ECG Left main coronary artery occlusion Left main coronary artery (LMCA) occlusion is a rare but catastrophic manifestation of acute coronary syndromes. The LMCA supplies…

…impairment of gas exchange Hypotension, cool peripheries or rising lactate Circulatory compromise or an alternative diagnosis Silent or nearly silent chest Very severe airflow obstruction…

…In some of these patients, microvascular obstruction or epicardial spasm may account for the ischaemia. STEMI usually results from rapid thrombotic occlusion of a previously…

…HCM) — This type of cardiomyopathy is characterized by pronounced hypertrophy of the myocardium. It may also lead to obstruction of the LVOT (Hypertrophic Obstructive Cardiomyopathy…

…laryngeal mask of the correct size as a rescue airway, and surgical airway equipment (a size 10 scalpel, a bougie, a size 6.0 tube)…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…altitude sickness Aspiration Chronic obstructive pulmonary disease (COPD) Bronchospasm (asthma) Other : Coma Central hypoventilation syndromes Neuromuscular diseases Anemia The natural course of asphyxia Should ventilation…

…reduced, potentially leading to complete obstruction of venous return by the uterus. This can be remedied by manual displacement of the uterus to the left…

…obstruction) of the left main coronary artery (LAD) or 2 epicardial coronary arteries (Felker et al). Left ventricular dilation entails a markedly elevated risk of…

…plaque and future events Angiographic stenosis severity is an imperfect predictor of future myocardial infarction or sudden death. Lesions causing only mild obstruction may rupture…

…are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically…

…or immediately after PCI. The clinical presentation depends on the extent of microvascular obstruction and the territory supplied by the treated vessel. Possible manifestations include…

…obstruction. Intensive lipid lowering improves endothelial function, lowers circulating high sensitivity C reactive protein, reduces thrombogenicity, and favourably modifies inflammatory and collagen related components of…

…output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia, shock, obstruction or advanced renal injury…

…nasal fracture or unilateral nasal obstruction. 2. Measure the depth of insertion by laying the tube from the tip of the nose to the earlobe…

…sided cardiac disease, chronic lung disease or hypoxia, chronic thromboembolic obstruction, or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification…

…obstruction. Furthermore, cardiomyocyte swelling, interstitial edema, and tissue inflammation promote extravascular compression, exacerbating myocardial injury. Clinical Presentation and Symptoms In up to one half of…

…NIV are two different treatments with different physiology, and the commonest source of error is confusing them. CPAP delivers a constant pressure that recruits alveoli…

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

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…lysis, and the quality of tissue level perfusion after epicardial flow is restored. Microvascular obstruction may persist despite successful PCI because of endothelial dysfunction, leukocyte…

…arrest also speak for anaphylaxis (airway obstruction caused by a foreign body is an important differential). Treatment of anaphylaxis and cardiac arrest Administer CPR as…

…EMG about 95 %). Contraindications Known hypersensitivity to edrophonium. Mechanical obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade…

…microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include embolism…

…size of the thrombus (i.e the degree of artery obstruction): The greater the obstruction the more extensive the ischemia/infarction. The location of the…

…larynx. The difficult airway rarely kills because the tube would not pass, but because the team keeps trying to intubate instead of changing the plan…

…which requires body plethysmography DLCO Diffusing capacity for carbon monoxide An obstructive pattern: FEV₁/FVC below the lower limit of normal (traditionally < 0.70)…

…is a marker of elevated left ventricular filling pressures and is linked to adverse outcomes. Left Ventricular Outflow Tract Gradient (LVOTG) : LVOT obstruction is a…

…The symptomatic territory is usually distal to the arterial obstruction: Buttock, hip or thigh symptoms suggest aortoiliac disease. Calf symptoms are typical of femoropopliteal disease…

…dissection with obstruction of the true lumen Occlusion of a major epicardial artery or bypass graft Side branch occlusion or thrombus Disruption of collateral flow…

…myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial coronary artery. A vulnerable atherosclerotic plaque and thrombogenic…

…measure of luminal obstruction. Calcified plaque is generally less likely to rupture than non calcified, lipid rich plaque. CAC nevertheless serves as a marker of…

…Medicinal charcoal Bowel obstruction, ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a reduced level of consciousness Gastric…

…ST segment elevation caused by spasm. The absence of obstructive disease generally indicates a more favourable course than VA accompanied by severe fixed lesions. Nevertheless…

…gastrointestinal perforation or obstruction is suspected. If the patient is intubated, administer activated charcoal through a gastric tube at a dose of 0.5 g…

…nucleus that often exhibits cavities, which consist of hemorrhages in the tumor. Polypoid myxoma usually causes haemodynamic complications due to obstruction. Papillary myxomas are small…

…ICA is based on the clinical likelihood of obstructive CAD, symptoms, findings from non invasive testing and the anticipated effect of the result on management…

…the expected information is likely to change management. In patients with a very low probability of obstructive CAD, testing may generate false positive results and…

…despite the absence of an angiographically obstructive lesion Coronary embolism or thrombus Epicardial coronary vasospasm Coronary microvascular dysfunction Spontaneous coronary artery dissection (SCAD) Standard angiography…

Cardiology Diagnosis and treatment of bradycardia (bradyarrhythmia) Acute bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should…

…is increased resistance in the aortic valve itself, due to the reduced area of the valvular orifice. Both aortic stenosis and hypertension result in increased…

…isolates microvascular resistance. Only indices that detect microvascular disease as an independent cause of ischemia, including with non obstructive epicardial arteries (ANOCA/INOCA); CFR has…

…treat an obstructive coronary lesion without avoidable delay. In contrast, haemodynamically stable patients without ST segment elevation after successful resuscitation from out of hospital cardiac…

…only investigation that distinguishes obstructive from restrictive impairment of lung function, and COPD cannot be diagnosed without it . The quality of the test determines its…

…with non obstructive coronary arteries (INOCA) denotes the subgroup in whom objective myocardial ischaemia is demonstrated. ANOCA may occur in up to 70% of patients…

…COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma…

…of mitral regurgitation Degeneration, prolapse DCM (dilated cardiomyopathy) Ischemic heart disease (coronary heart disease) Rheumatic valve disease Endocarditis Congenital mitral regurgitation Amyloidosis SLE Hypertrophic obstructive…

…without an obstructive epicardial lesion. Once conventional anti ischaemic targets have been exhausted, proposed therapeutic approaches act through several broad mechanisms: Promotion of coronary collateral…

…patients with asthma/chronic obstructive pulmonary disease (COPD). Dyspnea has been reported in patients treated with ticagrelor. Patients with a history of ischemic stroke can…

…dissection Physical disability that precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain…

…II Anatomical SYNTAX Score : Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher…

…diet, physical inactivity, and alcohol consumption. Additional considerations include psychosocial stress, obstructive sleep apnoea, social determinants of health, air pollution, family history, ethnicity, and frailty…

…angina, angina or ischaemia with non obstructive coronary arteries (ANOCA/INOCA), post ACS or post revascularization states, and heart failure of ischaemic or cardiometabolic origin…

…risk of fluid retention and impaired kidney function). Patients with bronchial asthma, chronic obstructive pulmonary disease, hay fever, or nasal polyps (increased risk of hypersensitivity…

…a lower suspicion of obstructive disease. Patients with no plaque or stenosis on CCTA should be reassured, and non atherosclerotic causes of symptoms should be…

…available, PET MPI is recommended in individuals with suspected chronic coronary syndrome and a moderate or high pre test likelihood of obstructive coronary artery disease…

…without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with suspected pulmonary embolism. Urgent bedside echocardiography, looking for right…

…substrate of angina may differ between patients. Myocardial ischaemia may result predominantly from obstructive epicardial coronary disease, coronary vasospasm, microvascular dysfunction, or combinations of these…