…arise from various causes, including acute pancreatitis, alkalosis due to hyperventilation, rhabdomyolysis (particularly the initial phase), sepsis, malignancies with osteoblastic metastases, diminished calcium absorption and…

…node dysfunction and tach brady syndrome. Ventricular tachycardia, ventricular fibrillation and torsade de pointes. Hypocalcemia Causes of hypocalcemia Acute pancreatitis, pancreas surgery, alkalosis (hyperventilation), rhabdomyolysis…

…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…

…Wheeze with preserved air entry Marked wheeze or reduced air entry Silent or nearly silent chest pCO₂ Low Usually low Normal or raised Other Moderate…

…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…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…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…

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

…acute glomerular disease or scleroderma renal crisis [1,2]. A hypertensive emergency means a markedly raised blood pressure together with ongoing or new organ damage…

…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…

…Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe, myocardial necrosis…

…Myocardial ischemia and infarction Factors that modify infarct size and the natural course in acute myocardial infarction (AMI) The traditional distinction between NSTE ACS (NSTEMI…

…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…

…precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for the prevention…

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

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

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI)…

…infarction (necrosis) . However, unstable angina is considered an acute coronary syndrome because it is an imminent precursor to myocardial infarction. Approximately 50% of patients with…

…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…

…pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment…

…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…

…Important presentations include: Hypotension or shock Acute severe aortic regurgitation with heart failure Cardiac tamponade from haemopericardium Myocardial ischaemia from coronary ostial compromise Focal neurological…

…together with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently develop myocardial necrosis…

…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…

…grade alone does not indicate how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected…

…Measure the plasma glucose immediately in everyone with a reduced level of consciousness, seizures, confusion, a change in behaviour, collapse or an acute neurological deficit…

…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%…

…necrosis. Plaque disruption may also be accompanied by haemorrhage into the plaque. The diagnosis is supported by the general criteria for acute MI together with…

…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…