…and coeliac serology , together with ultrasound of the liver and biliary tract . Go through the medication and any herbal preparations carefully — drug induced liver injury…

Njurmedicin Lathundar Acute management on call Acute kidney injury, AKI, is a syndrome of rapidly deteriorating renal function. Management is governed not by the creatinine…

…laboratory medicine Myocardial ischemia and infarction Definition and pathophysiology Myocardial infarction (MI) is a clinical diagnosis that integrates myocardial injury, evidence of acute myocardial ischaemia…

…and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer, aortic pseudoaneurysm and traumatic aortic injury…

…al, JAMA Cardiology (2020). Guo et al reported that 27.8% (52 of 187 patients) had myocardial injury, defined as elevated troponin T levels (TnT)…

… female sex; low body mass index; larger arterial sheaths; greater intensity of procedural anticoagulation; complex coronary anatomy and technically difficult PCI. For peri procedural stroke…

…many cases, the renal injury probably represents acute tubular necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The…

…or initiation of ECMO. The syndrome was first described by Negovsky , who identified four processes that defined the victim's outcome: Neurological injury Myocardial dysfunction…

…Gufoni manoeuvre for treatment. Contraindications Absolute: Unstable cervical spine injury, recent cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis…

…and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic alkalosis or an arterial…

…zone. Coronary Occlusion and Myocardial Injury STEMI generally results from abrupt reduction in coronary blood flow caused by thrombotic occlusion of a previously atherosclerotic artery…

…pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE comprises four clinically useful groups: High risk…

…true bradyarrhythmic or asystolic arrest from other tachyarrhythmic events. On the surface electrocardiogram, sinus bradycardia may appear at rates of 40 to 48 beats per…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…sedentary behaviour and loss of independence. Identification of PAD also provides an opportunity to recognise atherosclerosis in other arterial territories and to initiate secondary prevention…

…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…

…acute aortic dissection, thrombosis of a graft or aneurysm, popliteal artery entrapment, trauma, phlegmasia cerulea dolens, ergotism, hypercoagulable states or iatrogenic vascular injury. Acute occlusion…

…ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by ischaemia, and no obstructive stenosis in a major epicardial coronary artery. Non…

…Myocardial vulnerability, largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as…

…the efficacy of diuretics and antihypertensives. Risk of acute kidney injury increases when combined with ACE inhibitors. Corticosteroids and other NSAIDs: Increased risk of gastrointestinal…

…Types 2–5 MI have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis…

…association with other procedural complications, including distal embolization, coronary dissection, perforation, and abrupt closure. The clinical consequences depend heavily on the amount of viable myocardium…

…obstruction of epicardial coronary arteries. Endothelial dysfunction, coronary microvascular disease and vasospasm may coexist with atherosclerosis or may be the dominant cause of ischaemia. Other…

…of myocardial infarction. Cardiac troponin T and troponin I have emerged as the preferred biomarkers because they are extremely sensitive and specific for myocardial injury…

…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…

…Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with AF in the setting of ACS…

…Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated…

…Other congenital anomalies include anomalous origin of a coronary artery from the pulmonary artery and anomalous origin of one coronary artery from the opposite aortic…

…is a common and early electrocardiographic sign of acute pericarditis, reflecting pericardial involvement overlying the atria [4, 5]. Other Differential Diagnoses ST segment elevations simulating…

…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…

…macrophages, neurons and other tissues. This distribution helps explain why PA produces cardiovascular injury beyond its effects on blood pressure and potassium balance. The principal…

…progressive, and highly complex lipid driven inflammatory disease of the arterial intima that serves as the fundamental pathophysiological substrate for acute coronary syndromes (ACS), including…

…inflammation and other systemic influences. The severity of myocardial injury is determined not only by the epicardial obstruction but also by the vulnerability of the…

…concentration washes nitrogen out of the pleural air and speeds resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according…

…start of dialysis < 0.3 mL/kg/h for ≥ 24 h, or anuria ≥ 12 h Other kidney related values The fractional excretion of sodium…

…drinking in either sex. Other definitions of unhealthy drinking include at least two drinks daily in women or three in men, or at least four…

…represents a form of arterial hyperplastic disease arising after percutaneous coronary intervention (PCI). In contemporary practice, ISR remains the most frequent cause of PCI failure…

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

…closer monitoring — the patient cannot feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with…

…Concussion, temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This corresponds to the principles of TiTrATE, in…

…Coronary arterial thrombi are predominantly platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes…

…occur simultaneously (if both territories are affected by the same artery occlusion). Approximately 30% of patients with posterolateral infarction will also have right ventricular infarction…

…vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess…

…if there is suspicion of cervical spine injury, in which scenario head tilt chin lift should only be used if other methods fail to open…

…Oral vancomycin (only for C. difficile) is likewise dosed independently of renal function. Require drug concentration monitoring Drug Comment : : Vancomycin (intravenous) Loading dose by weight…

…or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or suspected oesophageal perforation Gastric lavage Petroleum products Gastric…

…ischemia. Inverted U waves are even more typical of ischemia (but the sensitivity is low). U wave changes always accompany other ischemic ST T changes…

…Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the blood…

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

…Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease…

…benefit of therapy. Lifestyle modification is appropriate across the risk spectrum. Statin therapy is considered when the anticipated benefit is sufficient, with coronary artery calcium…

…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…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…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…

…disease (ASCVD). Atherosclerosis develops through the progressive deposition and retention of LDL C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory…

…other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention refers to individuals without established atherosclerotic cardiovascular disease (ASCVD), coronary artery…

…two vascular beds. Carotid disease therefore commonly coexists with coronary artery disease (CAD), peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal…

…three main questions discussed in media, blogs and on social plattforms: Is high cholesterol a true cause of coronary artery disease? Does diet affect cholesterol…

…from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI or other very high risk features. Noninferiority studies…

…coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass…