…more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of…

…clinical characteristics and ECG features of pericarditis will be discussed here. From a clinical point of view, clinicians must be able to separate pericarditis from…

…dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated, distinguishing it from classic allergic reactions…

…The decision must be documented and alternatives (iron, tranexamic acid, cell salvage, haemorrhage control) planned in advance. A history of a severe transfusion reaction: contact…

Procedurer Oxygen is a drug and must be prescribed as one: with an indication, a route of administration and a target range for the saturation…

…referred to as high sensitive cardiac troponin, may actually detect the presence of troponins in most normal persons. In 2017 it was possible to detect…

…local revascularization must be accompanied by systemic treatment aimed at stabilizing the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing…

…the cells which respond by contracting. The action potential generates electrical currents that give rise to the classical ECG waveforms presented here. Activation of the…

…neuronal cell death starts within 5–6 minutes. Biological death usually occurs within minutes thereafter; survival is highly unlikely after 8–10 minutes of no…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

…aspiration must be performed by an orthopaedic surgeon under strictly sterile conditions. For corticosteroid injection there is an additional absolute contraindication: the slightest suspicion of…

…with CAR T cells or other advanced immunotherapies may require separate local protocols. Definition Criterion Practical definition : : Fever A single temperature of at least 38…

…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…

…responders. Left heart disease is the most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure…

…electronics (cell phones, computers, etc) must also be ignored. The atrial lead is therefore set to record signals with an amplitude range of 1.5…

…potassium and calcium channels of the outer cell membrane. Clinical presentation of Brugada syndrome Most patients are asymptomatic until the age of 20 to 55…

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

…state, or brain death. The cause of brain injuries is anoxic cell death, continued dysfunction in cerebral blood flow (autoregulation) after ROSC and cerebral hypoperfusion…

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

…parasternally and apically, and choose the site where the rim of fluid is widest and lies most superficially, where the distance from the skin is…

…Danlos syndrome Inflammatory aortitis, including Takayasu arteritis and giant cell arteritis Bicuspid aortic valve Coarctation of the aorta Previous aortic trauma Pregnancy, particularly the third…

…high body mass index (BMI) was linked to approximately 4.0 million deaths worldwide, with more than two thirds—roughly 67%—of these fatalities resulting…

…coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection…

…of transistors, programmable circuits, lithium batteries, and Internet connected devices. Additional breakthroughs have been achieved in recent years, with the leadless pacemaker being the most…

…for the evaluation of microvascular function. For a radiotracer to be suitable for quantifying myocardial blood flow, its uptake by the myocardium must closely correlate…

…cells are capable of normalizing their membrane potentials immediately as oxygen becomes available. Recall that ST segment elevations also become normalized as a part of…

…means that ECG leads with similar angles must display similar ECG curves (diagrams). For some purposes (e.g. diagnosis of some arrhythmias) it is not…

…development of increased left ventricular hypertrophy and mass. Initially, myocardial abnormalities may be subclinical. Progressive dilation can subsequently impair left ventricular ejection fraction. Enlargement of…

…19]. It is currently considered the most frequent form of CA worldwide [15]. Clinical Presentation and Course Both AL and ATTR CA typically present as…

…also called idioventricular rhythm . The hallmark of all ventricular rhythms is the wide QRS complex (QRS duration ≥0.12 seconds). The QRS complex is wide…

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…

…plugging. Expiratory flow limitation causes air trapping and dynamic hyperinflation. The consequences are increased work of breathing, exhaustion and, in the most severe cases, hypotension…

…clinical judgement [5]. Recognising sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have…

Procedurer Catheterisation is straightforward in most patients and dangerous in a few. The male urethra is about 25 cm long with two curves and a…

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

…J point to the onset of the T wave. Because of the long duration of the plateau phase most contractile cells are in this phase…

…cells—both conduction and contractile cells—must undergo rapid repolarization to ensure they are excitable when the next action potential occurs. If any component of…

…sodium loading. It is the most common form of secondary hypertension. Aldosterone acts principally through the mineralocorticoid receptor (MR). After entering target cells, it binds…

…into the following categories: Bradyarrhythmia s (bradycardia): arrhythmias commonly due to dysfunctional automaticity in pacemaker cells or blocking of impulses somewhere along the conduction system…

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)…

…majority of these are genes encoding desmosomal proteins . The desmosome is a component of the intercalated disc that connects myocardial cells mechanically and electrically. Most…

…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…

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

…by cells near the node. The following must be noted: There are cells with pure automaticity around the atrioventricular node. These cells are capable of…

…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…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…depolarized by impulses generated by cells outside of the sinoatrial node (i.e by an ectopic focus), the morphology of the P wave may differ…

…largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow…

…muscle cells. Cardiac troponin levels are extremely low in healthy subjects; the 99 th percentile is less than a few nanograms per liter of blood…

…that depolarizes cells in contact with the lead tip, and thus generate an action potential that will spread through the myocardium. Components of an artificial…

…clinical trials) have suggested the benefit of ischemic preconditioning, while other studies have failed to establish such a relation. The most cited study to date…

…Adam Stokes attack . Causes of sinoatrial arrest/pause High vagal tone is benign and the most common cause of sinus arrest/pause. It commonly affects…

…causes of sinus bradycardia In all other situations, sinus bradycardia should be regarded as a pathological finding. Numerous pathological conditions cause sinus bradycardia. The most…

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

…chronic value [4]. The grading must not be used mechanically. A patient with a plasma potassium of 6.2 mmol/L, new bradycardia and acute…

…major haemorrhage protocol early. Protocols improve above all the logistics, the communication and the simultaneous delivery of red cells, plasma and platelets. Observational data from…

…or frequent blood gases are needed 3 Blood grouping and cross matching. Order red cells early with ongoing major bleeding 4 Tests: haemoglobin, platelet count…

…potential and action potential duration of affected myocardial cells. The resulting voltage gradient between normal and ischaemic myocardium generates currents of injury that are expressed…

…The most common cause is valvular regurgitation (insufficiency). For example, aortic regurgitation causes the flow of blood from the aorta back into the left ventricle…

…Potassium levels must always be assessed in patients using digoxin whenever they seek medical attention. Arrhythmias may occur already at therapeutic plasma levels of digoxin…