…device damage. Oversensing is more likely with unipolar leads. Electrocautery is the most frequent source of EMI, although radiofrequency procedures, nerve stimulators, and other electronic…

…80 years. This was expressed in 1961 by Beck et al in the Journal of American Medical Association (JAMA): [...] Of every 10 such victims, the…

…order to evaluate ventricular function, since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management…

…to transient ischaemic attack (TIA) or stroke. The risk associated with asymptomatic disease depends substantially on stenosis severity and plaque characteristics. In the general population…

…They intend to present an ECG with early repolarization (which is associated with 5 times as great a risk of ventricular fibrillation and sudden cardiac…

…the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no practical risk prediction tool currently exists. At the other end…

Continous medical discussion: the ECG blog ECG The best ECG book is not the one making it simple In the thrilling and ever evolving field…

…which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were strongly associated with coronary artery disease and myocardial infarction. However…

…outcomes. The vast majority of infections with COVID 19 result in mild disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections…

CPR Hearts too good to die In 1961 the Journal of the American Medical Association (JAMA) published an article titled Hearts too good to die…

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

…to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard post ACS…

…is given. An ECG without ischemic ST T changes when recording during chest pain is not consistent with myocardial ischemia. In other words, chest pain…

…relief of angina in some patients and a greater likelihood of repeat PCI. Multivessel disease in ACS is associated with an adverse prognosis. In STEMI…

…of cardiac arrest with a separate category for cardiac etiologies. Cause Definition Medical cause Includes cardiac arrest caused by heart disease, other medical conditions (pulmonary…

…the only absolute indication, and always urgent. A large pericardial effusion with symptoms despite medical treatment. Diagnostic drainage in suspected purulent pericarditis, tuberculosis or malignancy…

…lesion proximal to the first septal perforator of the left anterior descending artery was associated with lower five year survival than a more distal lesion…

…Earlier diagnosis is associated with a greater likelihood of cure. When to investigate General indications Patients with suggestive signs, symptoms, or medical histories should undergo…

…In out of hospital cardiac arrest (OHCA) the initial rhythm is recorded by the EMS (emergency medical service) team upon their arrival at the scene…

…physicians in the emergency medical system (EMS), as well as the hospital cardiac arrest team (CAT) and intensive care units and other units caring for…

…creatinine ≥133 µmol/L Rivaroxaban 20 mg once daily with food 15 mg once daily at eGFR 15 49 mL/min Edoxaban 60 mg once…

…and the incidence is particularly high after hip fracture, major surgery and intensive care [1,2]. The condition is associated with falls, aspiration, pressure sores…

…with reduced ejection fraction (HFrEF), and post myocardial infarction (MI) care. Despite their proven morbidity and mortality benefits, their use is limited by specific adverse…

…generally tolerate ischaemia for approximately 4–6 hours, making ALI a medical emergency in which prompt recognition, specialist assessment and restoration of perfusion are essential…

…or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular dysfunction and/or MVD…

…the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities…

…environmental factors and genetic background. Thrombotic susceptibility is likewise affected by inflammation and other systemic influences. The severity of myocardial injury is determined not only…

…Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated in patients with severe hypertension…

…In such scenarios, it is very common to provide the patient with a permanent pacemaker to continue optimal medical treatment. Sick sinus syndrome (sinus node…

…250–300 people and is the most common inherited metabolic disorder associated with premature cardiovascular disease. Prevalence is higher in populations with a founder effect…

…or a medical or surgical illness is present before the event. Although STEMI may occur at any time, circadian variations have been reported, with clusters…

…wall motion abnormality (RWMA) during stress. A fixed abnormality that remains unchanged with stress generally indicates previous infarction. Extensive ischaemia may produce a reduction in…

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

… the long term outcome is worse Medial epicondylitis At the flexor origin Avoid the ulnar nerve Carpal tunnel syndrome The carpal tunnel An acceptable bridge…

…TdP) and long QT syndrome (LQTS) is presented below. With regards to drugs, the risk of QT prolongation and TdP varies markedly across the list…

…the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular complications Symptoms are determined by the cardiovascular…

…first Other situations that argue for the operating theatre rather than the emergency room: a very large or deep abscess, a markedly unwell patient with…

…feel pressure injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the…

…Repeat on the other arm. 2. Ankle pressure. Place the cuff just above the malleoli, with its lower edge about 2 cm above the tip…

…93%) for myocardial infarction. Moreover, fragmented QRS is associated with an increased risk of sudden cardiac death and ventricular arrhythmias. Figure 2. Fragmented QRS complex…

…Akutsjukvård Lathundar Key messages Two things set the COPD exacerbation apart from many other causes of acute dyspnoea: oxygen must be titrated cautiously and the…

…precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for the prevention…

…phenotype later and require delayed or individualized assessment. Disease specific genetic architecture HCM is predominantly associated with variants affecting sarcomeric proteins, particularly MYH7 and MYBPC3…

…between LDL C exposure and ASCVD risk is characterized by several principles: Lower LDL C is associated with lower ASCVD risk across the range studied…

…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…

…drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The treatment is a repositioning manoeuvre…

…reported with acetylsalicylic acid. Discontinue acetylsalicylic acid at the first sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other…

…intervention while limiting major and clinically relevant bleeding. Long term antiplatelet therapy after STEMI is associated with approximately a 25% reduction in recurrent infarction, stroke…

…used. Risk in these circumstances appears to track more closely with apoB. Discordantly high apoB is especially associated with metabolic syndrome and mildly elevated triglycerides…

…only one pathway of platelet activation, its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and…

…not specific for myocardial infarction. Other conditions may produce cardiomyocyte injury and elevated troponin, so biomarker interpretation must be integrated with the clinical history, ECG…

…The European definition uses BP ≥180/110 mmHg with acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence…

…Patients with acute coronary syndrome should be offered cessation support during hospitalization. Depression and adverse environmental exposures are associated with continued or resumed smoking after…

…persons with significant heart disease, predominantly ischemic heart disease. However, most cardiac conditions may be associated with atrial flutter. As compared with several other supraventricular…

…ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out…

…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…

…administration. Radiotracers with higher levels of redistribution can move from areas of higher concentration to regions with lower concentration, for reasons other than perfusion differences…

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

…block: ECG criteria, clinical characteristics and management This chapter discusses third degree AV block, which is synonymous with AV dissociation, complete AV block, AV block…

…expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist / hip Men 0.90…