…infection or other circumstances that may affect cessation or treatment monitoring. Single question screening can identify unhealthy drug use requiring counselling regarding cardiovascular effects and…

…Untreated delirium tremens has historically carried a high mortality. With modern sedation, supportive treatment and treatment of the precipitating illness the prognosis is considerably better…

…bifurcation involvement Coexisting multivessel disease The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of possible revascularization…

…or other symptoms suggestive of the five conditions listed above. It is important that history taking and physical examination is carried out systematically and carefully…

…with established clinical ASCVD require LDL C lowering to reduce recurrent major cardiovascular events, including myocardial infarction, stroke, peripheral arterial disease events and mortality. The

…of infection on the flap is called vegetation. As a rule, some kind of damage to native (own) valves is required to become vulnerable and…

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

…be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile response. A neutropenic patient with a suspected infection and organ…

…tendon and the patellar tendon — do not inject into or beside them. Anticoagulant treatment is not a contraindication to these superficial injections. Preparation and equipment…

…compression. Infection in the skin overlying the puncture site. Previous pelvic irradiation on the intended side (yields fibrotic, unrepresentative marrow — choose the other side). A…

…of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…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…

…with several simultaneous renal insults. Infection, hypovolaemia, cardiac dysfunction, haemodynamic instability, anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast…

…Epiglottitis and other severe upper airway infection cefotaxime 1–2 g × 3 IV Depends on the diagnosis Always assess the severity clinically, whatever the DS…

…clinical signs of herniation halt the puncture, and antibiotics and a corticosteroid are then given immediately after blood cultures. For questions other than acute meningitis …

…block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need is more…

…abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected…

…intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel occlusion, dissection or other vascular pathology…

…tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of renal function Doxycycline, erythromycin, clindamycin, metronidazole, moxifloxacin and fusidic…

…and measure the ankle brachial index with Doppler. 4. Culture only in the presence of clinical signs of infection — all chronic wounds are colonised, and…

Myocardial ischemia and infarction Procedurer Definition and Clinical Role Invasive coronary angiography (ICA) is a catheter based investigation that visualizes the coronary arterial tree after…

…Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes…

…few randomized trials and the evidence is often conflicting. Many recommendations are therefore based on observational data, expert opinion, or extrapolation from other fields (e…

…Differentiating acute pericarditis and acute ST elevation myocardial infarction (STEMI) The retrosternal chest pain caused by acute pericarditis may be very similar to that seen…

…obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked…

…and infarction Definition and Pathophysiology Intravascular imaging comprises catheter based techniques that directly visualize the coronary lumen, vessel wall, plaque, thrombus, and implanted stents. The…

…Syndrome]); blocking AV node conduction may result in accelerated transmission of atrial impulses to the ventricles and thus ventricular fibrillation and cardiac arrest. High degree…

…tamponade. Causes of pericardial effusion and cardiac tamponade The most common cause of pericardial effusion is infections, such as viral, bacterial, and tuberculous infections. Post…

…complex and the P wave is positive in lead II. Sinus tachycardia is always considered pathological and the underlying cause must be investigated. Pain, infections…

…order to evaluate ventricular function, since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management…

…tests and other radiological examinations are most often required, in particular computed tomography (DT) and/or magnetic resonance imaging (MRI). Anatomy of the pericardium The…

…after all other causes have been ruled out. Inappropriate sinus tachycardia is presumably more common than previously thought and the condition may hamper the quality…

…tachycardia and should not be used. Specific dosing adjustments are required in certain patient populations: Pediatric patients: For patients weighing less than 50 kg, the…

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

…evidence of infarction caused by ischaemia, and no obstructive stenosis in a major epicardial coronary artery. Non obstructive disease is generally defined as the absence…

…ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source…

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

…recommended that the 12 lead ECG (conventional ECG) be used for interpretation of ischemia. All available ECG criteria for acute myocardial infarction and ischemia are…

…a primary differential diagnosis and presents with distinct characteristics compared to transmural ischemia [4, 5]. Acute Pericarditis vs. Acute Myocardial Infarction The ST segment elevation…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

…factors: The stage of the ischaemic process: acute, evolving or chronic The severity of ischaemia and whether infarction has occurred The extent and degree of…

…changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of complete ischemia. After this period the…

…may originate from other branches of the same coronary artery or another coronary artery, will alleviate the ischemia, improve myocardial function and increase resistance to…

…breathlessness. Other less common presentations, with or without pain, include sudden loss of consciousness, a confusional state, profound weakness, the appearance of an arrhythmia, evidence…

…they represent coronary atherothrombotic events in the setting of a stent thrombosis or restenosis. Type 1 myocardial infarction Definition and pathophysiology Type 1 MI results…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…the other hand, may only display ST depressions and/or T wave inversions. STE ACS (ST Elevation Acute Coronary Syndrome) & STEMI (ST Elevation Myocardial Infarction…

…infarction) Lead Definition of pathological Q wave Normal variants V2–V3 ≥0,02 s or QS complex None All other leads ≥0,03 s and…

…Infarction (NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE ACS (Non ST Elevation Acute Coronary Syndromes) . This chapter deals with the…

…transmural ischemia. On the other hand, leads V1–V3 (occasionally V4) may detect the injury currents and present them as ST segment depressions. These depressions…

…driven by platelet derived growth factor (PDGF) and other cytokines. Within the intima, SMCs undergo a phenotypic switch from a contractile to a synthetic state…

…the ischemic ST T changes on ECG. In summary, left bundle branch block (LBBB) can result from, mimic, or obscure acute myocardial ischemia and infarction…

…to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard post ACS…

…other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The…

…myocardial infarction, or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and…

…stroke and myocardial infarction occur in fewer than 1%, while mortality is generally below 0.1% in contemporary series. Reported risks vary according to the…

Myocardial ischemia and infarction Definition and Pathophysiology No reflow is impaired anterograde myocardial perfusion despite the absence of a flow limiting epicardial coronary stenosis. It…

…coronary microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other mechanisms capable of obstructing coronary arteries include…

…in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), myocardial infarction, and repeat…