…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…

…primary care first. If ischaemic discomfort persists, emergency medical services should be called. Patients who have been prescribed sublingual nitroglycerin should be instructed in its…

…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…

…changes Thromboembolic complications, particularly stroke In ACS, AF may be present before the acute event, detected for the first time during its management, or arise…

…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…

…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…

…Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does not feel the pressure sore. Preparation and equipment Material Comment : : Stockinette Innermost against…

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

…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…

…in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the…

…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…

…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…

…in the worst case, amputation. The decisive step is therefore not the choice of dressing but the ankle brachial index before the first bandage is…

…electrocardiographic pattern in every case; it may represent the posterior component of a broader infarct territory. Clinical Presentation and Symptoms The source material addresses posterior…

…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…

…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…

…major contributors to maternal, fetal, and neonatal morbidity and mortality. Their incidence has increased in parallel with older maternal age at first childbirth and the…

…of the umbilicus. The fetus should ideally be delivered within 5 minutes following the maternal cardiac arrest. Within the context of pregnancy, hypovolemia and other…

…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…

…and laboratory components; the diagnostic criteria themselves are not reproduced in the available source material. Waist circumference is particularly important because intra abdominal, or visceral…

…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…

…Immediately — pressure necrosis across the septum A live insect As soon as possible — kill it first; the patient is in great distress Organic material (peas…

…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…

…or reversible causes. The first step in treating sinus bradycardia is to discontinue any medications that may be contributing to the slow rate. Acute treatment…

…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…

…BMS now account for less than 10% of contemporary PCI procedures according to the source material. First generation DES The first widely used DES included…

…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…

…procedural complications and bleeding. Clinical presentation The available source material does not provide a detailed description of the presenting symptoms of NSTEMI. It does identify…

…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…

…to demonstrate an intramural haematoma or double lumen Type 1 is reported in fewer than one third of cases in the pregnancy related source material…

…0.5% per year beyond the first year, although the available material does not establish a significant increase in late morbidity or mortality attributable to…

…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…

…in neurogenic bladder dysfunction, in the first instance with clean intermittent self catheterisation rather than an indwelling catheter. A catheter is not, however, indicated for…

…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…

…non cardiac surgery. The vascular examination should include: palpation of peripheral pulses; auscultation for carotid, femoral, and abdominal bruits; bilateral brachial blood pressure measurement; cardiac…

…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…

…In observational data, a lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than…

…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…

…Q waves Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality in an ischemic distribution Angiographic evidence of a…

…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…