…segment depression or T wave inversion can occur without coronary artery disease. Proposed explanations in the source material include cardiac memory after abnormal ventricular activation…

…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…

…negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury, not a disease specific marker of…

…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…

…and hyperkalemia. When bradycardia occurs in the context of inflammatory heart disease, it often reflects myocardial pathology that may also reduce myocardial contractility and cause…

…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…

…coronary disease and progressive, “piece meal” necrosis extending beyond the original infarct zone. Coronary Occlusion and Myocardial Injury STEMI generally results from abrupt reduction in…

…individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care. In adults with elevated blood pressure, nonpharmacological management should…

…penis has been abandoned in the modern literature for commercial preparations at normal concentrations; be cautious nonetheless in known peripheral vascular disease and follow local…

…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…

…cardiac origin. Oxygen supply–demand mismatch, including demand related events in the presence of fixed coronary disease. More than one mechanism may operate simultaneously. Some…

…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…

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

…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…

…absolute contraindications, but be cautious and consider referral in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the…

…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…

…synthesis Electrical channelopathies Oxidative stress Cellular apoptosis and necrosis Progressive structural remodelling Alcohol associated hypertension and atherosclerotic coronary disease In patients with heavy alcohol use…

…or STEMI. Aspirin 75–162 mg once daily is described as an acceptable secondary prevention range in chronic coronary disease. For prolonged treatment, doses of…

…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…

…in early disease or after effective treatment. HFrEF is commonly associated with structural and functional ventricular abnormalities and progressive neurohormonal activation. The therapeutic rationale for…

…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…

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

…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…

… 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…

…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…

…associated vascular disease. In patients with AAA, duplex ultrasound screening for femoropopliteal aneurysms should be considered. Opportunistic screening may also be useful in patients with…

…TIA) or stroke. The risk associated with asymptomatic disease depends substantially on stenosis severity and plaque characteristics. In the general population, the prevalence of asymptomatic…

…and renal disease are particularly susceptible. The risk is also greater when several predisposing factors coexist, rather than being determined by contrast exposure in isolation…

…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…

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

…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…

…of epicardial coronary artery disease (CAD). Assessing the haemodynamic significance of lesions whose angiographic severity is uncertain. Supporting decisions regarding revascularization and, in selected patients…

…shaft or distal bifurcation involvement Disease in the left anterior descending and left circumflex arteries The number of additional diseased vessels Lesion morphology and technical…

…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…

…MI associated with in stent restenosis. Type 5 MI: MI related to CABG. Type 4b and type 4c events fulfil the criteria for type 1…

…the clinical value of any diagnostic test depends not only on its sensitivity and specificity but also on disease prevalence in the population being tested…

…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…

…rupture or erosion. The relative contributions of plaque disease and thrombus vary considerably. Thrombotic material may embolize distally and cause additional myocyte necrosis. Plaque disruption…