…of Cardiac Amyloidosis Demographic and Clinical Context Cardiac amyloidosis should be suspected in patients older than 65 years presenting with heart failure and increased left…

…somewhere that makes incision in the emergency department the wrong move — in the hand, in the medial triangle of the face or perianally. Indications Fluctuant…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…the left subclavian artery. Penetrating atherosclerotic ulcer PAU is focal ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media…

…include plaque formation with calcium deposition, medial thinning, destruction of muscular and elastic tissue, fragmentation of the internal elastic lamina, and superimposed platelet and fibrin…

…consequences of diabetes may present through any major cardiovascular phenotype: CAD, including chronic coronary syndromes and acute coronary syndromes HF across the spectrum of left…

…dilation. Atrial dilation causes a significantly increased risk of atrial fibrillation. The increase in left atrial pressure may also propagate backward to the pulmonary circulation…

…pressure in that leg ÷ highest arm pressure of the two arms Interpretation ABI Interpretation Action : : : 1.40 Incompressible vessels — medial sclerosis Measure the toe pressure…

…5 mg/mL: clean with 3–4 swabs in wide circles and let it dry for a couple of minutes before the needle is inserted…

…digital block Anaesthetise from the dorsal aspect, one injection medial and one lateral to the base of the phalanx, 2–3 mL on each side…

…lies about 3–5 cm superior and medial to the anterior superior iliac spine and lateral to the lateral border of the rectus abdominis — this…

…of coronary artery segments. CT = computerized tomography. LMCA = Left main coronary artery (5) LAD = left anterior descending artery: proximal segment (6) medial…

…peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack…

…resistant to resolution. Known predictors of cardiac arrest The only risk biomarker in genuinely widespread use is left ventricular ejection fraction (LVEF), measured by echocardiography…

Continous medical discussion: the ECG blog ECG Early repolarization pattern: confused J points, notches and slurs I once had the privilige of attending a lecture…

Continous medical discussion: the ECG blog Myocardial ischemia and infarction Myocardial ischemia The definition of ischemia may appear trivial but it is actually a very…

…medical discussion: the ECG blog ECG The best ECG book is not the one making it simple In the thrilling and ever evolving field of…

Arrhythmias and arrhythmology Continous medical discussion: the ECG blog Genetic and miscellaneous conditions A novel potentially life threatening cardiac arrhythmia syndrome identified with ECG The…

Cardiology Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health…

…stopping statins. There are three main questions discussed in media, blogs and on social plattforms: Is high cholesterol a true cause of coronary artery disease?…

Cardiology Continous medical discussion: the ECG blog Endocrinology & metabolism Cardiovascular medicine is currently witnessing a paradigm shift. For decades, the management of type 2 diabetes…

ECG The artificial pacemaker is one of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the…

…Journal of the American Medical Association (JAMA) published an article titled Hearts too good to die (JAMA, 1961). A total of 500 cases of fatal…

…interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off…

…and scope Coronary angiography is an invasive fluoroscopic procedure in which contrast media are injected selectively into the epicardial coronary arteries through a catheter advanced…

Cardiology Nephrology Definition and terminology Contrast associated acute kidney injury is an acute deterioration in renal function occurring after exposure to iodinated contrast media, particularly…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…is relevant for medical prognostication as it serves as a quick, low cost, and reliable screening tool for body composition, risk of type 2 diabetes…

…instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction…

…barriers to participation Occupational and sporting goals Current pharmacological treatment Early assessment of left ventricular ejection fraction is recommended before hospital discharge because the first…

…PCI), or medical management. The standard post ACS regimen is DAPT for 12 months, generally consisting of low dose aspirin and a potent P2Y12 inhibitor…

…followed by disruption of the intima. Intramural haematoma differs from classic dissection because haemorrhage occurs within the media without imaging evidence of an intimal tear…

…medicine). This is high quality medical education simply. Life in the Fast Lane Australian site with one of the most impressive ECG libraries available. A…

…be controlled despite escalation of antianginal medical therapy, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI), including attempted recanalization of a chronic total…

…medical attention due to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left…

…of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of…

…These layers are analogous to tunica intima , tunica media , and tunica adventitia , respectively. Figure 1. Layers of the left ventricular wall, pericardium and ventricular cavity…

…contrast media and recently stopped drugs. 8. Treat sepsis, bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and…

…Acute exacerbation of COPD with respiratory acidosis , that is, a pH below 7.35 and a PaCO₂ above 6.0 kPa despite optimal medical treatment…

…Delirium is common but often missed. On medical and geriatric wards a substantial proportion of older patients are affected, and the incidence is particularly high…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

Info A comprehensive list of conditions and drugs that may prolong the QT interval, and cause torsade de pointes (TdP) and long QT syndrome (LQTS…

…a medical emergency in which prompt recognition, specialist assessment and restoration of perfusion are essential. The abrupt arterial obstruction may result from progression of peripheral…

…information Assessment of response to selected medical, revascularization, rehabilitation, ablative or surgical interventions The test does not define the structure or composition of coronary atherosclerotic…

…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…

…particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from…

…underlying coronary atherosclerotic process. Their clinical effects therefore occur within the broader framework of guideline directed medical therapy and secondary prevention. PCI treats focal stenotic…

…or chest pain equivalent symptoms. The ECG assessment remains necessary even when symptoms have improved by the time of medical evaluation, because transient or evolving…

…medical and medication histories should specifically assess drugs or substances that may increase blood pressure. The source material does not provide an exhaustive list of…

…should therefore prompt consideration of systemic arteriopathy rather than being regarded solely as an isolated coronary event. SCAD predominantly affects the left sided coronary circulation…

…extent of myocardial injury is strongly influenced by total ischaemic time. This interval includes: The time from symptom onset to recognition and seeking medical assistance…

…In out of hospital cardiac arrest (OHCA) the initial rhythm is recorded by the EMS (emergency medical service) team upon their arrival at the scene…

…causes of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical conditions…

…and medical therapies. Adults with congenital heart disease are mostly managed in GUCH clinics (Grown Up Congenital Heart disease). Prevalence of congenital heart disease (CHD…

…the median age of 70 years at the onset of the disease. Approximately 12% die within 30 days, compared to the 30 day mortality of…

…the data sources for out of hospital cardiac arrest (OHCA) and in hospital cardiac arrest (IHCA). Age and sex The median age in OHCA is…

…left posterior fascicular block is due to block in the posterior fascicle. Approximately 5–10% of all individuals have a third fascicle – the median or…

…under guideline directed medical therapy (GDMT). These patients must be managed as having HFrEF, as their underlying pathophysiology, trajectory, and risk of relapse upon GDMT…

…specifically classified by the 2022 AHA/ACC/HFSA and 2021/2023 ESC guidelines as HF with a left ventricular ejection fraction (LVEF) of ≤40% [14…