…in coronary perfusion pressure, typically within a range of 50 120 mmHg. This process is primarily mediated by local metabolic mechanisms, which adjust vascular tone…

…before the next inspiration. Phase 0 : Indicates the beginning of the next inspiration. Normal ETCO 2 : 38 mmHg (5 kPa) or 5%. Monitoring ETCO 2…

…checked with a capillary or venous measurement [5]. Treatment The awake patient who can swallow safely Give 15 to 20 g of rapid acting carbohydrate…

…Current diagnostic criteria According to the international consensus report of 2024, the diagnosis of DKA requires three components: diabetes or hyperglycaemia, ketosis and metabolic acidosis…

…apply to the anti inflammatory effect. They say nothing about the mineralocorticoid effect or about suppression of the HPA axis, where a long half life…

Endokrinologi & metabolism Lathundar An inpatient has a different insulin sensitivity from at home: less food, more stress, often corticosteroids, often impaired renal function. Prescribe basal…

…A systolic blood pressure of 100 mmHg or less, a MAP below 65 mmHg, delayed capillary refill, cold or mottled skin Metabolism and perfusion A…

…Endocrinology & metabolism Definition and pathophysiology Hypertriglyceridaemia (HTG) is defined by an increased concentration of circulating triglycerides. Both fasting and non fasting measurements provide prognostic information…

Cardiology Endocrinology & metabolism Definition and pathophysiology Primary aldosteronism (PA), also termed primary hyperaldosteronism or Conn syndrome, comprises disorders in which aldosterone secretion is inappropriately increased…

…as blood pressure ≥140/90 mmHg. Screening is particularly pertinent in the presence of hypokalaemia or treatment resistance. Hypokalaemia should not be permitted when assessing…

…conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic alkalosis or an arterial pH above…

…cardiovascular societies, defines HF as a clinical syndrome corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [3] . Within…

…loss or large volume shifts. Patients in whom non invasive measurement is unreliable: marked obesity, pronounced vasoconstriction, arrhythmia, intra aortic balloon pump. Assessment of stroke…

…LDL C in many studies, although the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large population…

…or ambulatory pressure. Masked hypertension: office pressure below the hypertension threshold but hypertensive home or ambulatory pressure. Office measurements provide only a limited representation of…

…across the mitral valve using pulsed Doppler. Estimating left ventricular filling pressure via e' . Measurement of deceleration time (DT) . Diastolic function can be estimated from…

…with its most common waveforms. Important intervals and points of measurement are depicted. ECG interpretation requires knowledge of these waves and intervals. The P wave…

…high Lp(a) level may lead to substantial underestimation of cardiovascular risk. Conversely, Lp(a) measurement provides limited additional reclassification beyond currently recommended global risk…

…or supranormal ejection fraction , despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction of ventricular volume and subsequently…

…25% Normal FS, 2D measurement 18% Advantages of fractional shortening If ventricular geometry is normal and there are no regional wall motion abnormalities, then fractional…

…this chapter, you will learn the physiological basis of all ECG waves and how to determine whether the ECG is normal or abnormal. Although heart…

…2 ) This formula is excellent for measuring pressure gradients across small openings, such as the valves. Importantly, in the setting of valvular stenosis or regurgitation…

…measurement in evaluating aortic root morphology. Age stratified formulas help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of…

…than for office measurement. Classification of office blood pressure Category Systolic Diastolic : : : : : Optimal < 120 and < 80 Normal 120–129 and/or 80–84…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…LVOT to improve the accuracy of the measurement. Flow velocity in LVOT : Velocity is measured in apical four chamber view (4C) or five chamber view …

…with a braked, workload controlled resistance; 12 lead ECG with continuous recording; automated or manual blood pressure measurement. Resuscitation trolley with defibrillator, oxygen, suction and…

…e.g left ventricular diameter, are evaluated in several views in order to assess the reliability and reproducibility of the measurements. The parasternal and apical…

