…and a button battery is an emergency — it can cause perforation in seven hours. Indications Every foreign body in the ear canal or the nasal…

…electrical current through the heart. Asphyxia Asphyxia as a result of external causes, for example foreign body, hanging or strangulation. Drug overdose Intentional or accidental…

…Other microorganisms, generally, cause subacute endocarditis. Endocarditis can affect native (own) valves and valve prostheses. As always, foreign materials pose a high risk of infection…

…accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI. QTc prolongation The QT (QTc) interval may be prolonged, shortened or…

…on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and…

…anemia associated with neurological findings, renal failure, or fever. It's a potentially fatal condition that requires prompt treatment, including plasmapheresis. Interference with Platelet Function…

…a variant inherited from a parent. A de novo variant. Less commonly, autosomal recessive inheritance. X linked or other non autosomal dominant mechanisms. Complex or…

…is the principal therapeutic target in lipid management because LDL and other apolipoprotein B containing lipoproteins play a causal role in atherosclerotic cardiovascular disease (ASCVD)…

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

…diagnosis at a non PCI hospital to wire crossing As quickly as possible, primary PCI if the total expected time is 120 minutes or less…

…other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a…

…to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications: Hemophilia…

…of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute…

…many studies, although the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large population study, LDL C…

…disease, or peripheral artery disease. Secondary prevention concerns patients with established vascular disease, in whom aspirin has a substantially more favourable benefit–risk profile. Aspirin…

…DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low…

…or non cardiac . The term “atypical” is discouraged because it may understate the possibility of ischaemia. A focused history should establish: Quality of the discomfort…

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

…is DAPT for 12 months, generally consisting of low dose aspirin and a potent P2Y12 inhibitor, preferentially prasugrel or ticagrelor. This strategy reflects the substantial…

…cocaine intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of antihypertensive medication, particularly clonidine, can also precipitate a hypertensive crisis. Pregnancy Hypertensive emergencies in…

…left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment…

…is a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral…

…electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment…

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

…cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest…

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

…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…

…SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a six hour half life allowing high doses for better image quality. this tracer diffuses passively into cardiomyocytes…

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

…the QRS complexes. The QRS complexes may be normal or wide. P waves have constant PP interval and ride straight through the strip, without any…

…kg/m² Ideal and dosing weight Drug dosing often requires a weight other than the actual body weight. Ideal body weight (Devine): men 50 kg …

…The other DOACs are possible according to FASS, but the documentation is insufficient; check more frequently. Warfarin is often preferable <15 or dialysis DOACs are…

…the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position…

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

…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the test is helpful. A test…

…IV Standard dose after stabilisation or piperacillin–tazobactam 4 g × 4 IV plus gentamicin 5–7 mg/kg IV as a single dose Urosepsis with…

…an intensive care unit, a coronary care unit or another setting that allows frequent blood pressure measurement and continuous monitoring. An arterial line is often…

…a meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other…

…other acute causes, for example hypoglycaemia, poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or…

…pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of…

…lactate. Add a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus…

…A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy. Tamponade is a clinical diagnosis supported by…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…It is a bridge to a permanent pacemaker or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C…

…with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and at the same time reduces the passage of salicylate into the…

…diameter (SOVd) is a critical measurement in evaluating aortic root morphology. Age stratified formulas help determine expected normal values based on body surface area (BSA…

…4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment…

…more closely associated with other comorbidities and age rather than sex alone. Consequently, the CHA₂DS₂ VA score was developed to provide a more accurate risk…

…with a maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or…

…educed platelet count or function (1 point) R e bleeding risk, i.e., prior bleeding (2 points) H ypertension, uncontrolled (1 point) A nemia (1…

…subcutaneous or submucosal tissues, most frequently involving the face, lips, tongue, and upper airway. Due to the risk of airway compromise, it represents a medical…

…produce a transient and reversible mismatch between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another stressor. Manifestations include angina, other…

…Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions incorporated into validated clinical risk tools Acute RV failure is a rapidly…

…Representative quantities are a 12 ounce regular beer containing approximately 5% alcohol, 5 fluid ounces of wine containing approximately 12% alcohol, or 1.5 fluid…

…cells within the arterial intima. Monocytes enter the intima, differentiate into macrophages and participate in a sustained inflammatory response. Lipid accumulation, oxidative stress and immune…

…AF and acute deterioration is often bidirectional. AF with a rapid ventricular response may precipitate or aggravate haemodynamic decompensation, whereas acute illness and increased sympathetic…

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

…Continous medical discussion: the ECG blog Infectious diseases Cardiovascular effects of COVID 19 Coronavirus disease 2019 (COVID 19) has caused a global public health crisis…

…a calculated 10 year risk of ≥10% is considered sufficiently high to support BP lowering treatment, whether through lifestyle intervention, pharmacological therapy, or both. A…