…haematoma that compresses the true lumen. The resulting reduction in coronary blood flow may produce myocardial ischaemia, acute coronary syndrome (ACS), myocardial infarction (MI), or…

…parallel with older maternal age at first childbirth and the rising prevalence of obesity. Gestational hypertension is defined in the supplied guideline material as blood…

…fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in decompensated…

…50 beats per minute in the first 4 to 6 hours after an acute infarction—patients may develop hypotension and signs of end organ hypoperfusion…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…factors. Plaque erosion Plaque erosion is increasingly recognized and is present in at least one third of acute coronary syndromes in the cited material. Eroded…

…is associated with hypertension and blood pressure variability, while obesity and hypertension together promote left ventricular hypertrophy and kidney injury. The syndrome is therefore both…

…The underlying aetiology is heterogeneous. Chronic heart failure evaluation should therefore seek reversible or treatable causes. The source material identifies coronary disease, hypertension, diabetes, obesity…

…The source material does not describe a characteristic symptom profile at initiation or during routine therapy. Potential clinically important complications and treatment related syndromes include…

…Hemorrhagic stroke implies bleeding directly into the brain parenchyma. The most common underlying etiology is hypertension. Ischemic stroke occurs when a cerebral artery is occluded…

…itself promotes cardiovascular disease and amplifies cardiovascular and all cause mortality. The excess risk is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity…

…delivered within 5 minutes following the maternal cardiac arrest. Within the context of pregnancy, hypovolemia and other etiologies of hypotension remain the predominant causes of…

…diuretic during the initiation of an ACE inhibitor to prevent symptomatic hypotension. Diagnostics The source material does not cover specific diagnostic modalities such as ECG…

…The source material describes hypertension using differing thresholds across international guidance. One framework defines confirmed hypertension as blood pressure consistently above 130/80 mmHg on…

…vascular tone. Accordingly, the source material describes no haemodynamic or contractility effects attributable to ivabradine. Because its action is exerted in the sinus node, it…

…Noradrenaline (norepinephrine) acts primarily as a vasopressor. While detailed receptor pharmacology is not specified in the source material, it is utilised alongside inotropes in acute…

…by manifestations of severe right ventricular failure. Typical findings include: Jugular venous distension Kussmaul’s sign Hepatomegaly Hypotension, which may or may not be present…

…major modifiable risk factor. Family history also increases risk, particularly among first degree relatives, with siblings appearing to be especially affected. The principal determinant of…

…material does not describe the typical symptoms or symptom burden of uncomplicated hypertension. It does, however, identify symptomatic hypotension and symptoms suggestive of orthostatic hypotension…

Cardiology Respiratory medicine Definition and Pathophysiology Pulmonary hypertension (PH) is a heterogeneous pathophysiological disorder characterized primarily by elevation of pulmonary arterial pressure. It may arise…

…blood pressure. The source material does not provide an exhaustive list of such agents. Resistant hypertension Resistant hypertension is not regarded as a discrete disease;…

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

…effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease, arrhythmias…

…glucose metabolism, hypertension, atherogenic dyslipidaemia, endothelial biology and platelet related pathways. The source material also describes possible antiarrhythmic effects, associated with reductions in sudden cardiac…

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

…in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery. Plaque erosion or rupture exposes thrombogenic material to circulating blood. Platelets adhere…

…PAD, or other atherosclerotic disease; diabetes and other cardiovascular risk factors; smoking, hypertension, hypercholesterolaemia, and sedentary behaviour; family history, particularly in the broader assessment of…

…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…

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

…a wound that needs to be inspected — use a windowed splint or external fixation. Established or impending compartment syndrome. An unstable fracture requiring operative fixation…

…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…

…with mild inflammation Splinting with a cotton wisp Ingrown nail with moderate inflammation Splinting with a strip of suture material or a drain Ingrown nail…

Procedurer The result of a repair is determined before the first needle goes in. A wound that has not been irrigated clean, has not been…

…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…

…denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction…

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

…exceeding those seen with native vessel PCI. Mechanisms The principal mechanism is distal embolization of atheromatous and thrombotic material. Plaque or thrombus may be dislodged…

…Definition and pathophysiological context Non ST segment elevation myocardial infarction (NSTEMI) is considered within the spectrum of non ST elevation acute coronary syndrome (NSTE ACS)…

…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…

…material does not cover the baseline clinical presentation and symptoms of the arrhythmias for which sotalol is prescribed. Evaluation and Physical Examination The source material…

…approximately 0.2%–0.5% per year beyond the first year, although the available material does not establish a significant increase in late morbidity or…

…pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly…

…risk of thrombosis and contamination, immobilises the patient The right internal jugular vein is the first choice in most situations. The femoral vein is the…

…amputation. The decisive step is therefore not the choice of dressing but the ankle brachial index before the first bandage is applied . Indications Venous leg…

…enough. Lidocaine 10 mg/mL to anaesthetise the marrow cavity in a conscious patient. Fixation material for the intraosseous needle. Procedure Peripheral venous cannula 1…

…bag or a vacuum bottle. Drainage: a chest drain, an underwater seal unit, suture material, a size 11 scalpel, artery forceps. Sample tubes according to…

…procedure must not then be started. Radiography before reduction A radiograph is taken before reduction in a first time dislocation , so as not to reduce…

…healing. Voiding problems in neurogenic bladder dysfunction, in the first instance with clean intermittent self catheterisation rather than an indwelling catheter. A catheter is not…

…73 m2. In patients with relatively normal renal function, defined in the source material as eGFR above 60 mL/min, the risk is low. In…

…appropriate first line pharmacological option when a patient is unable to tolerate any statin regimen. The treatment sequence for patients with chronic coronary syndrome is…

…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…

…approximately 20–50%. Their greater analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is…

…non HDL C and apolipoprotein B. Causes and secondary contributors A search for secondary contributors is an essential first step. Recognised causes include: Diabetes and…

…tomography (OCT) provide cross sectional information about plaque morphology and may clarify the mechanism of an acute coronary syndrome or guide percutaneous coronary intervention (PCI)…

…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…

…a lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than a more distal…

…may include systemic arterial embolic manifestations. The source material does not provide a detailed catalogue of specific embolic syndromes. Clinical suspicion should be heightened after…

…and acute MI procedures. Distal embolization of atheromatous or thrombotic material is an important proposed mechanism. No reflow may produce major short and long term…

…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…

…Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia. The first cellular abnormalities of ischaemia include depletion of glycogen, relaxation of myofibrils, and disruption…