…more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of lymphoma and myeloma. Suspected bone marrow metastasis. Assessment of…

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

…dependent. Similarly, angioedema occurring in the setting of ACE inhibitor therapy is bradykinin mediated rather than mast cell mediated, distinguishing it from classic allergic reactions…

…aborts most attacks within 15–20 minutes. An undrained pneumothorax. A high oxygen concentration washes nitrogen out of the pleural air and speeds resorption. Other…

…Most patients, however, display both ECG changes and symptoms. Troponins and other biomarkers of myocardial necrosis (infarction) Myocardium can endure 20 to 30 minutes of…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

…with CAR T cells or other advanced immunotherapies may require separate local protocols. Definition Criterion Practical definition : : Fever A single temperature of at least 38…

…local revascularization must be accompanied by systemic treatment aimed at stabilizing the broader atherosclerotic disease. Pathophysiology Mechanisms of acute coronary syndrome The major mechanisms producing…

…state, or brain death. The cause of brain injuries is anoxic cell death, continued dysfunction in cerebral blood flow (autoregulation) after ROSC and cerebral hypoperfusion…

…tomographic images of the left ventricle. In PET (Positron Emission Tomography), radiotracers emit positrons. When a positron collides with an electron, they annihilate each other…

…neuronal cell death starts within 5–6 minutes. Biological death usually occurs within minutes thereafter; survival is highly unlikely after 8–10 minutes of no…

…parasternally and apically, and choose the site where the rim of fluid is widest and lies most superficially, where the distance from the skin is…

…potassium and calcium channels of the outer cell membrane. Clinical presentation of Brugada syndrome Most patients are asymptomatic until the age of 20 to 55…

…means that ECG leads with similar angles must display similar ECG curves (diagrams). For some purposes (e.g. diagnosis of some arrhythmias) it is not…

…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…

…coronary artery spasm, coronary microvascular dysfunction (encompassing endothelial dysfunction, smooth muscle cell dysfunction, and dysregulation of sympathetic innervation), coronary embolism, and spontaneous coronary artery dissection…

…other situations than does ventricular rhythm; idioventricular rhythm is primarily seen after reperfusion in an occluded coronary artery. It also occurs as side effect of…

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…

…plugging. Expiratory flow limitation causes air trapping and dynamic hyperinflation. The consequences are increased work of breathing, exhaustion and, in the most severe cases, hypotension…

…Use of synchronized electric shock (i.e. a shock synchronized to the QRS complex). Typically used to treat atrial fibrillation, ventricular tachycardia, and other tachyarrhythmias…

…sodium loading. It is the most common form of secondary hypertension. Aldosterone acts principally through the mineralocorticoid receptor (MR). After entering target cells, it binds…

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

…J point to the onset of the T wave. Because of the long duration of the plateau phase most contractile cells are in this phase…

…must not delay reperfusion. 5. Give aspirin if acute coronary syndrome is likely and aortic dissection or active major bleeding is not suspected. 6. Call…

…On the other hand, sinus bradycardia developing during physical exercise is considered abnormal, because heart rate must increase during exercise. Mechanisms of cardiac arrhythmias The…

…majority of these are genes encoding desmosomal proteins . The desmosome is a component of the intercalated disc that connects myocardial cells mechanically and electrically. Most…

…clinical trials) have suggested the benefit of ischemic preconditioning, while other studies have failed to establish such a relation. The most cited study to date…

…and other emergency instruments. Personnel conducting the test must be formally trained to assess cardiovascular response, symptoms, and ECG changes. Although the risk of cardiac…

…and the most common cause of sinus arrest/pause. It commonly affects younger individuals who endure intense emotional stress, acute pain or other stimuli that…

…causes of sinus bradycardia In all other situations, sinus bradycardia should be regarded as a pathological finding. Numerous pathological conditions cause sinus bradycardia. The most…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…largely driven by coronary microvascular dysfunction, also contributes to the extension and severity of ischemic injury. In its most severe form, known as no reflow…

…local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or uncertainty…

…because urea crosses cell membranes relatively freely and therefore does not produce the same sustained shift of water [3]. Severity of DKA The classification helps…

…or frequent blood gases are needed 3 Blood grouping and cross matching. Order red cells early with ongoing major bleeding 4 Tests: haemoglobin, platelet count…

…favorable prognosis, as compared with other forms of ventricular tachycardia. Mechanisms of ventricular tachycardia Ventricular tachycardia (VT) may emerge due to increased/abnormal automaticity, re…

…recording, the amplitude must be increased in order to suggest ischemia. Inverted U waves are even more typical of ischemia (but the sensitivity is low)…

…electrical impulses at a rate exceeding that of the sinoatrial (SA) node. This enhanced atrial activity is most commonly attributable to abnormal automaticity or re…

…10 people must be treated to save 1. Thus, the greatest opportunities exist in the first few minutes, which is within the reach of bystanders…

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

…the apex. Please note that for most clinicians it is not necessary to be able to determine the direction of the re entry loop. Figure…

…SV aorta – SV mitralis Grading of the severity of stenoses using the continuity equation All valvular stenoses must be graded in order to optimize management…

…sequential activation of the piezoelectric crystals. The crystals are activated from one side to the other, as illustrated in Figure 2. The sequence of activation…

…posterior circulation stroke is the most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause…

Procedurer The ankle brachial index is the cheapest and most accessible method of objectively demonstrating peripheral arterial disease, and it is needed more often than…

…itself. It may cause symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other thromboembolic events. Subclinical…

Cardiology Clinical medicine Definition and Clinical Context Blood pressure management in older adults must account for chronological age, biological age, frailty, multimorbidity, cognitive status, functional…

…risk factor [2] . This change reflects robust evidence that female sex alone, in the absence of other comorbidities, does not significantly increase stroke risk. Conversely…

…myocardial ischemia. Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An…

…of cases in one large study, while variants of uncertain significance were found in a further 44%. Truncating variants in TTN are among the most…

…there are numerous other causes of chest pain, but the other causes are either subacute or non acute. The history taking must be systematic and…

…Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and AVRT (pre excitation, WPW syndrome) being the most common. Atrial fibrillation with…

…22 above 70 years, and reduced food intake together form the basis of most screening instruments and should prompt a nutritional assessment. See also unintentional…

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

…drug constitutes single antiplatelet therapy (SAPT). The benefit of antiplatelet therapy must always be balanced against bleeding. This balance changes according to the clinical setting…

…within all apoB containing particles. ApoB estimates the number of atherogenic particles. For most individuals in whom these measurements are concordant, their clinical utility is…

…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…

…patterns are the overall combinations of foods habitually consumed rather than isolated nutrients considered independently. For cardiometabolic health, the most favourable patterns generally contain more…

…Those of us who have read guidelines may agree with those viewpoints. Going through some guidelines the other day I realized that they are indeed…