…rehabilitation possible, not an alternative to it. See the separate guide to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff…

…characterized by short, rapid bursts of atrial activity. In the majority of cases, the arrhythmia is self limiting; however, it may recur and, in some…

…for pathological R wave progression is considerably lower than pathological Q waves and guidelines do not state any ECG criteria specific to R wave progression…

…other cardinal symptoms and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not…

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

…However, other inheritance patterns, de novo variants, incomplete penetrance and variable phenotypic expression complicate risk prediction. Familial clustering may also reflect shared environmental or behavioural…

…C pharmacologically has not been shown to reduce cardiovascular events. Very high HDL C may paradoxically be associated with increased risk, and HDL C should…

ECG Myocardial ischemia and infarction Myocardial ischemia: cellular changes, ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes…

…failed fibrinolysis Immediate rescue PCI The 120 minute limit is a ceiling for the choice between primary PCI and fibrinolysis, not an acceptable routine target…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the effect of anticoagulants, increasing bleeding risk. Monitor coagulation…

…maintenance treatment. The source material does not specify the loading dose. Efficacy and harms In secondary prevention trials involving patients with previous vascular disease, aspirin…

…containing lipoproteins, including: LDL Intermediate density lipoprotein (IDL) Lipoprotein(a) [Lp(a)] Very low density lipoprotein (VLDL) Chylomicrons and other triglyceride rich particles Thus, non…

…effect is relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to…

…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…

…release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin, so biomarker interpretation…

…blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However, association is not the…

…ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably…

…and cerebral involvement. Catecholamine excess and drug related presentations Severe hypertension may result from phaeochromocytoma, monoamine oxidase inhibitor crisis, cocaine intoxication, or other sympathomimetic exposure…

…myocardial infarction and stroke Likelihood of repeat revascularization Symptom burden and treatment goals Diabetes, left ventricular function and other comorbidities Surgical risk and contraindications to…

…Typical symptoms include: Ischaemic rest pain. Coldness or numbness of the foot and toes. Pain that is worse at night or when the limb is…

…with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption…

…with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2:1 block will be difficult…

…sided chest leads (V1, V2). Right ventricular hypertrophy causes large R waves in right sided chest leads and deeper S waves in left sided leads.

…display ST segment elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions (such as…

…measured. Continuous wave Doppler is therefore not limited by pulse repetition frequency (PRF). Figure 1. The principles of continuous wave Doppler and pulsed wave Doppler…

…annihilate each other, producing two gamma photons emitted in opposite directions. PET scanners detect these gamma rays to construct images with high spatial and temporal…

…currents are not strong enough to be detected on leads with opposite angle of observation. Other vectors may interfere with the injury currents, and inhibit…

…electrically dissociated from each other. This condition is referred to as atrioventricular (AV) dissociation. Importantly, for the ventricles to have any electrical (and thus pumping)…

…index 15–19 kg/m² 17–22 kg/m² Ideal and dosing weight Drug dosing often requires a weight other than the actual body weight…

…other DOACs are possible according to FASS, but the documentation is insufficient; check more frequently. Warfarin is often preferable <15 or dialysis DOACs are not…

…the periosteum that hurts, not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small…

…plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure and central venous…

…3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4. Protect the surroundings with petroleum jelly and, where necessary, a…

…not exclude myasthenia gravis. Today the test plays a marginal role in Sweden. Edrophonium is available only as a named patient (licensed import) product, and…

…then 100 mg × 1 5–7 days Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always…

…coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…the result is unexpected or does not fit the clinical picture. 4. Where possible, take the plasma osmolality, urine osmolality and urine sodium before treatment…

…not function. The tests that reflect the synthetic function of the liver are the prothrombin time (INR) , the albumin and the bilirubin — and they become…

…pregnant women, patients after allogeneic stem cell transplantation and patients treated with CAR T cells or other advanced immunotherapies may require separate local protocols. Definition…

…liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and to the left

…to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position also works and is…

…Poisoning with other weak acids where the poison control centre recommends it, for example certain phenoxy acid herbicides (2,4 D, MCPA) and methotrexate overdose…

[calc_aorta] Sinus of Valsalva (SOV) and Aortic Root Assessment The sinus of Valsalva diameter (SOVd) is a critical measurement in evaluating aortic root morphology…

…score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED, HEMORR2HAGES, and ORBIT scores. Each…

…AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and age rather than sex alone. Consequently…

…used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such as HEMORR2HAGES, ATRIA, ORBIT, and GARFIELD AF scores…

…with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and HAS…

…the sensitization of sensory nerve endings due to the accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins, such as substance P…

…is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial…

…haemodynamic collapse, and death. The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The…

…heart failure, cardiovascular mortality and atrial fibrillation. Consequently, alcohol should not be initiated as a cardiovascular preventive strategy. A drink equivalent contains approximately 12–14…

…cells and macrophages; a thin fibrous cap; positive remodelling; neovascularization; intraplaque haemorrhage; adventitial inflammation; spotty calcification. Nevertheless, the presence of these features does not imply…

…important. Cardioversion is generally not immediately indicated if the patient remains significantly decompensated, because recurrence is frequent while the precipitating haemodynamic and sympathetic abnormalities persist…

…pressure is not markedly elevated. These apparent J shaped associations are considered unreliable for guiding treatment because of potential confounding, reverse causality, and the association…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…SCORE2 and SCORE2 OP apply SCORE2 and SCORE2 OP are intended for apparently healthy people or for individuals with elevated BP who do not already…

…during effective decongestion and overall clinical improvement does not necessarily indicate an adverse outcome. Classification of CKD CKD severity is classified by eGFR and albuminuria…

…prevention because of fatal infections and high cost. Low dose methotrexate did not reduce cardiovascular outcomes, and several other agents, including pexelizumab, losmapimod and darapladib…