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

…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…

…lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over superficial nerves (the lateral aspects of the fingers…

…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…

…Presentation and Symptoms The clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest…

…or urgent transfer to a facility with vascular expertise. The initial evaluation should establish: The time of symptom onset and the rate of progression The…

…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…

…COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma…

…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…

…to additional mechanical revascularization. Despite treatment with antianginal drugs and PCI or CABG, daily or weekly angina remains present in approximately 2%–24% of patients…

…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…

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

…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…

…with a family history of premature coronary artery disease. CAC findings incidentally identified on a chest CT performed for another indication can also contribute to…

…with class I recommendation according to European (ESC) and North American (AHA, ACC) guidelines. For details regarding the management of bradycardia, please refer to Management…

…deals with the pathophysiology, definitions, criteria and management of patients with acute STEMI. Although ECG changes in acute STEMI have been discussed previously (refer to…

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

…Symptoms of congestion Dyspnea is the dominant presenting symptom in acute decompensated heart failure and occurs in more than 90% of patients presenting with the…

…cannot be established. Nasopharyngeal airways may cause complications in patients with skull fractures (risk of intracranial malposition of the tube) or coagulopathy (risk of bleeding…

…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…

…should be individualized according to the patient, device, procedure, and anticipated electrical environment. Preoperative evaluation Establish the nature and function of the device The following…

…be checked with a capillary or venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid acting…

…right ventricular impairment to cardiogenic shock. Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment…

…of hypotension, end organ hypoperfusion, shock states, and pulmonary congestion. In pregnant patients presenting with suspected acute heart failure, urgent hospital admission and referral to…

…overview 1. Activate the stroke call. 2. Establish the time of symptom onset or the time last known to be well. 3. Assess airway, breathing…

…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…

…Identification of life threatening arrhythmias. Assessment for high risk mechanical complications. Determination of symptom onset time and anticipated time to primary PCI. Patients with STEMI…

…fifth of adults during a hospital episode in international studies and is linked to substantial mortality, even though incidence and prognosis vary widely between patient…

…The ASCVD implications of chylomicronaemia itself remain uncertain, whereas moderate HTG, approximately 150–500 mg/dL, is associated with increased ASCVD risk. Management in this…

…Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic…

…independently of conventional factors, and whether they improve risk classification, remains incompletely established. Data concerning premature menopause and subsequent hypertension or diabetes are insufficient to…

…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…

…patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2, V3). IIa B In patients…

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…

…of the tachycardia. The cause may range from benign to highly malignant, which is why expeditious management is warranted. Initial management includes assessing the patient…

ECG Evaluation and management of stable coronary artery disease Chronic coronary syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris…

…and third degree AV blocks. Readers already familiar with the basics of AV blocks can proceed directly to the subsequent chapters, which provide detailed discussions…

…the findings of the ambulance crew The stated dose is often unreliable and must never be used on its own to declare the patient well…

…common to provide the patient with a permanent pacemaker to continue optimal medical treatment. Sick sinus syndrome (sinus node dysfunction), a common cause of brady

…half of all patients with heart failure die suddenly, as a result of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation). Early diagnosis and aggressive management can…

…the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead to consideration to perform…

…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…

…level of the throat, though it remains a nonspecific finding. In patients presenting with angioedema, a rapid assessment of the airway is paramount to evaluate…

…oedema, together with at least one of the following: airway compromise respiratory compromise circulatory compromise severe gastrointestinal symptoms, particularly after exposure to a drug, insect…

…the suspected focus, but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat…

…patients with resistant or severe hypertension and associated clinical features. Clinical presentation and symptoms The usual clinical manifestation is hypertension, often severe or resistant to…

…defined as spontaneous dissection of the coronary artery wall with accumulation of blood within the false lumen, which compresses the true lumen to varying degrees…

…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…

…instability. Fewer than 1% of patients with ST elevation myocardial infarction (STEMI) who reach the catheterization laboratory are found to have complete LMCA occlusion, likely…

…resuscitated patients. Figure 1. The chain of survival in out of hospital cardiac arrest. Although the required skills, complexity and costs of interventions increase with…

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

…escalation to catheter ablation or mechanical circulatory support remains a viable therapeutic pathway [4]. Furthermore, in the peri operative setting, patients at high risk for…