…in oedema and ascites, and in people under 18 years of age, where iso BMI or percentile charts should be used. Waist circumference Measure the…

…age, the sex and the ancestry before the measurement; the reference values are based on them. In kyphosis, or when the patient cannot stand, the…

…be questioned specifically about neurological symptoms during the preceding 6 months. Those with symptoms suggestive of TIA or stroke require neurological consultation and, when appropriate…

…quantify the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). This measurement is pivotal in diagnosing and managing congenital or acquired cardiac…

…How to measure the QT interval Measurement of the QT interval may be difficult due to T wave changes. Causes of prolonged QTc duration Antiarrhythmics …

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…types of heart failure: HFPEF , HFmrEF and HFREF . This classification is based primarily on the measurement of left ventricular ejection fraction (LVEF). The majority of…

…the LVEF measurement is reliable. Nevertheless, these findings increase diagnostic confidence. The presence of symptoms alone is insufficient. Anaemia and pulmonary, renal, thyroid or hepatic…

…can be determined since the speed of ultrasound is constant in the body. The investigator specifies where the measurement should be performed by moving the…

…myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of treatment response and measurement of residual…

…primarily in the context of suspected acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms…

…contractile function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects of systolic function and their combined…

…still and lowered at each measurement, and not to talk. Otherwise ordinary activities, including work. No showering or bathing. A diary of going to bed…

Echocardiography Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the Doppler effect can also…

…incorrect blood pressure measurement must be corrected before treatment is intensified [1,2]. The evidence that any particular intravenous drug improves mortality or long term…

…may be falsely normal because of medial sclerosis — in that case add toe pressure measurement. Absolute: ABI < 0.5 or toe pressure < 30…

…variable and echocardiographic measurement has meaningful variability. Patients with LVEF 40% have substantial morbidity and mortality, despite often having a greater burden of cardiovascular and…

…enabling depolarization and repolarization, and between cells via gap junctions, facilitating the propagation of depolarization across the cells. Electrical potential differences arise as the electrical…

…on a combination of clinical findings, oxygenation and objective measurement of airflow. International thresholds vary somewhat, but a PEF of 50 percent or less together…

…in haematological malignancy. Investigation of dementia with biomarkers (amyloid, tau, phospho tau). Measurement of the opening pressure in suspected idiopathic intracranial hypertension. Therapeutic drainage in…

…retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient…

…1. (A) Flow velocity increases as a liquid approach a circular opening. The flow profile gradually assumes the shape of a hemisphere with multiple layers…

…or dialysis DOACs are not recommended. Warfarin after individual assessment Rule of thumb for the monitoring interval: eGFR divided by 10 gives the number of…

…Haemodynamic measurements become interpretable only when related to one another. A low blood pressure may be due to low flow, low vascular tone or both…

…of the chosen finding — measurement, photograph or video. 3. Give atropine 0.5 mg intravenously (alternatively glycopyrronium 0.2 mg) to reduce the risk of…

…wide or narrow complex tachycardia in which the mechanism needs to be documented before referral to an arrhythmia unit. Assessment of the effect of adenosine…

…contractility of hypothermia are not tolerated. A decision to withhold further life sustaining treatment. Preparation and equipment Continuous core temperature measurement. An oesophageal probe or…

…ECG Initial hs cTn measurement Continuous cardiac monitoring The source material does not provide a detailed list of physical examination findings or a specific examination…

…U waves that are fused with the T wave should be included in the measurement. This may result in an overestimation of the QT interval…

…growth factor. Episodes of headache, palpitations, sweating and pallor that may suggest phaeochromocytoma. Systemic sclerosis, kidney disease, autoimmune disease or previous thrombotic microangiopathy. Antidepressants can…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

…consideration of treatable contributors, such as underlying comorbidities, supervised muscle strengthening physiotherapy, exercise, and coordination and balance training. Orthostatic Blood Pressure Measurement Before starting or…