…Mural vegetations are attached to the endocardium and, accordingly, less mobile. Echocardiography is the first place method for detecting vegetation in case of suspicion of…

…dyspnoea improves and sympathetic activation subsides, making it difficult to determine whether AF initiated the deterioration or resulted from it. AF has important consequences beyond…

…symptoms may be challenging to differentiate from normal physiological changes of pregnancy. Evaluation and Physical Examination The source material does not provide a detailed description…

…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…

…information obtained from longer serial intervals. Clinical Presentation and Initial Clinical Context Chest pain or discomfort is the most common symptom initiating evaluation for ACS…

…request form. Drainage material: rubber dam drain, a strip cut from a glove, petrolatum impregnated packing strip or a vessel loop for loop drainage. Gauze…

…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…

Arrhythmias and arrhythmology Critical care Pharmacology & dosing Definition and Pathophysiology Bradycardia and conduction disorders arise from dysfunction within the sinus node, the atrioventricular node (AVN…

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

…results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to…

…heterogeneous, and some patients may benefit from a more individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care…

…through a 20 mL syringe and a large bore needle. Chlorhexidine in alcohol to the skin around the wound — not into the wound. Sterile gloves…

…a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening for secondary hypertension…

…probe cover and sterile gel. Chlorhexidine in alcohol 5 mg/mL for skin disinfection. Allow it to air dry completely before puncture. Maximal barrier precautions:…

…screening for an underlying secondary cause. Evaluation and physical examination Standardized office measurement Accurate technique is essential because inconsistent or incorrect measurement may lead to…

…of Anaesthesiology and Intensive Care Medicine (SFAI), together with the antidotes. Material for immobilisation: a shoulder sling, a dorsal backslab, and a colleague to help…

…materials: two layer system, four layer system, short stretch bandage, zinc paste bandage (Unna boot), or a class 2–3 compression stocking. Tape measure for…

…account for the ischaemia. STEMI usually results from rapid thrombotic occlusion of a previously atherosclerotic coronary artery. Slowly progressive severe stenoses are less likely to…

…The transition from a quiescent plaque to a highly thrombogenic surface occurs via three primary mechanisms: Plaque Rupture: Accounting for 60 70% of ACS presentations…

…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…

…positioned as standard, and defibrillation energy levels should remain consistent with those used for non pregnant adults. The fetus is not harmed by defibrillation, amiodarone…

…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…

…in the available source material. Waist circumference is particularly important because intra abdominal, or visceral, adipose tissue is more closely related to insulin resistance and…

…obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18% to 52%…

…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…

…ear canal. A 30–60 mL syringe with a soft catheter and body temperature water for irrigation. Small children need help to keep still. Sedation…

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

…CKD). These agents interfere with the renin angiotensin aldosterone system (RAAS) by inhibiting the enzyme responsible for the conversion of angiotensin I to angiotensin II…

…for women or five for men on one occasion. Pharmacokinetics and pathophysiology Approximately 95% of ingested ethanol undergoes hepatic metabolism. Alcohol dehydrogenase converts ethanol to…

…bleeding. This balance changes according to the clinical setting, time from MI or percutaneous coronary intervention (PCI), ischaemic risk, bleeding risk, need for anticoagulation, and…

…source material does not provide specific details regarding the physical examination or general evaluation of patients with bradycardia. Diagnostics Electrocardiographic assessment is fundamental to the…

…has declined from at least 50%. This distinction is clinically important because the strongest evidence for the four pillar disease modifying strategy applies to symptomatic…

…for which the evidence and recommendations differ from those applicable to elective PCI. Clinical presentation and symptoms The source material does not describe a distinct…

…from whole grains. These combined effects may improve inflammation, insulin resistance, glucose metabolism, hypertension, atherogenic dyslipidaemia, endothelial biology and platelet related pathways. The source material…

…for non cardiac surgery, procedural complexity, and the relative merits of PCI and coronary artery bypass grafting (CABG). Definition and Pathophysiology From balloon angioplasty to…

…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…

…of thrombotic or atheroembolic material, but pharmacological and mechanical strategies directed specifically at reperfusion injury have not generally demonstrated sufficient clinical benefit for routine use…

…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…

…is essential for identifying a precapillary pulmonary vascular component. PAWP is used to distinguish pulmonary venous hypertension caused by left heart disease from pulmonary vascular…

…arrhythmias for which sotalol is prescribed. Evaluation and Physical Examination The source material does not cover the baseline physical examination of patients prior to sotalol…

… may be mistaken for vasospasm or diffuse disease Type 3 Focal or tubular stenosis resembling atherosclerosis Often requires intravascular imaging to demonstrate an intramural haematoma…

…autopsy documents thrombosis and the diagnostic criteria used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified…

…patient. Fixation material for the intraosseous needle. Procedure Peripheral venous cannula 1. Apply the tourniquet 10–15 cm proximal to the intended puncture site, let…

…coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan the aspiration for the trough level or pause the drug according to local practice Relative Skin infection…

…The material determines how long the catheter may stay: all silicone and latex with a hydrogel or silicone elastomer coating may remain for up to…

…The source material does not provide a detailed standardized physical examination protocol beyond assessment for a pulsatile abdominal mass and associated manifestations. Screening for AAA…

…high risk populations, prevalence may be sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of at least 70%, the reported 5…

…tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because…

…dL), and at least a 50% reduction from baseline. For a patient who experiences a recurrent atherothrombotic event while receiving maximally tolerated statin therapy, an…

…gene, LDLR, which account for most cases. Variants in APOB that impair apolipoprotein B binding to the LDL receptor. Gain of function variants in PCSK9…

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

…confined to the descending thoracic aorta. Type IIIb: extends below the diaphragm. The temporal classification is also clinically relevant: Hyperacute: less than 24 hours from…

…Clinical Indications Suspected Chronic Coronary Syndrome The decision to perform ICA is based on the clinical likelihood of obstructive CAD, symptoms, findings from non invasive…

…haemodynamic compromise and rhythm disturbance. The source material does not provide a specific examination profile or diagnostic physical signs for LMCAD. Diagnostic Assessment Coronary angiography…

Echocardiography Myocardial ischemia and infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic…

…the postprocedural increase results from the index MI and how much is related to the intervention. Diagnostic criteria General principles For events occurring within 48…

…and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of…

…who therefore require assessment for pseudo resistance, secondary hypertension, treatment related contributors, and excess cardiovascular risk. The European definition requires failure to reduce office systolic…

…left sided congestion—is an important clinical clue. Haemodynamic severity The presentation may range from mild right ventricular impairment to cardiogenic shock. Patients with hypotension…

…related to plaque rupture or erosion Type 2 MI caused by oxygen supply–demand imbalance unrelated to acute atherothrombosis Type 3 Cardiac death with suspected…