…and other sedating drugs. Thromboembolic risk, for example immobilisation, cancer and previous venous thromboembolism. A documented decision on the ceiling of care. Signs of a…

…liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's syndrome, haemolysis The R value = (ALT / upper limit of normal)…

…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…

…each other, the term perimyocarditis is often used. Image by Bruce Blausen, Blausen Gallery 2014. Causes of acute pericarditis/myocarditis The most frequent cause of…

…common cause of pericardial effusion is infections, such as viral, bacterial, and tuberculous infections. Post pericardiotomy syndrome. Acute transmural myocardial infarction. Rupture of the free…

…Causes Tamponade shares the causes of pericardial effusion. Important clinical associations include: Idiopathic or viral pericarditis Malignant pericardial disease Tuberculosis Purulent or bacterial pericarditis Trauma…

…has reduced orientation to the surroundings Other cognitive disturbance Disorientation, memory impairment, disorganised thinking, language disturbance or perceptual disturbance Organic cause The condition can be…

…managed as neutropenic sepsis even if the temperature criterion is not met. The first hour Step Action : : 1 ABCDE, full vital signs, level of consciousness…

…to vital organs than systolic blood pressure alone. Predictive Value : Elevated MAP has been associated with an increased risk of cardiovascular diseases, such as stroke…

…the fourth universal definition of MI. Type 1 MI is generally related to an atherothrombotic event, whereas Types 2–5 MI have other mechanisms of…

…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…

…and are at high risk of a new event. Treatment can be started without interruption as continuation treatment after the initial one year treatment with…

…and MYBPC3. Approximately 40–60% of tested patients have a single variant identified as the cause of disease, although the yield varies by cohort. A…

…It is calculated as: Non HDL C = total cholesterol − HDL C Apolipoprotein B (apoB) reflects the concentration of circulating atherogenic particles because each apoB…

…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…

…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 place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can otherwise…

…and other NSAIDs: Increased risk of gastrointestinal bleeding when combined with acetylsalicylic acid. Uric acid excretion agents (e.g., probenecid): Salicylates counteract the effect of…

…administered as soon as possible in the absence of contraindications, using a loading dose followed by maintenance treatment. The source material does not specify the…

…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…

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

…operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic stenosis is low, screening has…

…symptom The symptom should be classified as cardiac , possibly cardiac , or non cardiac . The term “atypical” is discouraged because it may understate the possibility of…

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

…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…

…or other vascular beds. Malignant hypertension represents an extreme form in which acute microvascular injury occurs, classically involving fibrinoid necrosis of small arteries in the…

…other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The…

…is the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of…

…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…

…as compared with atrial fibrillation, atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial…

…This is because the strong and oppositely directed forces tend to cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy…

…The balance between pro thrombogenic and pro thrombolytic factors varies from one minute to another, which may cause variations in the size of the thrombus…

…using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous…

…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…

…ischemia, it merely reduces the probability of ischemia as the underlying cause. Concave ST segment elevations are very common in the population (discussed below). Study…

…unreliable, such that they may cease and thus cause cardiac arrest. Junctional escape rhythm is more reliable (the risk of cardiac arrest is considerably lower)…

…between the lowest rib and the iliac crest, at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other…

…hours of the last dose. Andexanet alfa where available Low molecular weight heparin Protamine has only a partial effect Unfractionated heparin Protamine Antiplatelet agents Platelet…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…of infection. Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other…

…front , and this is why the margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis…

…obstruction of the bowel or the urinary tract. Marked bradycardia, sick sinus syndrome or high grade AV block without pacemaker protection. Asthma and other marked…

…pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function. Respiratory tract Diagnosis Agent Dose Duration…

…determine which agent is best. The choice is therefore governed chiefly by the target organ damage, the pharmacology of the drug, comorbidity, and the ability…

…palpitations hunger anxiety pallor paraesthesiae Neuroglycopenic symptoms An inadequate supply of glucose to the brain can cause: difficulty concentrating irritability or abnormal behaviour slurred speech…

…rise can cause osmotic demyelination syndrome [1,2]. Hyponatraemia is primarily a disorder of water balance. The plasma sodium reflects the ratio between the body…

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

…of loading, eccentric exercise, an NSAID, an orthosis — has not given a sufficient effect. Contraindications Absolute: Cellulitis, a skin wound or other infection over the…

…cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum, the other on the…

…overdose. Tumour lysis syndrome appears as an indication in older protocols but is no longer routinely recommended — alkaline urine increases the precipitation of calcium phosphate…

…help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key Formulas BSA Calculation (Mosteller formula): [ …

…Proietti M, Lane DA, Lip GYH. Evaluation of the HAS BLED, ATRIA, and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin. Am J…

…studies have questioned the significance of female sex as an independent risk factor for stroke in AF patients. Evidence suggests that the increased stroke risk…

…regardless of the type of oral anticoagulant used. Studies have shown that it performs similarly or superiorly to other bleeding risk assessment tools, such as…

…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…

…involve the sensitization of sensory nerve endings due to the accumulation of bradykinin. ACE is responsible for metabolizing bradykinin and other tachykinins, such as substance…

…The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The classification of acute PE…

…as at least eight drinks weekly in females or at least 15 drinks weekly in males, or binge drinking in either sex. Other definitions of…

…and control the adhesion and migration of inflammatory cells. Dyslipidaemia, cigarette smoking, hypertension, diabetes mellitus and other adverse influences disturb these functions. The resulting endothelial…

…beyond the arrhythmia itself. It may cause symptoms and impaired quality of life, contribute to heart failure, and increase the risk of stroke and other…