…in detail in other chapters, to which links are provided throughout the text. Heart rate During the first week of life, the heart rate is…

…fluid (exudate) to pure blood (exudate). Often pericardial effusion is detected randomly (for example, in CT, MRI, echocardiography). In other cases, the effusion is detected…

…anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine. The anterolateral position…

…a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific: motor neurone disease…

…injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access site to the aortic root, engaging the…

…first passage through the circulation. Due to this rapid clearance, adenosine must be administered as a rapid intravenous bolus. Unlike many other intravenous medications where…

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

…or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint. Known hypersensitivity to the…

…bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin…

…up of the foci of infection. Vegetations can be found on the flaps and appear as moving masses. Mural vegetations are attached to the endocardium…

…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…

…attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes. Mechanisms of action Colchicine Colchicine appears to…

…managed in the ICU. Post resuscitation care requires expertise and resources to diagnose, monitor and manage neurological injuries, hemodynamic and respiratory instability, multiorgan failure, infections…

…tend to accompany each other, the term perimyocarditis is often used. Image by Bruce Blausen, Blausen Gallery 2014. Causes of acute pericarditis/myocarditis The most…

…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 …

…depression. Sinus tachycardia. Refer to Figure 1 . Figure 1. Electrical alternans in patient with cardiac tamponade. The ECG shows varying QRS and T wave amplitudes.

…crucial task is to distinguish three types of sinus tachycardia. These types differ fundamentally in terms of pathophysiology, prognosis, and treatment. The types of sinus…

…and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an…

…but avoid sampling that delays antibiotics 6 Take a targeted history and examine the patient, with particular attention to the mouth, throat, skin, perianal region…

…other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco and ultimately…

…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…

…anaemia and other nephrotoxic exposures may contribute to tubular injury, making attribution to contrast alone difficult. In patients with normal renal function, the occurrence of…

…ACS), the early post event period is particularly vulnerable, and delayed intensification of lipid lowering therapy may leave patients exposed to avoidable risk. Contemporary guidance…

…antipsychotics, which mainly affect individual symptoms. Initial management ABCDE and immediate tests Assess the withdrawal and other life threatening conditions at the same time. Sec

…Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating…

…not routinely to a normoxic patient Temperature Treat fever and look for an underlying infection Swallowing Keep the patient nil by mouth until swallowing has…

…given to selected patients with an eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial…

…only in the presence of clinical signs of infection — all chronic wounds are colonised, and a culture taken without clinical suspicion leads only to unnecessary…

…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…

…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…

…other substances (including alcohol) causing cardiac arrest. Table 1. Classification of causes of cardiac arrest according to the Utstein protocol. Figure 1. Data from the…

…notions. Pathological Q waves may resolve in up to 30% of patients with inferior infarction. The amplitude of Q waves may also diminish over time…

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

…intraventricular conduction delays were at particularly high risk of death due to arrhythmias. Note that other causes of wide QRS complex must always be considered…

…from risk factors to acute coronary syndromes. It also presents a classification of acute coronary syndromes and myocardial infarctions. The reader should study this chart…

…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…

…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…

…or a prior heart attack and a high risk of developing an atherothrombotic event. Contraindications Hypersensitivity to the active substance or any excipient. Active bleeding…

…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…

…combined dyslipidaemia, non HDL C is particularly relevant because it captures triglyceride rich lipoproteins in addition to LDL and other apoB containing particles. Cardiovascular risk…

…the supply and demand of ATP; increased cardiac workload results in increased ATP production and vice versa. Importantly, cardiac myocytes require aerobic metabolism (oxygen) to…

…than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed by direct transfer to a PCI centre [1,5]. Situation Practical target…

…Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or…

…NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy…

…with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute importantly to arterial thrombus formation…

…non HDL C primarily reflect cholesterol content. The amount of cholesterol carried by individual particles varies according to particle size and composition. As a result…

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

…of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low, screening has not been shown to…

…is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin, so biomarker interpretation must be integrated with the clinical history…

…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…

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

…Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent or nonspecific Treatment setting Usually hospital…

…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…

…exert themselves sufficiently to provoke symptoms. Intermittent claudication Intermittent claudication is exertional discomfort in a limb muscle that improves with rest. The symptom may be…

…atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial flutter is caused by a…

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

…attention due to chest discomfort or other symptoms that may be caused by myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm…

… one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave Doppler and pulsed wave Doppler is…

…radiotracers emit gamma photons directly. These gamma rays are detected by gamma cameras to create tomographic images of the left ventricle. In PET (Positron Emission…