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…

…) [2]. Take home message: in the setting of acute coronary syndromes, be quick to administer antithrombotic medications and reperfusion. Refer to G Heusch's excellent…

…poisoning and severe withdrawal. 4. Establish whether the condition is new or clearly worse than baseline. Contact relatives, home care services, the residential care home…

…appropriate intensity, with attention to the emergence of symptoms. Evaluation Before Rehabilitation Clinical assessment Rehabilitation begins with patient assessment and ongoing medical surveillance. The programme…

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

…although practical clinical care requires diagnostic and treatment thresholds. The 2024 European guideline defines hypertension as an office systolic blood pressure (SBP) of ≥140 mmHg…

…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…

…patient (blue) and the corresponding high risk morph (red). Beyond the difference in R wave amplitude, note the slurred terminal portion of the R wave…

…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…

…Lange Nielsen F. Congenital deaf mutism, functional heart disease with prolongation of the Q T interval and sudden death. Am Heart J 1957;54:59…

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…

…FH). Heterozygous FH results in high LDL cholesterol levels (but nothing else) and increases the risk of acute myocardial infarction by more than 50 times…

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…

…of the great medical inventions of the 20th century. Cardiac pacing has evolved from a hazardous experiment in the 1930s, to a routine, safe, and…

…arrest requires comprehensive efforts and resources, ranging from continuously training laymen in the community to establishing advanced post resuscitation care. Since the majority of all…

…for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a diary. The set up and…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…height and weight. It is calculated by dividing body weight in kilograms by the square of height in meters. BMI is relevant for medical prognostication…

…myocardial infarction and at least one of the following criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment…

…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…

…Dr Rob Mac Sweeney's superb website which is a must for anyone interested in critical care medicine. Content is evidence based, comprehensive and qualitative…

…patients require a mechanism based assessment rather than reassurance based solely on the absence of obstructive CAD. Evaluation and Physical Examination Clinical assessment The asses

…defects ECG Management and treatment of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history …

…before starting and after about 1 hour — without a blood gas the treatment cannot be guided. A decision on the level of care and on…

…a raised filling pressure Marked respiratory variation in mitral and tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there…

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…

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

…to exercise Detection of exercise induced arrhythmias Identification of exercise related ST segment changes Prognostic and risk stratification information Assessment of response to selected medical…

…and angina related health status but does not reverse coronary atherosclerosis. Long term benefit therefore depends on the integration of revascularisation with guideline directed medical…

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

…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…

…first medical contact and interpreted within a target of 10 minutes. Prehospital ECG acquisition can shorten the time to diagnosis and facilitate triage of patients…

…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…

…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…

…or pulseless VT (i.e. shockable), and the probability of survival is higher (since these arrhythmias can be defibrillated). Likewise, the later the ECG is…

…The discrepancy between traditional figures and recent studies is due to the dramatic decrease in the incidence of acute coronary syndromes over the past decades…

…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…

…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…

…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…

…team (CAT) and intensive care units and other units caring for resuscitated patients. Figure 1. The chain of survival in out of hospital cardiac arrest…

…there is no consensus regarding grading of tricuspid stenosis severity. Tricuspid stenosis is visually characterized by thickened leaflets, with reduced motion and potentially fused commisures…

…drug and forgetting to restart it after the procedure. Document the restart date in the medical record. Sources ESC Guidelines for the management of atrial…

…care unit identifies a possible donor and the deceased person's own wishes are properly established. Two things determine the outcome — that the confirmation of…

…to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects…

…Most AAAs are located below the renal arteries and are related to atherosclerotic disease. At least 90% of AAAs larger than 4 cm are associated…

…medical emergency. Evaluation and Physical Examination The evaluation of chronic cough in a patient taking an ACE inhibitor should begin with a comprehensive history and…

…safety and efficacy of an approach based on starting and titrating oral medical therapy for heart failure within 2 days before anticipated hospital discharge and…

…should be reviewed after initiation and after each adjustment. Persistent symptoms despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization…

…strategy involving coronary angiography and subsequent revascularization may be undertaken early, delayed, or selectively after initial medical treatment. The presence of ST segment changes or…

…medical, social and multigenerational family history. The evaluation should establish: The magnitude of untreated LDL C elevation. The presence and age of onset of premature…

…analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of myocardial injury…

…equivalent or exertional dyspnoea. Patients may continue to have lifestyle limiting symptoms despite guideline directed medical therapy (GDMT), prompting consideration of revascularization. The likelihood that…

…perioperative planning should be individualized according to the patient, device, procedure, and anticipated electrical environment. Preoperative evaluation Establish the nature and function of the device…

…most persuasive when the initial probability is high enough that the result meaningfully increases the likelihood of disease and can justify further investigation or treatment…

…Presentation and Symptoms In up to one half of STEMI cases, a precipitating factor such as vigorous physical exercise, emotional stress, or a medical or…

…and an intercurrent medical or surgical illness. Events may occur at any time, although clustering in the morning within several hours of awakening has been…

…delays, and the time required for the selected treatment to restore flow. Early reperfusion is therefore the central priority of STEMI systems of care. Fibrinolysis…

…syndrome, stress testing may be considered after at least 24 hours of stabilization, provided that active ischaemia and haemodynamic or electrical instability are absent. A…

…to prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects…