, ischaemic stroke, cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or…

…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…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…with worse outcomes. Unprotected Left Main Disease : Increases complexity and risk. Peripheral Vascular Disease (PVD) : Indicates systemic atherosclerosis. Chronic Obstructive Pulmonary Disease (COPD) : Associated with…

…cardiac arrhythmia syndrome identified with ECG The ECG may be used to diagnose several cardiac genetic disorders, such as Brugada syndrome, long QT syndrome [LQTS…

…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…

…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…

…established predictors of ischaemic stroke and systemic embolism are previous stroke or TIA and mitral stenosis. In patients with AF and previous ischaemic stroke treated…

…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…

…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…

…end tidal carbon dioxide, ETCO2) Capnography refers to the measurement of end tidal carbon dioxide (ETCO 2 ) in the respiratory system. ETCO 2 is the…

…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…

…Long term prognosis is excellent, with the vast majority of patients recovering completely after restoration of sinus rhythm (or any other rhythm with normal ventricular…

…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…

…moment of sampling, but does not by itself identify the cause. The result must always be weighed together with the clinical picture, medication, fluid balance…

…axis, where a long half life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease)…

…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…

…Basal insulin (intermediate or long acting) Covers fasting glucose production Everyone with type 1 diabetes, always, including while fasting. Many with type 2 Mealtime insulin…

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