…marked distress. Delirium is an acute neuropsychiatric syndrome and a clinical diagnosis, often described as acute brain failure. It is precipitated by somatic illness, drugs…

…have other mechanisms of myocardial ischaemia and necrosis. Unstable angina (UA) represents myocardial ischaemia without demonstrable acute cardiomyocyte injury or necrosis. It is characterized by…

…thrombus can fragment, embolize to other coronary branches or vascular beds, propagate through gaps between stent struts, and compromise the treated lumen. Conventional angiography has…

…be blocked. The degree of blocking in the atrioventricular node is specified by counting the number of flutter waves preceding each QRS complex. If 3…

…longer expected delay and a symptom duration of less than 12 hours, immediate fibrinolysis is recommended in the absence of contraindications, followed by direct transfer…

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

…sensitivity is low). U wave changes always accompany other ischemic ST T changes. They may occur in both NSTEMI and STEMI. QTc prolongation The QT…

…Female specific and female predominant risk factors Risk assessment should include reproductive and pregnancy related history. Female specific or female predominant factors associated with later…

…present Factors that may be contributing to elevated blood pressure Other cardiovascular risk factors and relevant comorbidities Evidence of hypertension mediated organ damage Existing cardiac…

…two contiguous leads [8, 10]. The specific voltage thresholds vary based on patient age, sex, and lead location, as detailed below [8, 10]: Patient Demographic…

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

…caused by an acute coronary process. Myocardial injury leads to release of cardiac troponin, but troponin elevation is not specific for myocardial infarction. Other conditions…

…However, other inheritance patterns, de novo variants, incomplete penetrance and variable phenotypic expression complicate risk prediction. Familial clustering may also reflect shared environmental or behavioural…

…normal FFR and CFR are associated with an excellent prognosis, whereas discordant measurements require interpretation in the context of the clinical presentation and other findings…

…the conditions instead by temporarily withdrawing the cholinesterase inhibitor, under monitoring in a setting where the airway can be secured. Preparation and equipment Edrophonium 10…

…when every pacing spike is followed by a wide QRS complex and a pulse that can be felt. The other predictable error is forgetting that…

…containing lipoproteins, including: LDL Intermediate density lipoprotein (IDL) Lipoprotein(a) [Lp(a)] Very low density lipoprotein (VLDL) Chylomicrons and other triglyceride rich particles Thus, non…

…and SCORE2 OP The models include conventional cardiovascular risk factors: Age Sex Smoking status Systolic BP Cholesterol values Risk estimation uses the appropriate sex specific…

…and other arrhythmias or conduction abnormalities. CKD also worsens the prognosis of established CVD. Mechanisms linking CKD to cardiovascular disease The association is mediated by…

…a specific high affinity site on the extracytoplasmic face of the alpha subunit of the Na+ K+ ATPase. This binding is entropically driven and preferentially…

…Pericardial disease, including constriction Right ventricular dysfunction caused by pulmonary embolism Infiltrative cardiomyopathies, particularly cardiac amyloidosis Sepsis and other hyperdynamic states In cardiac amyloidosis, BNP…

…myocardial cell death caused by prolonged ischaemia. The first cellular abnormalities of ischaemia include depletion of glycogen, relaxation of myofibrils, and disruption of the sarcolemma…

…is mediated by the combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities…

…used if other methods fail to open the airway. Figure 1. Methods to open the airway. No large study has compared oropharyngeal and nasopharyngeal airways…

…have specific contraindications: Adenosine, Dipyridamole, Regadenoson : Should be avoided in patients with active bronchospasm, severe hypotension, or high degree AV block. Caffeine and other methylxanthines…

…by physicians, nurses, biomedical analysts, or other professionals. A physician is always formally responsible for conducting the test. All personnel must be appropriately trained and…

…decades. Advances in echocardiography have been propelled by breakthroughs in engineering, software development, and progress in our understanding of the pathophysiology of cardiac disease. Ultrasound…

…structures (discussed in detail in Chapter 1): Specific clusters of atrial myocardium : There are clusters of atrial myocardium that possess automaticity and thus pacemaker function…

…ischemia ST segment depressions caused by ischemia are characterized by a horizontal or downsloping ST segment. Indeed, North American and European guidelines assert that the…

…the other valves. The area is calculated by measuring the diameter of the valve ( area = π × radius 2 , where radius = diameter/2 ), and…

…intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis and can also be seen when the bleeding is slow or has stopped. The…

Arrhythmias and arrhythmology Emergency medicine Pharmacology & dosing Definition and Pathophysiology Bradycardia encompasses a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within…

…segment elevation myocardial infarction, and cardiogenic shock. Patient related and procedural risk factors The risk of adverse events is increased by: advanced age; diabetes mellitus…

…coronary arterial tree after selective intracoronary contrast injection under fluoroscopy. The procedure is performed by advancing guidewires and diagnostic catheters from a percutaneous arterial access…

…The extent of jeopardized myocardium Left ventricular systolic function Diabetes and other comorbidities Anatomical complexity and completeness of possible revascularization A proximal lesion jeopardizes more…

Cardiology Definition and Pathophysiology Resistant hypertension is a clinical indicator rather than a distinct disease. It identifies patients whose blood pressure remains uncontrolled despite intensive…

…ECG tracing lasting ≥30 seconds, characterized by irregularly irregular R R intervals and the absence of distinct P waves [1] [2] . Stroke Risk Scores: CHA2DS2…

…sensitive and specific for myocardial injury. Elevated levels of cardiac troponins is firm evidence of myocardial necrosis (i.e infarction). This is explained by the…

…the heart rate is steadily decreasing, and by age 10 years the rate is the same as in adults. These age variations in heart rate…

…by the sinoatrial node) is a common finding in athletes and during sleep; in these scenarios, it should not be considered abnormal. On the other…

…attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction between the ventricles and surrounding structures of the mediastinum…

…is both insensitive and non specific for SCD. Most people who die suddenly never had an ejection fraction measured before death, and among those who…

…higher than 18 mg are unlikely to revert a tachycardia and should not be used. Specific dosing adjustments are required in certain patient populations: Pediatric…

…herpes zoster pain are other considerations when assessing chest pain [2]. Autoimmune/Malignancy: A history suggesting an autoimmune disorder or known malignancy may suggest specific…

Cardiology Genetic and miscellaneous conditions Definition and pathophysiology Familial hypercholesterolaemia (FH) is an inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL…

…Pedro Brugada and his two brothers, Josep and Ramon, described this syndrome in 1992. The syndrome is characterized by a rather peculiar ECG and the…

…further classified based on the intensity of tracer uptake and associated myocardial changes: Mild defects : Characterized by decreased tracer counts while preserving normal wall thickness…

…altered by electrolyte imbalance, owing to changes in intra and extracellular electrolyte concentrations. Some electrolyte imbalances are clinically negligible (from an electrophysiological standpoint), whereas others…

…require a specific protocol and early specialist involvement. DKA and HHS are dynamic conditions. Treatment must be guided by the clinical response and by repeated…

…persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes. The central therapeutic objective is…

…precipitants are viral infection, bacterial infection and air pollution, but often no definite trigger can be identified [1,2]. Ask specifically about: Onset and time…

…rare cases, TTP has been reported with ticagrelor treatment. TTP is characterized by thrombocytopenia and microangiopathic hemolytic anemia associated with neurological findings, renal failure, or…

…LDL and other apolipoprotein B containing lipoproteins play a causal role in atherosclerotic cardiovascular disease (ASCVD). This causal relationship is supported by genetic, observational and…

…Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source. ATP is produced by metabolizing carbohydrates…

…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…

…sign of skin rash, mucosal lesions, or hypersensitivity. Interactions Pharmacodynamic interactions Anticoagulants, thrombolytics, or other platelet aggregation inhibitors: Salicylates inhibit platelet function and enhance the…

…using a loading dose followed by maintenance treatment. The source material does not specify the loading dose. Efficacy and harms In secondary prevention trials involving…

…with stroke risk factors, but this benefit was accompanied by increased serious gastrointestinal bleeding and a non significant increase in cerebral haemorrhage. Bleeding outcomes 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…

…FH). Heterozygous FH results in high LDL cholesterol levels (but nothing else) and increases the risk of acute myocardial infarction by more than 50 times…