…0.4 0.8 2.1 Table 1. Survival in out of hospital cardiac arrest due to external causes ( Kitamura et al). References DeBehnke DJ…

…syncope due to an arrhythmia or underlying cardiac disease. Relevant abnormalities include bradyarrhythmias or tachyarrhythmias, AV block, acute myocardial ischemia, old myocardial infarction, long QT…

…For example, in cardiac arrest due to pulmonary embolism the initial rhythm is typically PEA, which is explained by the fact that the embolus prevents…

…tachycardia secondary to disease and medications : A wide range of diseases and medications may cause sinus tachycardia; e.g congestive heart failure, lung disease (e…

…dipyridamole, regadenoson) These agents exert vasodilatory effects, increasing coronary blood flow by relaxing vascular smooth muscle. They are contraindicated in patients with bronchospastic lung disease…

…patients with left ventricular dysfunction, though those with depressed ejection fraction should receive it with great caution due to the risk of hypotension. Peripheral IV

…3: PH due to chronic lung disease, hypoxia, or sleep disordered breathing Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease Group…

…chronic lung disease, hypothyroidism, and amyloidosis. Furthermore, ongoing ischemia, hypomagnesemia, and moderate to severe renal impairment increase the likelihood of digitalis intoxication even at therapeutic…

…patients with obstructive lung disease or asthma. Irregular wide complex tachycardia (absolute contraindication) . Irregular wide complex tachycardia is most often due to atrial fibrillation with…

…long standing tachycardia, there is a risk of developing tachycardia induced cardiomyopathy. In pediatric populations, a distinct form of atrial tachycardia may occur due to…

…stroke volumes. Failure to increase cardiac output sufficiently will result in the following compilations: Pulmonary edema develops due to rising LAP and LVEDP. Cardiogenic shock…

…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…

…valvular disease (e.g mitral stenosis) requires intervention. Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the…

…heart disease or reduced left ventricular ejection fraction (LVEF). Sustained VT: Defined as VT lasting longer than 30 seconds or requiring termination earlier due to…

…fibrillation arrests and moderate left ventricular dysfunction. This patient died at age 17 years due to complications related to his arrhythmia. His father and uncle…

…the impulse. The resulting QRS complex has a right bundle branch block morphology (rSR pattern), which is due to aberrant ventricular conduction (aberration, aberrancy). In…

…with ECG may reveal atrial fibrillation. Unfortunately, atrial fibrillation is too often discovered first at hospital admission due to its complications (stroke, thromboembolism, heart failure…

…early due to the massive ischemia. Complete LMCA occlusion is typically fatal within minutes, hence its designation as the “widow maker.” Patients who survive long…

…with other forms of ventricular tachycardia. Mechanisms of ventricular tachycardia Ventricular tachycardia (VT) may emerge due to increased/abnormal automaticity, re entry or triggered activity…

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

…its surroundings, the myocardium and valves. ECG is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood…

…symptoms, and occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal surgery in a patient with known lung disease. Follow…

…CFVR) Pulmonary congestion detected by B lines on lung ultrasound Myocardial perfusion when ultrasound contrast agents are used The technique is particularly useful because it…

…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…

…3 IV Pneumonia, in chronic lung disease amoxicillin 750 mg × 3 PO 5–7 days or benzylpenicillin 3 g × 4 IV Pneumonia, suspected atypical pathogen…

…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…

…predictors of adverse outcomes. Non acute or asymptomatic bradycardia Non acute bradycardia is a common finding in both healthy and diseased individuals. Asymptomatic bradycardia may…

…or Thromboembolism history (2 points) V ascular Disease (1 point) A ge 65 74 years (1 point) The total score ranges from 0 to 9…

…delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat, skin, perianal region, vascular access, lungs, abdomen…

…resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according to international guidelines are decompression sickness and sickle cell crisis…

…or recurrence. Special situations Situation Comment : : Pregnancy Leg ultrasound first. CT pulmonary angiography or lung scintigraphy according to local procedure. Low molecular weight heparin, not…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…relevant in established cardiac disease. Alcohol also increases the rise in myocardial oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can…

…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…

…moderate to severe mitral stenosis, where warfarin applies. Apixaban is often preferred, among other reasons because it has the least renally dependent elimination. Agent Standard…

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

…disease and contributes to microvascular and macrovascular complications. It is frequently clinically silent, which promotes both patient and clinician inertia and contributes to inadequate long…

…3 years. Long term prognosis in aortiv stenosis is presented in Figure 3. Figure 3. Prognosis in aortic stenosis according to type of stenosis. The…

…disease. In lateral epicondylitis the effect is in fact worse than no treatment at all at one year . The injection is therefore a tool to…

…a high index of suspicion for drug induced arrhythmias in patients receiving agents known to alter the electrical properties of the heart (inducing QRS or…

…inflammatory disease of the arterial wall in which lipid accumulation, vascular cell dysfunction, immune cell recruitment, extracellular matrix remodelling, and thrombosis interact to produce focal…

…secondary prevention intervention for patients with cardiovascular disease, including those recovering from myocardial infarction. It extends beyond exercise training to incorporate individualized physical activity counselling…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

…relative to gravity: perform Dix Hallpike and, if needed, the supine roll test. Spontaneous attacks without a clear trigger: consider vestibular migraine, Ménière's disease…

…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…

…rationale Bempedoic acid is an oral, small molecule lipid lowering agent used to reduce low density lipoprotein cholesterol (LDL C), particularly when statins cannot be…

…commonly related to the left atrial appendage, although competing mechanisms such as large artery atherosclerosis and small vessel disease may also contribute to stroke in…

…to renal or hepatic impairment or the inhibition of cytochrome P450 metabolism [1]. Nonmodifiable risk factors encompass female sex, underlying genetic predisposition, structural heart disease…

…condition with a poor long term prognosis. The 5 year survival rate after hospitalization for heart failure is 60%, which is comparable to common cancers …

…condition with a poor long term prognosis. The 5 year survival rate after hospitalization for heart failure is 60%, which is comparable to common cancers …

…manifestation of cardiovascular disease, accounting for 50% of all cardiovascular deaths ( Tsao et al ). A recent meta analysis showed that survival to hospital discharge is…

…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…

…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…

…for example in pregnancy, acute glomerular disease or scleroderma renal crisis [1,2]. A hypertensive emergency means a markedly raised blood pressure together with ongoing…

…and the test is performed later. Contraindications Known hypersensitivity to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a…

…wound. Heavily contaminated wounds where a long time has passed since the injury (see below). Be particularly cautious with impaired healing: peripheral vascular disease, diabetes…

…patients after acute myocardial infarction (MI), antianginal drugs have not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients…

…dyspnoea improves and sympathetic activation subsides, making it difficult to determine whether AF initiated the deterioration or resulted from it. AF has important consequences beyond…

…the external constriction that characterizes restenosis after balloon angioplasty. The biological response therefore occurs primarily through intimal thickening. DES release antiproliferative and anti inflammatory agents…

…obstructive disease. Ischaemia with non obstructive coronary arteries (INOCA) denotes the subgroup in whom objective myocardial ischaemia is demonstrated. ANOCA may occur in up to…