…may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS have more comorbidities…

…MINOCA when they are established as the explanation for the presentation. Clinical presentation and symptoms Patients typically present with symptoms suggestive of ACS and troponin…

…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…the ventricles with the same rate. This occurs if ventricular stimulation is set to be triggered by the atrial impulse. Another cause of pacemaker mediated…

…Initial assessment should establish whether the presentation represents ACS and whether the patient is clinically unstable. Particular attention is required for evidence of: Ongoing or…

…collateral circulation is adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate…

…10€) and may reduce morbidity and mortality substantially in patients with acute coronary syndromes. Importantly, the ECG findings dictate the management of acute coronary syndromes…

…unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach…

…Generally, adenosine is considered safe for patients with narrow complex tachycardia (NCT). Adenosine typically causes a short lasting second or third degree AV block which…

…twice the normal level Neurological symptoms are particularly important because of the increased risk of cerebrovascular complications. Seizures in a patient with preeclampsia indicate eclampsia…

…management depends on the mechanism responsible for symptoms and ischaemia. The increasing prevalence of refractory angina reflects population ageing and improved survival among patients with…

…adherence, although prospective outcome trials have not directly established that upfront combination therapy is superior to upfront monotherapy for every patient with isolated hypertension. Single…

…exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD…

…<20% Intermediate ≥20% High Management should incorporate the estimated risk, risk enhancing factors and a clinician–patient discussion regarding the expected net benefit of therapy…

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

…sex , and race based percentile Comparison with the expected score for a person of the same age and sex CAC may also reveal extracoronary findings…

…highest with AV block 2 Mobitz type 2 and AV block 3. The only treatment with a class I recommendation for the management of acute…

…The chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system involving both prehospital and hospital based services…

…This approach fails to identify a substantial subset of patients with acute coronary occlusion (ACO) who do not meet the established ECG criteria for STEMI…

…treated initially with diuretics, whereas norepinephrine and/or inotropes are reserved for low output and hemodynamic instability. Evaluation and physical examination The objective of decongestion…

…risk of bleeding). An advanced airway (tracheal tube, supraglottic airway) should be established as early as possible. Airway management should not interrupt compressions for more…

…establishing a diagnosis of inappropriate sinus tachycardia. Although there are no evidence based treatments for inappropriate sinus tachycardia, patients frequently benefit from obtaining a diagnosis…

…period of anticipated EMI. The perioperative strategy should also recognize that CRT patients may rely on continuous biventricular pacing for haemodynamic stability. In patients with…

…all in diabetes. The severity of the symptoms and the patient's need for help matter more than a single measured value [2]. Level Plasma…

…Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to…

…low cardiac output, and dyspnea at rest that persists despite administration of diuretics and vasodilators. Clinically, these patients exhibit hypotension—often with a systolic blood…

…the national guideline for the management of reperfusion treatment in ischaemic stroke, Nationell arbetsgrupp Stroke (the national stroke working group), version 4 of 27 February…

…ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

…patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about one fifth of…

…while severe HTG is clinically important because of its association with acute pancreatitis. Evaluation and physical examination Evaluation should establish: The triglyceride concentration and whether…

…regional poison control centre for advice on the treatment threshold and on whether haemodialysis should be considered. Rhabdomyolysis with marked elevation of CK and threatened…

…factors associated with later cardiovascular risk include: Premature menopause Premature ovarian insufficiency Hypertensive disorders of pregnancy Preeclampsia Preterm delivery Gestational diabetes Small for gestational age…

…Trimipramine. If a reversible cause of bradycardia is suspected, management should be targeted at that cause. With regards to medications, the clinical need must be…

…It may be very difficult to establish a diagnosis of third degree AV block if the atrial and ventricular rate is equal and the P…

…for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment elevation acute myocardial infarction). 1 Initial diagnosis of…

Overview of diagnosis, classification and management of heart failure

…group is associated with high mortality when malperfusion or rupture develops; surgery or endovascular treatment is therefore generally favoured within 14 days of symptom onset…

…comorbidity, and procedural complexity. Overall incidence and major complications Complications during diagnostic coronary angiography occur in approximately 2% of patients. Serious events such as stroke…

…treatment and management Any heart rate faster than 100 beats per minute is defined as tachycardia , which is synonymous with tachyarrhythmia. Except for sinus tachycardia…

…of diagnostic tests, and treatment strategies have been updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with…

…is intentionally slow (due to the low concentration of gap junctions in AV nodal cells), which allows for ventricular filling to complete prior to ventricular…

…low Glasgow Coma Scale is not on its own an absolute indication for intubation. Assess ventilation, airway protection, the expected course and the possibility of…

…risk of terminating the medication as compared with implanting a permanent pacemaker and continuing the treatment. Commonly, patients with bradycardia have a strong indication for…

…risk of hospitalization for patients with heart failure. Several landmark studies followed and proved that beta blockers, ACE inhibitors, and ARBs were effective for treating…

…waves) do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead…

…of arrhythmias, particularly tachyarrhythmias, is often considered challenging, separate chapters are dedicated to their diagnosis and management. The recommendations presented throughout this section align with…

…and guide appropriate management strategies. For instance, administering nitroglycerin to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia…

…therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart disease, heart failure with reduced ejection fraction (HFrEF), and post myocardial…

…ones [5]. For acute clinical use the following simplification can be used: Grade Clinical picture Management : : : Mild allergic reaction Skin or mucosa only, stable breathing…

…may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and…

…cerebrovascular accident at a young age in the patient or family Hypertensive first degree relatives of patients with PA Patients with hypokalaemia may develop weakness…

…stressor superimposed on the patient's baseline cardiovascular state. For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia following…

…levels of myocardial proteins. These proteins are cardiac troponins (henceforth referred to only as troponins). When elevated troponin levels are confirmed in patients with STE…

…prognostic implications, and management strategies. In the GRACE ECG substudy of 5000 patients with non ST elevation ACS (Yan et al), ST elevation in lead…

…complexity and costs of interventions increase with each step in the chain of survival, it is the first 3 actions that are fundamental for survival…

…the management of heart failure, digoxin improves hemodynamics without increasing heart rate or decreasing blood pressure, making it a consideration for patients with low blood…

…and 8% for Class III antiarrhythmic agents depending on the specific drug and dosage [1]. Acute Management and Treatment Alternatives The management of TdP and…