…myocardial ischaemia and, when prolonged or severe, myocardial necrosis. It most commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation…

…question. A patient who declines blood transfusion. The decision must be documented and alternatives (iron, tranexamic acid, cell salvage, haemorrhage control) planned in advance. A…

Cardiology Endocrinology & metabolism Definition and pathophysiology Primary aldosteronism (PA), also termed primary hyperaldosteronism or Conn syndrome, comprises disorders in which aldosterone secretion is inappropriately increased…

…of the intercalated disc that connects myocardial cells mechanically and electrically. Most mutations are inherited in an autosomal dominant manner, with variable penetrance and expressivity…

…injury. In its most severe form, known as no reflow, structural and functional impairments sustain vascular obstruction. Endothelial dysfunction triggers leukocyte and platelet activation, while…

…Note the branched cell structure and the connections between the cells. The cardiac action potential The action potential includes a depolarization (activation) followed by a…

…cells must be stimulated in order to evoke an action potential. Upon stimulation, sodium (Na+) channels open which causes a rapid influx of sodium and…

…with the leadless pacemaker being the most promising improvement. 1 Given the wide use of pacemakers and the trend towards increased use of cardiac devices…

…effects through direct activation of receptors in target tissues. 15 Recent evidence clarifies that while the benefits in conditions like osteoarthritis and obstructive sleep apnea…

…relatively small muscle mass. If the rhythm is sinus rhythm (i.e under normal circumstances) the P wave vector is directed downwards and to the…

…visible, it is retrograde in lead II (because of the reversed direction of atrial activation) and may be located before or after the QRS complex…

…parallel to definitive control of the bleeding. Activate the protocol in Activation must be based on an overall assessment, not on a single threshold value…

…inhibitor therapy is bradykinin mediated rather than mast cell mediated, distinguishing it from classic allergic reactions. Clinical Presentation and Symptoms ACE Inhibitor Induced Cough ACE…

…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…

…by the fact that there is no (or very little) turnover of myocardial cells and therefore myocardial troponins should not be detected in the blood…

…neuronal cell death begins in the central ischemic zone, where the ischemia is most pronounced and extends towards the penumbra zone (the outermost and less…

…Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma…

…cold urticaria. Relative: Basal cell carcinoma and squamous cell carcinoma — these can be treated with cryotherapy by an experienced practitioner in selected cases, but surgery…

…directed medially and slightly caudally, parallel to the posterior surface of the patella. The shoulder The patient sits with the arm hanging relaxed and slightly…

…adults with neutropenia related to cancer treatment. Children, pregnant women, patients after allogeneic stem cell transplantation and patients treated with CAR T cells or other…

…into the subcutis Never a shave — the depth must be measurable Basal cell carcinoma, squamous cell carcinoma 3–4 mm punch or shave Diagnostic biopsy…

…cell disease. The classification also recognizes vasoreactivity subgroups among patients with idiopathic PAH, including acute responders and non responders. Left heart disease is the most…

…Also, external signals from electronics (cell phones, computers, etc) must also be ignored. The atrial lead is therefore set to record signals with an amplitude…

…the outer cell membrane. Clinical presentation of Brugada syndrome Most patients are asymptomatic until the age of 20 to 55 years. The disorder may manifest…

…survival. It includes diagnosis of post cardiac arrest syndrome (PCAS), optimization of ventilation, oxygenation, hemodynamics, antiischemic treatment, temperature treatment, treatment of seizures, and infections. However…

…the effective osmolality, because urea crosses cell membranes relatively freely and therefore does not produce the same sustained shift of water [3]. Severity of DKA…

…With ultrasound guidance, the point at which the fluid lies most superficially is chosen and the needle is followed all the way in, which has…

…associations include: Systemic hypertension Marfan syndrome Loeys–Dietz syndrome Ehlers–Danlos syndrome Inflammatory aortitis, including Takayasu arteritis and giant cell arteritis Bicuspid aortic valve Coarctation…

…an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand, which is not related to acute coronary atherothrombosis…

…its uptake by the myocardium must closely correlate with actual blood flow. An ideal tracer exhibits high extraction from blood to tissue and high retention…

…and this confirms that the coronary artery flow is patent. The rapid ST segment return is explained by rapid normalization of myocardial cell membrane potentials…

…lead systems and constellations of leads have been tested but the standard 12 lead ECG is still the most used and the most important lead…

…impair left ventricular ejection fraction. Enlargement of the left ventricle predisposes to atrial and ventricular arrhythmias. In advanced alcohol related cardiomyopathy, dilation may involve all…

…cells produce misfolded immunoglobulin light chains [8, 19]. Light chains are directly toxic to cardiomyocytes, inducing the elaboration of high levels of natriuretic peptides and…

…myocarditis and electrolyte disorders. Because the rate (60–100 beats per minute) is on a par with the rate in sinus rhythm and there is…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

…Immediate management The most dangerous asthma attack is the silent one. A patient who has become calm, quiet in the chest and stopped struggling may…

…for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical intravenous antibiotics, fluid, a vasopressor and early source control…

…a complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage. Preparation and equipment A sterile catheterisation pack, sterile gloves…

…and low right atrial pressure favor coronary blood flow. A CPP of approximately ≥ 15 mmHg is required to induce spontaneous electrical activity in myocardial cells…

…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…

…discussed, all cardiac cells—both conduction and contractile cells—must undergo rapid repolarization to ensure they are excitable when the next action potential occurs. If…

Arrhythmias and arrhythmology ECG Mechanisms of cardiac arrhythmias: from automaticity to re entry This section introduces the most common arrhythmias encountered in clinical practice, beginning…

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…

…Briefly, exercise stress testing must not be performed in the presence of absolute contraindications. Relative contraindications call for an individualized assessment of the risks; if…

…most persons have some degree of atherosclerosis in the coronary arteries. Advanced atherosclerotic plaques contain inflammatory cells, smooth muscle cells, extracellular matrix, lipids and acellular…

…lowers the automaticity in the sinoatrial node to the point where cells in the AV junction establish an escape rhythm. This is asymptomatic and benign…

…must not delay reperfusion. 5. Give aspirin if acute coronary syndrome is likely and aortic dissection or active major bleeding is not suspected. 6. Call…

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

…among different assays (see Table 1), with values between 10 ng/L and 20 ng/L being most common. Elevated troponin : A value above the

…i.e applying an external electrical current that depolarizes cells in contact with the lead tip, and thus generate an action potential that will spread…

…acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows: The size of the thrombus …

…infarction. Sinus Node Dysfunction (SND) – Sinus node dysfunction implies that the cells of the sinoatrial node are defective and fail to generate electrical impulses. Side…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…or arrhythmia. 4. Shift potassium into the cells with insulin and glucose. Add high dose salbutamol in marked hyperkalaemia if there is no contraindication. 5…

…In acute blood loss, plasma and red cells are lost simultaneously, which means the haemoglobin can be normal before fluid has redistributed or been given…

…with a clinically unstable acute coronary syndrome, but the examination does not reliably establish or exclude the diagnosis. The ECG and serial assessment remain central…

…ECG as increased amplitudes of the QRS complexes. The explanation is straightforward: myocardial muscle mass is increased and therefore it generates greater electrical potentials. However…

…sinoatrial node (which lowers heart rate) and also slows conduction over the atrioventricular (AV) node. The most classical ECG finding is generalized ST segment depressions…

…for the ventricles to exhibit any electrical—and consequently mechanical—activity, an escape rhythm must originate from an ectopic focus located distal to the block…