…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)…

…to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can otherwise be hard to see, particularly when the patient…

…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…

…value normalised to body surface area — the difference is substantial in very small and very large people. Acute kidney injury (KDIGO) Stage Creatinine Urine output : : :…

…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…

…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…

…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…

…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…

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…

…ostia. It remains the reference standard for defining the extent of coronary artery disease because it provides anatomical information while permitting functional assessment and, when…

…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…

…Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic…

…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…

…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…

…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…

…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…

…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…

…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…

…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]…

…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…

…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…

…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…

…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…

…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…

…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…

…the clinical importance of non fatal gastrointestinal and intracranial haemorrhage is substantial, particularly because the absolute cardiovascular benefit is small in many primary prevention populations…

…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…

…left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures…