…or non cardiac . The term “atypical” is discouraged because it may understate the possibility of ischaemia. A focused history should establish: Quality of the discomfort…

…mid cavity , and apical . These three parts are divided into a total of 17 segments (Figure 1). Six basal segments, constituting 35% of myocardial mass…

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

…Epigastric or subxiphoid pain may be mistaken for indigestion. Associated manifestations include: Sweating Nausea and vomiting Anxiety A sense of impending doom When STEMI begins…

…on the coronary arteries. The tumors can be asymptomatic for a long time and be detected randomly when investigating other conditions. More dramatic onset of…

…None All other leads ≥0,03 s and ≥1 mm deep (or QS complex) Individuals with electrical axis 60–90° often display a small q…

…as exercise ECG or exercise tolerance test . Because the vast majority of all exercise stress tests in the United States are performed using a treadmill…

…in subsequent chapters. Stroke volume (SV) Stroke volume is the volume of blood pumped from the left ventricle into the aorta during systole. It is…

…than a routine referral being made. Two or more magnets constitute the same kind of urgency by a different mechanism. They attract one another through…

…accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI. QTc prolongation The QT (QTc) interval may be prolonged, shortened or…

…on intubation early. Initial assessment Confirm that the presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and…

…anemia associated with neurological findings, renal failure, or fever. It's a potentially fatal condition that requires prompt treatment, including plasmapheresis. Interference with Platelet Function…

…a variant inherited from a parent. A de novo variant. Less commonly, autosomal recessive inheritance. X linked or other non autosomal dominant mechanisms. Complex or…

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

…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…

…diagnosis at a non PCI hospital to wire crossing As quickly as possible, primary PCI if the total expected time is 120 minutes or less…

…other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a…

…to patients with a history of asthma, rhinitis, or urticaria triggered by: Acetylsalicylic acid (aspirin). Other non steroidal anti inflammatory drugs (NSAIDs). Other contraindications: Hemophilia…

…of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet activation and aggregation contribute…

…many studies, although the relative advantage of apoB over non HDL C or standard lipid testing remains unsettled. In a large population study, LDL C…

…does not reduce cardiovascular or all cause mortality. Reported relative effects include: Approximately 11% reduction in cardiovascular events in a meta analysis of primary prevention…

…DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low…

…among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However, association is not the same as causation . A cause is…

…is DAPT for 12 months, generally consisting of low dose aspirin and a potent P2Y12 inhibitor, preferentially prasugrel or ticagrelor. This strategy reflects the substantial…

…cocaine intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of antihypertensive medication, particularly clonidine, can also precipitate a hypertensive crisis. Pregnancy Hypertensive emergencies in…

…left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment…

…is a manifestation of systemic arterial disease rather than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral…

…electronic cigarettes or other inhaled products. Readiness to attempt cessation. Depression, schizophrenia, schizoaffective disorder, HIV infection or other circumstances that may affect cessation or treatment…

…Note that with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2:1 block will…

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

…elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions (such as bundle branch blocks…

…two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave…

…SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a six hour half life allowing high doses for better image quality. this tracer diffuses passively into cardiomyocytes…

…upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other hand, are much…

…the QRS complexes. The QRS complexes may be normal or wide. P waves have constant PP interval and ride straight through the strip, without any…

…index 15–19 kg/m² 17–22 kg/m² Ideal and dosing weight Drug dosing often requires a weight other than the actual body weight…

…The other DOACs are possible according to FASS, but the documentation is insufficient; check more frequently. Warfarin is often preferable <15 or dialysis DOACs are…

…the needle may perforate into the mediastinum. The anterior superior iliac spine is a second line alternative in marked obesity or when the supine position…

…incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of central venous pressure…

…in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is needed for management. Cryoglobulinaemia…

…or the number of seconds the patient can hold the head lifted off the couch. Filming before and during the test is helpful. A test…

…IV Standard dose after stabilisation or piperacillin–tazobactam 4 g × 4 IV plus gentamicin 5–7 mg/kg IV as a single dose Urosepsis with…

…an intensive care unit, a coronary care unit or another setting that allows frequent blood pressure measurement and continuous monitoring. An arterial line is often…

…a meal or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other…

…other acute causes, for example hypoglycaemia, poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or…

…pregnancy or malignancy. A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of…

…lactate. Add a blood gas, coagulation tests and other investigations according to the clinical picture 5 Take cultures or molecular tests from the suspected focus…

…A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy. Tamponade is a clinical diagnosis supported by…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…pacing: burns or wounds in the area where the pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous…

…with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and at the same time reduces the passage of salicylate into the…

…calc_aorta] Sinus of Valsalva (SOV) and Aortic Root Assessment The sinus of Valsalva diameter (SOVd) is a critical measurement in evaluating aortic root morphology…

…4 2.6% High risk 5 or more 5.8% Interpretation of ATRIA risk score. Comparison with other bleeding risk models Several bleeding risk assessment…

…more closely associated with other comorbidities and age rather than sex alone. Consequently, the CHA₂DS₂ VA score was developed to provide a more accurate risk…

…with a maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension, impaired renal or…

…educed platelet count or function (1 point) R e bleeding risk, i.e., prior bleeding (2 points) H ypertension, uncontrolled (1 point) A nemia (1…

…subcutaneous or submucosal tissues, most frequently involving the face, lips, tongue, and upper airway. Due to the risk of airway compromise, it represents a medical…

…produce a transient and reversible mismatch between myocardial oxygen demand and blood supply, generally during exertion, emotional stress, or another stressor. Manifestations include angina, other…

…Syncope or altered clinical status Comorbid cardiopulmonary disease, active cancer, and other conditions incorporated into validated clinical risk tools Acute RV failure is a rapidly…

…Representative quantities are a 12 ounce regular beer containing approximately 5% alcohol, 5 fluid ounces of wine containing approximately 12% alcohol, or 1.5 fluid…