…Haemodynamic instability or cardiogenic shock Life threatening arrhythmias or cardiac arrest after presentation Mechanical complications of myocardial infarction Recurrent dynamic ECG changes suggestive of ischaemia…

…accounting for approximately 80% of cases. Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral…

…mechanical stability. Atherosclerotic lesions commonly arise at sites of disturbed flow, including branch points in the epicardial coronary arteries. Early lesions may undergo positive or…

…of dissection and impaired distal flow. These alternative causes must be distinguished from isolated no reflow because their treatment may require immediate stenting or other…

…acute severe mitral regurgitation, and other mechanical complications. Shock occurs more often when the coronary artery is completely occluded and is particularly associated with MVD…

…be established. Nasopharyngeal airways may cause complications in patients with skull fractures (risk of intracranial malposition of the tube) or coagulopathy (risk of bleeding). An…

…STEMI or PCI requires consideration of several possibilities: Extension of the original infarction or reinfarction Acute native vessel thrombosis Stent thrombosis Mechanical complications of myocardial…

…and risk assessment The evaluation of a patient with AF who may require anticoagulation should establish: Whether AF is clinical or device detected subclinical AF…

…loss of mechanical cardiac function. Results in loss of consciousness, cessation of breathing, and absence of a palpable pulse. Ventricular contraction has ceased or unable…

…agents Platelet transfusion has weak evidence; discuss with the on call coagulation service Always in parallel: mechanical control of bleeding, tranexamic acid where it is…

…Mechanical obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other…

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

…endotracheal intubation, mechanical chest compressions, targeted temperature management, etc.) and are much less effective in terms of the number needed to treat (NNT). The Number…

…region. The time limit is not a guarantee. Where the stroke risk is high or the time of onset uncertain, choose the more cautious course…

…to try yet another dose. Chronotropic support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace…

…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…

…g skeleton, calcifications, mechanical heart valves) and reflect virtually all sound waves, leaving too few waves to explore the area behind the reflector. This results…

…that ensures that no other sound waves affect the transducer. The crystals are supported by a backing layer that suppresses the vibrations of the crystals…

…of neoatherosclerosis helps explain why ISR and other stent related events may arise well after the initial intervention. Mechanical mechanisms Mechanical abnormalities may initiate or…

…researchers compared the effectiveness of milrinone and dobutamine . The primary composite outcome included in hospital mortality, resuscitated cardiac arrest, cardiac transplantation or mechanical circulatory support…

…while others will transfer the mechanical (pressure) energy to the new medium, which may also start to vibrate (Figure 1). Figure 1. The principle of…

…at any age. Exercise, or any other activity causing adrenergic stimulation, increase the risk of syncope, ventricular arrhythmias and sudden cardiac arrest. ARVC can cause…

…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…

…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…

…treatment with ticagrelor. Caution is advised for patients with hyperuricemia or gout. Use of ticagrelor is discouraged in patients with uric acid nephropathy. Thrombotic Thrombocytopenic…

…from: Incomplete penetrance of a variant inherited from a parent. A de novo variant. Less commonly, autosomal recessive inheritance. X linked or other non autosomal…

…and the magnitude of LDL C reduction. Thus, even a modest absolute reduction may be clinically important in individuals at high or very high risk…

…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…

…lead ECG within 10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood…

…test and the absence of other neurological findings. The treatment is a repositioning manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so…

…NSAIDs). Other contraindications: Hemophilia. Thrombocytopenia. Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy…

…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…

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

…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…

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

…and other symptoms may occur without chest pain and should be considered anginal equivalents. The emergency evaluation of non traumatic chest discomfort is structured around…

…example, high HDL cholesterol levels appears to be beneficial, whereas triglyceride levels seem to be of little or no importance for atherosclerosis. When discussing atherosclerosis…

…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…

…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…

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

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

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

…hours, or days. In the vast majority of cases, the re entry circuit in atrial flutter is located in the right atrium and it typically…

…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…

…of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or…

…1). This is possible by using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves…

…designed to identify ischemic areas of the myocardium by highlighting regions with reduced blood flow. Radiotracers for SPECT Technetium 99m (Sestamibi or Tetrofosmin): With a…

…repolarization or even early phases of ischemia). To conclude, concave ST segment elevation is atypical of ischemia, but they do not rule out ischemia. Other…

…features of third degree AV block On the ECG P waves have no relation to the QRS complexes. The QRS complexes may be normal or…

…in oedema and ascites, and in people under 18 years of age, where iso BMI or percentile charts should be used. Waist circumference Measure the…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…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…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline 200 mg × 1…

…Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit, a coronary care unit or another setting that…

…can swallow safely. 4. Give intravenous glucose if the patient has a reduced level of consciousness, is having seizures or cannot swallow. 5. If there…

…5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6. Document the…

…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…

…abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the febrile…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…