…A single central feature is enough to proceed with urgent investigation , and a normal CT of the brain does not exclude an infarction in the…

…developed rapidly in the past few decades. The repertoire of available methods includes echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CT), single photon emission…

…singly or in combination. Syncope is particularly important as a marker of potentially severe disease. The presence of haemodynamic instability places the patient in the…

…necessarily require the larger effect of a PCSK9 inhibitor. Place in lipid lowering therapy General treatment sequence High intensity statin therapy remains the foundation of…

…ECGs in pediatric patients is slightly different from adults, due to obvious anatomical differences. There are, however, no differences regarding the ECG grid. As in…

…lead is in place — but only if it is working, and the commonest source of error is believing that it is. Twitching of the chest…

…a therapeutic objective. LDL C as the primary treatment target Current lipid management frameworks place LDL C at the centre of treatment. Lifestyle intervention is…

…how the patient is positioned, which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the…

…washes nitrogen out of the pleural air and speeds resorption. Other conditions in which high flow oxygen is given irrespective of the saturation according to…

…or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the adjacent joint. Known hypersensitivity to the…

…effusion is detected randomly (for example, in CT, MRI, echocardiography). In other cases, the effusion is detected under more dramatic circumstances, as is the ca

…Local anaesthesia works poorly in inflamed tissue — the acidic environment inactivates the anaesthetic. Place a field block in healthy skin around the abscess instead of…

…in the same way as on the arm. 4. Posterior tibial artery — behind the medial malleolus. Measure. 5. Repeat on the other leg. If the…

…other LDL C lowering drugs, when additional LDL C reduction is required, including in patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolaemia. The…

…4. Make a small skin incision with the scalpel. 5. Aspiration: advance the needle with the stylet in place perpendicular to the bone surface, angled…

…appear as moving masses. Mural vegetations are attached to the endocardium and, accordingly, less mobile. Echocardiography is the first place method for detecting vegetation in…

…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…

…the Doppler line is placed in the valve orifice. The ultrasound machine displays the recorded flows as the spectral curve (Pulsed wave Doppler or Continuous…

Echocardiography The Continuity Equation: What Goes In Must Come Out As previously discussed, stroke volume is usually calculated by measuring area and VTI (velocity time…

…stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following…

…inferobasal) transmural ischemia causes reciprocal ST segment depressions in V1–V3 (occasionally V4). Leads V7–V9 must be placed to reveal the ST segment elevations…

…the lead in the other chamber, resulting in inappropriate inhibition of the pacemaker in the latter chamber. This type of oversensing is referred to as…

…using the Cabrera format. As evident in Figure 3, if leads I, II and III would have been displayed next to each other, the T…

…when the leg is placed in a dependent position. With advanced disease, rest pain may become persistent. Tissue loss, ulcers and gangrene may develop. In…

…sample volume in the mitral valve plane. Color Tissue Doppler Color tissue Doppler analyzes myocardial velocities within a color sector. Myocardium moving towards the transducer…

…then the frequency of the reflected sound waves will differ from the emitted sound waves. The change in frequency is referred to as the Doppler…

…by the following two mechanisms: Increased or abnormal automaticity Triggered activity Increased or abnormal automaticity As discussed in Chapter 1, several structures in the heart…

…as its inner diameter, is strongly related to heart failure, ventricular tachyarrhythmias, and overall mortality. Ventricular dimensions are measured using an electronic caliper, with the…

…arrhythmia that originates in the ventricles. A wide range of conditions may cause ventricular tachycardia and the ECG is as nuanced as are those conditions…

…as early as possible. In out of hospital cardiac arrest (OHCA) ACLS is performed by paramedics, nurses or physicians, depending on the design of the…

…As mentioned above, this is similar to the situation in left bundle branch block (LBBB), which explains why paced QRS complexes are similar to the…

…illustrates the vectors in the horizontal plane. Study Figure 7 carefully, as it illustrates how the P wave and QRS complex are generated by the…

…as in Figure 1 . Any type of infarction may cause pathological R wave progression. However, the specificity for pathological R wave progression is considerably lower…

…antibiotics on the basis of sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV without undue delay in persistent…

…in the test. Information about concurrent ticagrelor treatment is required for interpreting platelet function tests for HIT. Other cosiderations Based on a relationship observed in…

…a single variant identified as the cause of disease, although the yield varies by cohort. A causative variant is more likely to be found in…

…ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source…

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

…80 mg tablet once daily. Warnings and precautions Use Aspirin with caution in the following cases: Concurrent anticoagulant therapy (e.g., coumarin derivatives or heparin…

…aspirin is also preferred in patients with intracoronary stents. In acute ACS, aspirin should be administered as soon as possible in the absence of contraindications…

…Cholesterol Non HDL C is calculated as: Non HDL C = total cholesterol − HDL C It represents the cholesterol contained in all apoB containing lipoproteins…

…its antiplatelet effect is relatively limited compared with agents that inhibit other platelet pathways. The distinction between primary and secondary prevention is fundamental: Primary prevention…

…or other atherosclerotic disease; diabetes and other cardiovascular risk factors; smoking, hypertension, hypercholesterolaemia, and sedentary behaviour; family history, particularly in the broader assessment of peripheral…

…Relevant predispositions, such as connective tissue disease. No single pain descriptor is diagnostic. The severity of pain also has limited discriminatory value. Features suggesting myocardial…

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

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…

…The objective is to reduce aortic wall shear stress and rapidly lower systolic pressure. Renal and microvascular complications Renal involvement may manifest as deterioration in…

…In chronic coronary disease, the principal symptomatic indication for revascularization is angina that remains refractory despite medical therapy when significant stenoses are anatomically or physiologically…

…is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products. In cardiovascular medicine, the objective…

…standard in the US and many other countries, a 2:1 block will be difficult to discern because the flutter wave may fuse with the…

…hypertrophy ECG In case the ECG or other examinations suggest left ventricular hypertrophy (LVH), one should suspect concomitant right ventricular hypertrophy (RVH) if the following…

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

… one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave Doppler and pulsed wave Doppler is…

…al.). As evident in Figure 1, 15 O water is the only tracer with myocardial uptake linearly related to coronary blood flow. 15 O Water…

…on the other hand, are much less likely to be caused by ischemia ( Figure 1 B ). This is noted in both North American and European…

…to as atrioventricular (AV) dissociation. Importantly, for the ventricles to have any electrical (and thus pumping) activity at all, an escape rhythm must arise in…

…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…

…50 Dose reduction as in the table above for rivaroxaban and edoxaban. Check every 6 months 15 30 Dabigatran contraindicated. The other DOACs are possible…

…controlled. Contraindications In life threatening conditions all contraindications are relative — but they govern which site is chosen. Infection, burns or trauma over the insertion site…

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