…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…

…injection has gone to the right place — immediate pain relief is a diagnostic finding — and appears to reduce the risk of a post injection flare…

…greater risk of progression or rupture than asymptomatic lesions. Predisposing conditions Aortic dissection and its variants are associated with conditions that cause medial degeneration or…

…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…

…and peripheral artery disease (PAD). Diabetes also substantially increases the risk of chronic kidney disease (CKD), which itself promotes cardiovascular disease and amplifies cardiovascular and…

…P1 (anterior or medial scallop), P2 (middle scallop), and P3 (posterior or lateral scallop). Figure 1. Anatomy of the mitral valve The leaflets are connected…

…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…

…sterile gauze, and a fenestrated drape for injection. A needle of 0.8–1.2 × 50 mm for large joints (knee, shoulder), 0.5–0…

…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…

…first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than on the right, and…

…RCA) proximal segment (1) medial segment (2) distal segment (3) posterior descending artery (PDA) (4) Additional coronary artery segments : RPLB : Posterolateral branch of the right…

…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…

…prediction tool currently exists. At the other end, roughly two thirds of ICDs implanted for reduced LVEF never deliver an appropriate shock, so the false…

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…

…disease with prolongation of the Q T interval and sudden death. Am Heart J 1957;54:59 68. Brugada P, Brugada J. Right bundle branch…

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…

…medical surveillance, and appropriate pharmacological treatment. After myocardial infarction, rehabilitation aims to: Restore and improve functional capacity Reduce disability and rehospitalization Improve quality of life…

…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…

…and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to…

…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…

…of the most useful signs Low voltage on the ECG, electrical alternans Supportive; it does not exclude Diastolic collapse of the right atrium and right…

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…

…Capillary refill and venous filling Pulses proximal and distal to the suspected obstruction Arterial and venous Doppler signals Evidence of systemic disease or a potential…

…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…

…not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical therapy and secondary prevention. Clinical Presentation and…

…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…

…by separation within the coronary arterial wall, usually through formation of an intramural haematoma that compresses the true lumen. The resulting reduction in coronary blood…

…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…

…conduction defect. Roughly 7% of cases progress to bifascicular block (which means that the LAFB is accompanied by a right bundle branch block), while 3…

…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…

…Data from the TRED HF trial demonstrated that withdrawal of guideline directed medical therapy (GDMT) in these patients leads to a high rate of relapse…

…80 years. This was expressed in 1961 by Beck et al in the Journal of American Medical Association (JAMA): [...] Of every 10 such victims, the…