…intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or…

…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…

…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…

…setting of ST elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes…

…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…

…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…

…Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular hypertrophy or left…

…An anomalous left coronary artery is less common but more malignant than an anomalous right coronary artery. Anomalous origin of a coronary artery from the…

…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…

…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…

…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…

…the conventional 12 lead ECG. These situations are as follows: Transmural ischemia located in the posterolateral portion of the left ventricle . Transmural ischemia located in…

…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…

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…

…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)…

…stroke, coronary perforation, haemodynamic collapse, acute kidney injury, and death. The risk profile differs between diagnostic angiography and PCI, and is strongly influenced by the…

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

…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…

…marked elevation of CK and threatened kidney injury, as an adjunct to the decisive measure: early and generous fluid administration. The benefit of alkalinisation over…

…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…

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

…Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of systemic arterial disease rather…

…and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent distal to the obstruction…

…in other reports. It is more frequent in women and in patients presenting with NSTEMI than in those presenting with STEMI. Approximately one third of…

…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…

…liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's syndrome, haemolysis The R value = (ALT / upper limit of normal…

…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…

…myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or necrosis. It is distinguished from acute myocardial infarction (AMI…

…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…

…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…

…which translocates to the nucleus and induces expression of aldosterone responsive genes. Although the kidney is a major target—where MR activation promotes sodium transport…

…by the gradual accumulation of inert cholesterol debris, modern vascular biology has redefined atherosclerosis as a dynamic, immune mediated fibroproliferative response to endothelial injury [2]…

…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…

…resolution does not consistently permit identification of foamy macrophages. The occurrence of neoatherosclerosis helps explain why ISR and other stent related events may arise well…

…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…

…platelet rich because they form under high shear conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation…

…A normal creatinine can conceal markedly reduced renal function. Acute kidney injury changes clearance from day to day. Reassess the dose daily and follow creatinine…

…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…

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

…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…

…begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical contact, attach continuous rhythm monitoring…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory reactions that promote plaque formation and progression. As the burden of retained…

…aggregation. Because aspirin affects only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The…

…peripheral artery disease (PAD), and other manifestations of systemic atherosclerosis. The principal clinical concern is cerebral embolism or haemodynamic compromise leading to transient ischaemic attack…

…with homozygous FH typically die from acute myocardial infarction at 20 to 30 years of age. People with familial hypercholesterolemia have no other metabolic aberration…

…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…

…arteries. It frequently coexists with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous…