…risk of complications calls for careful consideration of contraindications. Contraindications may be absolute or relative. Briefly, exercise stress testing must not be performed in the…

…Other causes include acute mechanical complications—particularly ventricular septal defect (VSD) and papillary muscle rupture with acute severe mitral regurgitation—predominant right ventricular (RV) infarction…

Procedurer What determines the outcome of a central venous catheter insertion is decided before the needle goes in: the choice of site, the use of…

…heals venous leg ulcers; everything else is supportive. But the same compression applied to a limb with arterial insufficiency can cause necrosis and, in the…

…sputum purulence, the other cardinal symptoms and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive…

…0 A mechanical valve may require a higher target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and pulmonary embolism differ from the…

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

…syndrome (ODS). It is therefore recommended to raise serum sodium by a maximum 8 mEq/L in the first 24 hours. Hyponatremia of unknown duration…

…in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for the operating theatre rather than the…

…even though incidence and prognosis vary widely between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1…

…premedication, plus further atropine drawn up in a syringe as a standby dose. Glycopyrronium (Robinul) 0.2 mg is an alternative premedication. Peripheral venous cannula…

…ventilation before decompression where possible: anaesthesia and intubation can precipitate circulatory collapse in a tamponaded patient , since positive airway pressure further reduces the venous return…

…pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site, known thrombosis in the target vein…

…in older protocols but is no longer routinely recommended — alkaline urine increases the precipitation of calcium phosphate. Contraindications Hypokalaemia — must be corrected first or in…

…standard formulas. Therefore, while MAP is a valuable indicator of hemodynamic status, it should be interpreted in conjunction with other clinical assessments and diagnostic information.

…and near equalization of diastolic pressures in the cardiac chambers, with chamber pressures approaching intrapericardial pressure. The jugular venous waveform typically has a prominent x…

…associated with elevated central venous pressure, which is transmitted to the renal veins and can reduce GFR. Conversely, a rise in creatinine during effective decongestion…

…pressure minus coronary venous pressure Normal coronary driving pressure: mean aortic pressure minus coronary venous pressure In routine clinical practice, coronary venous pressure is generally…

…tachycardia is most often due to atrial fibrillation with wide QRS complexes due to bundle branch blocks or other conduction defects. However, in rare instances…

…the maternal cardiac arrest. Within the context of pregnancy, hypovolemia and other etiologies of hypotension remain the predominant causes of cardiac arrest. Should cardiac arrest…

…than by a distinct advantage of one drug over the other. Mathew et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock…

…function. Central venous pressure, pulmonary capillary wedge pressure and systemic vascular resistance increases. Harmful neurohormonal pathways are activated, similar to those seen in heart failure…

…jugular venous distention. Other frequent symptoms are pulsus paradoxus, pericardial friction sounds, tachycardia, tachypnea, weakened peripheral pulses, edema, cyanosis. Cardiac tamponade is seen in Video…

…exhaustion and, in the most severe cases, hypotension, pneumothorax and respiratory arrest [1]. The first few minutes 1. Sit the patient up and minimise physical…

…or a recently inserted venous port. Procedure 1. Arm pressure. Place the cuff on the upper arm. Locate the brachial signal in the antecubital fossa…

…acidosis or alkalosis in a haemodynamically stable patient A venous blood gas is often sufficient as the first sample Precise pCO₂ in suspected ventilatory failure…

…3. Insert a peripheral venous cannula. 4. Measure the blood pressure in both arms at the first assessment, particularly in chest pain, back pain or…

…Capillary refill is delayed, and venous filling may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent…

…during its first passage through the circulation. Due to this rapid clearance, adenosine must be administered as a rapid intravenous bolus. Unlike many other intravenous…

…The condition occurs above all in: treatment with SGLT2 inhibitors pregnancy prolonged fasting or a very low carbohydrate intake excessive alcohol consumption vomiting or othe

…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…

…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…

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

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

…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…

…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…

…spot, in three minutes, without drugs . The diagnosis rests on the history, a positive Dix–Hallpike test and the absence of other neurological findings. The…

…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…

…contained in all apoB containing lipoproteins, including: LDL Intermediate density lipoprotein (IDL) Lipoprotein(a) [Lp(a)] Very low density lipoprotein (VLDL) Chylomicrons and other triglyceride…

…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…

…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…

…although some series report 10–20%. Other life threatening cardiopulmonary conditions account for approximately 5% of presentations in some populations. Despite this relatively low prevalence…

…1960s. In 1948 the NHLBI initiated the Framingham Heart Study, which demonstrated that high blood pressure and high cholesterol levels, among other risk factors, were…

…with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably exclude clinically important differences in ischemic events…

…intoxication, or other sympathomimetic exposure, including methamphetamine. Abrupt withdrawal of antihypertensive medication, particularly clonidine, can also precipitate a hypertensive crisis. Pregnancy Hypertensive emergencies in pre

…left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization procedures…

…of the aorta or arteries supplying the limbs. In adults over 40 years of age, atherosclerosis is the predominant cause. Other mechanisms include thrombosis, embolism…

…where possible, other inhaled nicotine products. In cardiovascular medicine, the objective is not merely to reduce cigarette consumption but to achieve complete abstinence from tobacco…

…with a paper speed of 25 mm/s, which is standard in the US and many other countries, a 2:1 block will be difficult…

…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…

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

Echocardiography Continuous Wave Doppler In continuous wave Doppler (CW Doppler), ultrasound waves are continuously emitted from the transducer and the reflections of these waves are…

…In PET (Positron Emission Tomography), radiotracers emit positrons. When a positron collides with an electron, they annihilate each other, producing two gamma photons emitted in…

…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…

…3. In third degree AV block, no atrial impulses are conducted to the ventricles. The atria and the ventricles are electrically dissociated from each other…

…and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist / hip Men 0.90, women 0.85 = abdominal…

…this first . Thrombocytopenia, by contrast, is not a contraindication; the specimen may be taken even at very low platelet counts, followed by compression. Infection in…

… spray technique is better on irregular surfaces and in the scalp. Complications Complication Frequency and comment : : Pain during thawing The rule rather than the exception…

…has been achieved, 7 days in bacteraemia or cefotaxime plus metronidazole 1 g × 3 IV plus 1.5 g for the first dose, then 1…