…lupus erythematosus and rheumatoid arthritis, are important risk enhancing conditions and are more prevalent in women. Chronic kidney disease and several other comorbidities also contribute…

…severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement…

…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…

…Rupture of the free ventricular wall. Neoplasms (particularly breast and lung cancer). Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and rheumatic fever…

…individuals of all ages. However, a wide range of local and systemic conditions may cause pericarditis. The most common causes are as follows: Rheumatoid arthritis…

…as compared with 36% for pathological Q waves. However, the specificity was lower for fragmented QRS (89% vs 99%). The absence of fragmented QRS has…

…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…

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

…Familial and genetic screening in cardiovascular medicine is the systematic assessment of relatives and other individuals who may carry an inherited predisposition to cardiovascular disease…

…patients with: Diabetes or other cardiometabolic risk factors Obesity Insulin resistance or metabolic syndrome Elevated triglycerides Low or apparently well controlled LDL C with suspected…

…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…

…primary PCI should be considered even if symptoms have subsided, particularly with continuing ischaemia, heart failure, electrical instability or a large area of myocardium at…

…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…

…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…

…C and other apoB containing lipoproteins within the arterial wall. This initiates inflammatory reactions that promote plaque formation and progression. As the burden of retained…

…trial analyses. Some data from a study of healthy women suggested a reduction in ischaemic stroke, particularly among women with stroke risk factors, but this…

…with carotid stenosis have no focal neurological symptoms. Asymptomatic disease may be discovered during targeted duplex ultrasound (DUS), pre operative assessment, or evaluation of other…

…minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5–10%, although some series report 10–20%. Other life…

…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…

…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…

…BP ≥180/110 mmHg with acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence of ongoing acute organ…

…arteries. It frequently coexists with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous…

…than an isolated disorder of the lower limbs. Patients frequently have concomitant coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the…

…and cardiovascular rationale Smoking cessation is the complete discontinuation of tobacco smoking, with avoidance of second hand smoke and, where possible, other inhaled nicotine products…

…beats per minute. Note that with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2…

…show features characteristic of biventricular hypertrophy. Biventricular hypertrophy ECG In case the ECG or other examinations suggest left ventricular hypertrophy (LVH), one should suspect concomitant…

…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…

…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…

…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…

…Note that a patient with STEMI may present during any of the phases illustrated in this figure, which is why it should be studied in…

…rhythms with narrow QRS complexes indicate that the block and the ectopic focus (which generates the escape rhythm) are located proximal to the bifurcation of…

…percentile charts should be used. Waist circumference Measure the waist between the lowest rib and the iliac crest, at the end of expiration, with the…

…min, the other DOACs at eGFR <15 mL/min) at least 96 hours should have elapsed since the last dose before an invasive procedure. Exact…

…smears immediately at the bedside from the first aspirate, which should be small — a few tenths of a millilitre, at most about 0.5 mL…

…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…

…stimulation with a decrement ≥ 10 % at 3 Hz, sensitivity about 75 %; single fibre EMG about 95 %). Contraindications Known hypersensitivity to edrophonium. Mechanical obstruction of the…

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

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms and the patient…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

…days, or shorter neutropenia with clinical risk factors International guidelines generally use a single temperature of 38.3 degrees as the threshold [4,5]. Some…

…tricuspid inflow The echocardiographic counterpart of pulsus paradoxus Contraindications In overt tamponade with shock there are no absolute contraindications other than the conditions in which…

…Contraindications Absolute: Cellulitis, a skin wound or other infection over the injection site. Bacteraemia or suspected septic bursitis or arthritis. A joint prosthesis in the…

…preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the back between the left scapula and the spine…

…Heart failure, pulmonary oedema and other conditions with a high risk of fluid overload — a relative contraindication requiring invasive monitoring and slower administration. Significant metabolic…

…aortic features 45 mm • Patients who are undergoing aortic valve surgery • Patients with Marfan syndrome who have additional risk factors • Patients with mutations in TGFBR1…

…and Risk Factors in Atrial Fibrillation) Bleeding Risk Score is a clinical tool designed to estimate the risk of major bleeding in patients with atrial…

…independent risk factor for stroke in AF patients. Evidence suggests that the increased stroke risk in women is more closely associated with other comorbidities and…

…assigned 1 point, with a maximum score of 9. The score takes into account various risk factors that contribute to bleeding risk, including uncontrolled hypertension…

…3 Interpretation of HEMORR₂HAGES score. Comparison with ATRIA and HAS BLED Scores Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk…

…The evaluation of chronic cough in a patient taking an ACE inhibitor should begin with a comprehensive history and physical examination. Clinicians should inquire about…

…neck, jaw, shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or vomiting. Persistent shortness of breath. Weakness, dizziness…

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

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…plaque architecture The major coronary risk factors—high LDL cholesterol, cigarette smoking, hypertension and diabetes mellitus—disturb endothelial function and favour the accumulation of fat…

…of stroke and other thromboembolic events. Subclinical cerebral injury may contribute to vascular dementia, and thromboembolism may affect organs other than the brain. Patients with…

…who were described as frail generally had no more than mild frailty, limiting the applicability of trial findings to people with substantial functional impairment, multimorbidity…

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