…inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular activation, transient rate related conduction abnormalities…

…for days after the infusion is discontinued. Noradrenaline (norepinephrine) acts primarily as a vasopressor. While detailed receptor pharmacology is not specified in the source material…

…or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal…

…be admitted for management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest…

…involve a surgeon The following locations must not be handled routinely in primary care or in the emergency department without contacting the appropriate specialty: Location…

…territory. Clinical Presentation and Symptoms The source material addresses posterior infarction primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients…

…less mobile. Echocardiography is the first place method for detecting vegetation in case of suspicion of endocarditis. Transthoracic echocardiography (TTE) has a sensitivity of about…

…activity (PEA). Evaluation and Physical Examination The source material does not provide specific details regarding the physical examination maneuvers for patients with bradycardia. Diagnostics Electrocardiography…

…The source material emphasizes that patients and families should be educated to recognize chest discomfort or dyspnoea as potentially indicating myocardial infarction, particularly in individuals…

…In the setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases…

…be initiated concurrently. In patients with a confirmed indication for treatment but blood pressure in the range of 120–139/70–89 mmHg, concomitant indications…

…needle goes in. A wound that has not been irrigated clean, has not been inspected to its depth, and has not been assessed for tendon…

…should undergo a structured assessment and be referred to a specialized centre because the work up may require expertise and technologies unavailable in primary care…

…intensive care. Exhausted peripheral venous access during prolonged intravenous therapy. The need for central access is not in itself an indication for emergency insertion in…

…for 5 minutes. The back and arm should be supported, with the cuff at heart level. A standard cuff measuring approximately 12–13 cm in…

…Material for immobilisation: a shoulder sling, a dorsal backslab, and a colleague to help. Analgesia and sedation The options, in ascending order: Method Comment : : A…

…else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the worst case, amputation. The decisive…

…have no critical epicardial stenosis. In some of these patients, microvascular obstruction or epicardial spasm may account for the ischaemia. STEMI usually results from rapid…

…Accounting for 60 70% of ACS presentations, plaque rupture typically occurs in thin cap fibroatheromas (TCFAs). These vulnerable plaques possess a massive necrotic lipid core…

…and the potential for stroke even at blood pressure levels that might otherwise be considered only moderately elevated. The syndrome can produce widespread maternal complications…

…used for non pregnant adults. The fetus is not harmed by defibrillation, amiodarone, or adrenaline (epinephrine). In the event of a cardiac arrest in a…

…Aspirate and biopsy answer different questions and do not replace one another: the aspirate shows cellular morphology and provides material for flow cytometry and genetics…

…coexistence of defined clinical and laboratory components; the diagnostic criteria themselves are not reproduced in the available source material. Waist circumference is particularly important because…

…defined in the source material as stenosis greater than 70%, and are an important reason that patients are referred for coronary artery bypass grafting rather…

…class of oral agents initially developed for glucose lowering in type 2 diabetes mellitus (T2DM). The principal drugs identified in the source material are canagliflozin…

…cannot be kept still without sedation. Suspected tympanic membrane perforation. Irrigation is contraindicated in: suspected perforated tympanic membrane, organic material that swells, batteries and magnets…

…and equipment Chlorhexidine in alcohol or an iodine solution. Lidocaine 10 mg/mL without adrenaline for the block (adrenaline is safe in fingers and toes…

…and Symptoms The source material does not provide specific information on the clinical presentation and symptoms of the underlying conditions for which ACE inhibitors are…

…established. The source material identifies chronic intake of approximately 60 g daily in males and 40 g daily in females as capable of causing cardiomyopathy…

…pathway, whereas P2Y12 receptor antagonists inhibit a separate platelet activation pathway. The principal oral P2Y12 inhibitors discussed in the source material are clopidogrel, prasugrel, and…

…For recurrent symptomatic bradycardia, temporary or permanent pacing may be required. However, transcutaneous pacing in the setting of cardiac arrest has not demonstrated clear benefit…

…Association (NYHA) classification. The source material specifically frames many pharmacological recommendations for patients with symptomatic NYHA class II–IV HFrEF. Advanced or refractory heart failure…

…not reliably exclude clinically important differences in ischemic events or stent thrombosis. Stable coronary disease and elective PCI For chronic coronary syndromes treated with elective…

…and platelet related pathways. The source material also describes possible antiarrhythmic effects, associated with reductions in sudden cardiac death and atrial fibrillation. Dietary quality also…

…need for emergency CABG. Metal only stents, now termed BMS, reduced restenosis compared with balloon angioplasty but did not eliminate it. Angiographic restenosis—defined in…

…level C. The European regulatory threshold described in the source material differs from the trial based threshold: ivabradine was approved for patients with HFrEF, LVEF…

…SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG PCI, slow flow or no reflow rates may reach 15%–20%, substantially exceeding…

…with suspected ACS are categorized into a STEMI pathway or an NSTE ACS pathway according to the initial ECG and clinical presentation. For suspected NSTE…

…mmHg ≤15 mmHg ≤2 Wood units The source material also presents a CpcPH threshold of PVR ≥3 Wood units in an overlapping clinical classification table…

…l isomers, which share similar efficacy in prolonging repolarization. However, the l isomer is responsible for virtually all of the beta blocking activity. Sotalol does…

…vertebral and coronary arteries. In one study cited in the source material, FMD was identified in 86% of patients with SCAD. SCAD should therefore prompt…

…the first year, although the available material does not establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and…

…is not enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the intraosseous needle. Procedure Peripheral venous…

…very small or loculated effusion — consider image guided puncture in the radiology department The thresholds for the INR and the platelet count vary between regions…

…suspected. Indications Acute urinary retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in…

…In patients with AAA, duplex ultrasound screening for femoropopliteal aneurysms should be considered. Opportunistic screening may also be useful in patients with symptomatic or asymptomatic…

…For asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14.6%, and revascularisation may be beneficial in appropriately selected…

…for the smaller subgroup in which iodinated contrast is considered causally responsible. This distinction is important because AKI after a contrast study frequently occurs in…

…for patients with chronic coronary syndrome, acute coronary syndrome (ACS), atherosclerotic peripheral arterial disease, and other very high risk settings described in the source material…

…manifestations of coronary, cerebral or peripheral arterial disease, although the source material does not specify symptom patterns in detail. Physical manifestations Tendinous xanthomas, particularly over…

…for secondary contributors is an essential first step. Recognised causes include: Diabetes and insulin resistance Thyroid disease Kidney disease Excessive alcohol consumption Diets high in…

…malperfusion or rupture develops; surgery or endovascular treatment is therefore generally favoured within 14 days of symptom onset in the source material. Clinical Presentation and…

…particularly for intermediate non left main coronary stenoses. Myocardial ischaemia may occur despite the absence of significant epicardial obstruction. In patients with anginal symptoms and…

…with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the documented ischaemic burden. In chronic coronary syndrome, revascularisation…

…should include evaluation for: Hemodynamic instability or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with…

…of new loss of viable myocardium or a new regional wall motion abnormality in an ischemic distribution Angiographic evidence of a flow limiting procedural complication…

…is normal. Probability categories The source material describes several clinically useful probability thresholds: Very low probability: less than 5% in the European guideline framework. Diagnostic…

…included in the European guideline definition. Clinical Presentation and Symptoms The source material does not describe a distinctive symptom profile for resistant hypertension. In clinical…

…is suspected in the setting of an inferior infarction. The presence of right sided ST segment elevation supports the diagnosis, although the source material does…

…Types 4b and 4c fulfil the criteria for type 1 MI because they represent coronary atherothrombotic events in the setting of a stent thrombosis or…