…hallucinations More easily detected, but accounts for a minority of cases Hypoactive Lethargy, slow responses, reduced speech, immobility, poor food intake, reduced eye contact Common…

…heated paper clip for trephination. Antibiotic ointment, a non adherent dressing, gauze. The digital block Anaesthetise from the dorsal aspect, one injection medial and one…

…110 mmHg Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism Systolic blood pressure <90 mmHg, with increased risk of hypotension in…

…in the medical record. Sources ESC Guidelines for the management of atrial fibrillation. Internetmedicin, DOACs, measures in bleeding and medical procedures. Svenska Sällskapet för Trombos…

…CEA), coronary artery bypass grafting (CABG), or major non cardiac surgery. The vascular examination should include: palpation of peripheral pulses; auscultation for carotid, femoral, and…

…familiar to every electrophysiologist, is that LVEF is both insensitive and non specific for SCD. Most people who die suddenly never had an ejection fraction…

…pattern) with a condition which is associated with 5 times as great a risk of sudden cardiac death. For readers interested in recognizing early repolarization…

…in heart rate and contractility appears to act through a redistribution of blood from non ischemic to ischemic myocardium (i.e an increase in blood…

…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…

…cancer, etc – are the most important risk factors for poor outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms…

…50 years for researchers to finally conclude that high cholesterol levels caused coronary artery disease and atherosclerosis in general. This required thousands of observational studies…

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…

…mechanism of death for most diseases and conditions, including non cardiovascular conditions. A cardiac arrest can be expected or unexpected. The most common cause of…

…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…

…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…

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

…patients should bypass non PCI centres to a PCI capable centre. I C Reperfusion therapy Management Recommendation Level of evidence Reperfusion is indicated in all…

…to the emergence of symptoms. Evaluation Before Rehabilitation Clinical assessment Rehabilitation begins with patient assessment and ongoing medical surveillance. The programme should account for: The…

…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…

…guidelines for emergency medicine (and prehospital medicine). This is high quality medical education simply. Life in the Fast Lane Australian site with one of the…

…because management depends on the mechanism responsible for symptoms and ischaemia. The increasing prevalence of refractory angina reflects population ageing and improved survival among patients…

…Society for Holter and Non Invasive Electrocardiology , where it is stated that it is extremely uncommon to have a non ischemic ECG (absence of ST…

…2 and AV block 3. The only treatment with a class I recommendation for the management of acute bradycardia is transcutaneous pacing. Pharmacological interventions (Table…

…masks are alternatives in intolerance. A hydrocolloid dressing for the bridge of the nose applied before the mask goes on, not after the sore has…

…the only absolute indication, and always urgent. A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy…

…with neuroleptic and anti histamine properties. Sleep disorder Aceprometazine is often used in combination with meprobamate for the treatment of sleep disorders. <a href="http:/…

…generally tolerate ischaemia for approximately 4–6 hours, making ALI a medical emergency in which prompt recognition, specialist assessment and restoration of perfusion are essential…

…exercise induced arrhythmias Evaluating the blood pressure response Refining risk stratification and prognosis For patients with low or moderate pre test likelihood of obstructive CAD…

…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…

…for a selective invasive approach? Is the clinical likelihood of true NSTE ACS low enough that non invasive evaluation is more appropriate? The presence of…

…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…

…a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo appropriate screening for secondary hypertension…

…the need for targeted public education, particularly among underserved groups and ethnic minority communities. Late presentation is clinically important: Within 12 hours of symptom onset…

…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…

…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…

…and consideration of genetic testing for all patients with non ischemic HFrEF. Toxic and infiltrative causes are increasingly recognized. The burgeoning field of cardio oncology…

…puzzled researchers for over 80 years. This was expressed in 1961 by Beck et al in the Journal of American Medical Association (JAMA): [...] Of every…

CPR Time is the most critical factor for survival in cardiac arrest. Life saving interventions must be initiated momentarily to maximize the probability of survival…

…of management Medical therapies do not alter disease progression. Diuretics may be used for symptom relief. Surgical repair or valve replacement is considered when medical…

…period, for example after poisoning, since this is not compatible with a DCD process. The assessment of medical suitability is made by the transplant team…

…Ibutilide, Sotalol Class IV Non dihydropyridine L type Ca 2+ channel blockers Diltiazem, Verapamil Singh–Vaughan Williams classification of antiarrhythmic drugs. Bold text indicates agents…

…by radiography. Assessment should include consideration of associated vascular disease. In patients with AAA, duplex ultrasound screening for femoropopliteal aneurysms should be considered. Opportunistic screening…

…Definition and Pathophysiology Angiotensin converting enzyme (ACE) inhibitors are foundational therapies in cardiovascular medicine, widely utilized for the management of hypertension, chronic ischemic heart disease…

…HF trial demonstrated the safety and efficacy of an approach based on starting and titrating oral medical therapy for heart failure within 2 days before…

…Persistent symptoms despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization. Revascularization may be selected for symptom relief after shared…

…Patients with suggestive symptoms, signs or a medical history indicating possible secondary hypertension should undergo appropriate screening for an underlying secondary cause. Evaluation and physical…

…or selectively after initial medical treatment. The presence of ST segment changes or a positive troponin assay identifies patients in whom an invasive strategy is…

…LDLR, which account for most cases. Variants in APOB that impair apolipoprotein B binding to the LDL receptor. Gain of function variants in PCSK9, which…

…assessment is required. Patients with NSTE ACS should be admitted for management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal…

…despite guideline directed medical therapy (GDMT), prompting consideration of revascularization. The likelihood that symptoms are attributable to the CTO is increased when non invasive testing…

…inhibition during the period of anticipated EMI. The perioperative strategy should also recognize that CRT patients may rely on continuous biventricular pacing for haemodynamic stability…

…A normal or non obstructive coronary anatomy does not necessarily exclude an ischaemic mechanism. Clinical assessment and estimation of pre test probability Symptoms and clinical…

…on the presenting electrocardiogram (ECG) and the presence of troponin elevation, ACS are classified into unstable angina (UA), non ST segment elevation myocardial infarction (NSTEMI)…

…or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins during…

…cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a working diagnosis of STEMI should, whenever possible…