…Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood gas…

…dangerous differential diagnoses [1,2]. STEMI and other ECG patterns suggesting acute coronary occlusion are time dependent conditions. The decision on immediate reperfusion is based…

…right ventricular hypertrophy (RVH) from posterior acute ischemia. Both these conditions cause ST segment depressions in V1–V3 along with large R waves ( Figure 2…

…of ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI…

…is often more rapidly reversible than that of other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other…

…bleeding, shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be…

…FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an inadequate response…

…angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology CT perfusion Used with an unclear time of…

…Spontaneous attacks without a clear trigger: consider vestibular migraine, Ménière's disease, TIA and arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does…

…adequate. For example, a patient with acute graft occlusion may report an abrupt reduction in walking distance before claudication, accompanied by moderate pain or paresthesia…

…with NSTE ACS (NSTEMI, unstable angina), on the other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute…

…is given. An ECG without ischemic ST T changes when recording during chest pain is not consistent with myocardial ischemia. In other words, chest pain…

…symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis…

…alone [2]. A markedly raised blood pressure without acute organ damage should as a rule not be lowered rapidly with intravenous drugs. Restart or optimise…

…acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery is completely occluded and is particularly associated with MVD…

…other cases result from spasm, microvascular dysfunction, embolism, dissection, hypotension or shock, respiratory failure, severe anaemia, sustained bradyarrhythmia, tachyarrhythmia, or severe hypertension with or without…

…patients with total and proximal occlusions may present without ST segment elevations (which they should exhibit) due to rich collateral circulation in the ischemic area…

…than by a distinct advantage of one drug over the other. Mathew et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock…

…typically concealed in the setting of LBBB. A patient with acute STEMI may therefore display a normal LBBB pattern. LBBB may be caused by ischemia…

…Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal bleeding when combined with acetylsalicylic acid…

…at high risk of developing a new event. Administration Ticagrelor can be administered with or without food. For patients who cannot swallow the tablets whole…

…1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation…

…and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms or signs, with or without electrocardiographic…

…UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis…

…grouped. The chain of care in NSTEMI and unstable angina Management of patients with acute coronary syndromes is permeated by the mantra time is myocardium…

…with one notable exception. Occurrence of upsloping ST segment depressions with prominent T waves in the majority of the chest leads may indicate an acute…

…elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European definition uses BP ≥180/110 mmHg with acute HMOD, although other guidance emphasizes…

…infarction or ischemic episode to result in ventricular arrhythmia, it must coincide with other pro arrhythmogenic factors. The emergence of ventricular tachycardia or ventricular fibrillation…

…stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges posed…

…As in other acute coronary events, the thrombotic process is dynamic, with varying degrees of occlusion that may provide a window of opportunity for reperfusion…

…influenced effects on the cardiovascular system. Acute exposure produces transient haemodynamic and myocardial effects, whereas sustained heavy consumption is associated with hypertension, coronary artery disease…

…organs other than the brain. Patients with AF in the setting of ACS have more comorbidities and a higher risk of complications than patients without…

…Definition and pathophysiological rationale Dual antiplatelet therapy (DAPT) denotes treatment with aspirin plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS)…

…A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than…

…aorta: Stanford type A: involves the ascending aorta, with or without extension into the arch or descending aorta. Stanford type B: does not involve the…

…although not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of…

…is recorded in all patients with suspected pericardial disease. In addition to echocardiography, ECG and clinical examination, blood tests and other radiological examinations are most…

…there is concomitant acute life threatening organ damage. Isolated malignant retinopathy without other acute organ damage can often be treated more cautiously with oral drugs…

…1. Assess airway, breathing and circulation. 2. Assess the neurological symptoms and at the same time exclude other acute causes, for example hypoglycaemia, poisoning, stroke…

…or glucagon. In a person without diabetes, a hypoglycaemic disorder is defined primarily by Whipple's triad : 1. Symptoms or signs consistent with hypoglycaemia. 2…

…burden of retained atherogenic particles accumulates over time, the probability of an acute atherosclerotic cardiovascular event increases. Non HDL Cholesterol Non HDL C is calculated…

…of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5–10%, although some series report 10–20%. Other life threatening…

…in which the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia…

…continue. After acute coronary syndrome, tobacco abstinence has been associated with reductions in reinfarction of approximately 30–40% and in death of approximately 35–45%…

…haemorrhage into the plaque. The diagnosis is supported by the general criteria for acute MI together with evidence of acute coronary atherothrombosis. Post mortem demonstr

…atrial fibrillation. Acute and paroxysmal cases are common in clinical practice. Chronic flutter is, however, very rare. Thus, as compared with atrial fibrillation, atrial flutter…

…cases of fatal myocardial infarction were examined. The authors reported that 60–70% of all cases had no myocardial disease or acute coronary syndrome. Indeed…

…severe reduction of coronary flow caused by acute atherothrombosis. Table 1: Myocardial and ECG reaction in various settings with ischemia or increased workload STATUS OF…

…thrombus, or other acute complications; investigation of restenosis and stent thrombosis. Intravascular imaging may also clarify the mechanism of an acute coronary syndrome (ACS), particularly…

…Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation—predominant right ventricular (RV) infarction…

…Approximately 20% of all endocarditis affect people with valve prostheses and among other cases 18% show significant valvular disease. Table 1. Etiologies in acute endocarditis…

…A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness…

…well the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging…

…in parallel with the investigation. 8. Document the diagnosis and communicate it at every handover. Recognise it Core criteria Core criterion Meaning : : Acute onset The…

…is not a test for BPPV. It is used in the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus, nausea and difficulty walking that has…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

…discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of…