…normally need investigation on the basis of an isolated, asymptomatic low sensor reading alone. Symptoms Autonomic symptoms Early warning symptoms are due to sympathetic activation…

…Repeat on the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip…

…A documented decision on the ceiling of care. Signs of a serious condition Finding Significance : : Inability to speak in full sentences Marked work of breathing…

…and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure sores…

…about to stop breathing. Diminishing wheeze means improvement only if air entry, speech, work of breathing, level of consciousness and PEF improve at the same…

…or below 1.0 × 10⁹/L with an expected fall to below 0.5 × 10⁹/L within 48 hours Profound neutropenia A neutrophil count below…

…pericardiocentesis is at best a bridge to it. A small (under 10 mm), loculated or purely posterior effusion with no safe route for puncture — surgical…

…clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy. Its purpose is to guide clinicians…

…premature ventricular contractions When every other beat on the ECG is a premature ventricular complex (PVC), the rhythm is referred to as PVC in bigeminy…

…has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively insensitive findings. Some patients with subacute tamponade may…

…increased vulnerability to adverse outcomes. It is dynamic and may improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and…

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

…all other cases aligns with the approach used for atrial fibrillation and atrial flutter. Beta blockers, digoxin, and calcium channel blockers may be used to…

…which scenario head tilt chin lift should only be used if other methods fail to open the airway. Figure 1. Methods to open the airway…

…resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according to international guidelines are decompression sickness and sickle cell crisis…

…These estimates should be viewed as approximations due to the following: Registry data indicate that survival is possible with longer periods of no flow ( Rawshani…

…uniform across the HFmrEF population. Some patients have a pathophysiological profile closer to HFrEF, whereas others have features overlapping with HFpEF, including abnormalities of LV…

…to markedly impaired renal function [3]. Urine output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to…

…assistants who rely on such books will realize their shortcomings at their first encounter with an ECG in reality. Books that claim to make it…

…accompanied by a rise and subsequent fall in cardiac specific troponin attributable to myocardial ischaemia. UA presents with compatible ischaemic symptoms but without cardiac specific…

…is indicated in persisting STEMI. 12 to 48 hours: primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia, heart failure…

…arrest due to asphyxia, the probability of return of spontaneous circulation (ROSC) is high but survival is very low, as is the proportion surviving with…

…skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A patient who cannot lie…

…sterile gown, sterile gloves and a large full body drape. Lidocaine 10 mg/mL for local anaesthesia, normal saline to flush all lumens, suture material…

…m² Abnormal urinalysis or renal imaging Risk of progression rises with proteinuria and depends on cause 2 60 mL/min/1.73 m² Abnormal urinalysis…

…patients may rely on continuous biventricular pacing for haemodynamic stability. In patients with resynchronization devices, maintaining CRT during surgery is recommended to provide better haemodynamic…

…myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local…

…fail to demonstrate plaque disruption, intraluminal thrombus, or dissection. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can reveal lesions that are not apparent on…

…Acute myocardial injury , demonstrated by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence…

…does not fall into the other categories. Trauma Cardiac arrest caused by violence, accidents, burns, or other trauma. Drowning Cardiac arrest due to drowning Electrocution…

…neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms require immediate treatment with hypertonic sodium chloride…

…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…

…bradycardia is likely due to drug side effects, it is necessary to weigh the risk of terminating the medication as compared with implanting a permanent…

…receptors. With prolonged alcohol exposure the nervous system adapts through reduced GABA mediated inhibition and increased glutamatergic activity. When the alcohol level suddenly falls, the…

…delayed — may justify charcoal later, in some cases up to 6 hours or more. Discuss this with the poison control centre. Gastric lavage is considered…

…of the R waves. This is believed to be due to delayed (and thus electrically unopposed) depolarization in the ischemic area. Fragmented QRS complex The…

…is recommended. Creatinine levels may rise during treatment with ticagrelor. The mechanism is unclear. Kidney function should be monitored according to clinical practice. Special attention…

…dominant transmission, in which an affected heterozygous individual has a 50% risk of transmitting the relevant variant to each child. However, other inheritance patterns, de…

…in addition to LDL and other apoB containing particles. Cardiovascular risk categories Primary prevention For adults aged 40–75 years without diabetes and with LDL…

…and ischemia cannot occur. No changes on resting ECG. Increased myocardial workload (exercise) Oxygen supply increases in parallel with increased oxygen consumption during exercise. Thus…

…test; performed on the wrong patient or by an inexperienced examiner it is unreliable. A single central feature is enough to proceed with urgent investigation …

…Use with caution in patients on low dose acetylsalicylic acid for cardioprotection. Pharmacokinetic interactions Methotrexate: NSAIDs inhibit tubular secretion of methotrexate, increasing plasma levels and…

…term interventions intended to reduce recurrent infarction, ischaemic stroke, cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular…

…discordant with LDL C or non HDL C, cardiovascular risk may be misestimated if cholesterol measures alone are used. Risk in these circumstances appears to…

…relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to individuals without…

…embolism or haemodynamic compromise leading to transient ischaemic attack (TIA) or stroke. The risk associated with asymptomatic disease depends substantially on stenosis severity and plaque…

…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…

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

…a potent P2Y12 inhibitor to clopidogrel; reducing the dose of prasugrel; extending DAPT beyond 12 months in carefully selected patients with high ischemic risk and…

…BP reduction is required, these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety, or distress have transient…

…and treatment goals Diabetes, left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator…

…in approximately 40–50%. Distal disease is particularly common in older people and in patients with diabetes. The haemodynamic consequences depend on lesion location, severity…

…as compared with atrial fibrillation, atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial…

…ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out…

…be performed on all patients seeking medical attention due to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include…

…two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave…

…administration. Radiotracers with higher levels of redistribution can move from areas of higher concentration to regions with lower concentration, for reasons other than perfusion differences…

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

…on the ST T segment ( Figure 1 , upper panel). The atrial rate is typically faster than the ventricular rate. It may be very difficult to…

…expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist / hip Men 0.90…