…in myocardial oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although the exact exposure threshold and duration…

…funnel or a lavage system, lukewarm fluid (tap water for adults, isotonic saline for children), a collecting vessel, a bite block, and powerful suction with…

…conceptual and lacks scientific evidence. As suggested by Heusch, [1] this may be due to the fact that interventions that appear to modify oxygen demand…

… the patient can eat and talk. Flows above 6 L/min dry the mucosa without delivering more oxygen Simple face mask 5–10 L/min…

…reduced partial pressure of oxygen in the blood. Asphyxia is characterized by insufficient ventilation, leading to hypoxia. Etiologies of hypoxic cardiac arrest : Trauma and injuries :…

…SVR = 80 × (MAP − CVP) / CO PVR = 80 × (mean PA − PCWP) / CO Oxygen delivery (DO₂) = CO × (1.34 × Hb × SaO₂ + 0.003 × PaO₂)…

…determines the outcome. Transfusion restores circulating volume, oxygen transport and haemostatic capacity, but it cannot compensate for an uncontrolled source of bleeding. Minimise the time…

…advised in interpreting it without corroborating evidence of a coronary mechanism. The clinical context and the underlying mechanism of the oxygen supply/demand imbalance must…

…Copious secretions without an effective cough. Choice of method and settings Condition Method Starting pressure Escalation Oxygen target : : : : : Cardiogenic pulmonary oedema CPAP 5–7.5…

…three hours. The evidence for an absolute one hour requirement is clearest in septic shock and less certain in sepsis without shock [3,4]. The…

CPR Neurons are exceptionally vulnerable to hypoxia and anoxia ( Casas et al ). In cardiac arrest without chest compressions (i.e. if cerebral perfusion ceases), irreversible…

…bundle branch blocks are treated sub optimally (in terms of evidence based medications and use of PCI), as compared with individuals without bundle branch blocks…

…involving the epicardial coronary arteries and/or the coronary microcirculation. These abnormalities may produce a transient mismatch between myocardial oxygen demand and coronary blood supply…

…than one mechanism may coexist. Supply–demand mismatch MINOCA may result from a mismatch between myocardial oxygen supply and demand. The clinical history should therefore…

…physiological basis is an imbalance between myocardial oxygen demand and coronary blood supply. Stress increases myocardial oxygen requirements, principally through increased heart rate and contractility…

…and its positive inotropic effect (horizontal axis). Grey = pure vasopressors, orange = phosphodiesterase inhibitors, blue/turquoise = calcium sensitisers and a beta agonist without…

…newly discovered complete heart block without current symptoms, alternating bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk…

…and blood culture bottles. Suction and oxygen to hand. The patient sits leaning forward with the arms on a table for diagnostic and therapeutic aspiration…

…guideline discussion. By contrast, the benefit of beta blockers in patients with CAD without previous MI and with normal LVEF is uncertain. Similarly, evidence for…

…preload and afterload Lower left ventricular wall stress Reduced sympathetic nervous system activity Improvement in cardiac metabolic efficiency, including increased oxygen delivery and beta hydroxybutyrate…

…operate simultaneously. Some acute coronary events occur without an identifiable culprit thrombus. NSTE ACS generally reflects an imbalance between myocardial oxygen supply and demand. In…

…Oxygen targets Aim for a saturation of 92–96 % in most patients, and 88–92 % where there is a risk of carbon dioxide retention (COPD…

…management of all poisonings ABCDE Step Assessment and action : : A Assess the airway, the pharyngeal reflexes, vomiting and secretions. Suction and give oxygen as needed…

…the NIHSS and document which symptoms are disabling. 6. Measure the blood pressure, initially in both arms if this can be done without losing time…

…result in reduced coronary oxygen content, coronary steal, and myocardial ischaemia. Coronary fistulae create an abnormal connection between a coronary artery and a cardiac chamber…

…for appropriately selected patients. Pathophysiological basis Exercise progressively increases myocardial oxygen demand through increases in heart rate, myocardial contractility and blood pressure. When coronary blood…

…purpose of the stress test is to increase the myocardial workload (and thus the oxygen demand) in order to provoke ischemia in myocardium supplied by…

…and therefore it faces the highest workload; for the same reason, the left ventricle has the highest oxygen demand. The right ventricle and the atria…

…1 mg/mL, an antihistamine, oxygen, and the ability to lay the patient down. Injection Needle Angle Maximum volume per site : : : : Deltoid, adult 23–25…

…in symptoms or clinical signs, with or without diagnostic electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges from…

…oxidative modification by reactive oxygen species (ROS) and enzymes such as myeloperoxidase and lipoxygenase. Oxidized LDL (oxLDL) is highly immunogenic and acts as a potent…

…blood pressure Respiratory insufficiency, manifested by tachypnoea and/or low arterial oxygen saturation Syncope These findings may occur singly or in combination. Syncope is particularly…

…hypotension and hemorrhage, it is imperative to administer appropriate fluid or erythrocyte boluses to restore circulatory volume. To ensure optimal oxygen delivery, high flow oxygen…

…primarily mediated by local metabolic mechanisms, which adjust vascular tone in response to myocardial oxygen demand, and myogenic responses, where vascular smooth muscle constricts or…

…setting of ACS have more comorbidities and a higher risk of complications than patients without AF; both short and long term prognosis are worse than…

…oxygen supply and demand, without the presence of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and…

…and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency. Sustained hypoperfusion reduces oxygen and nutrient delivery…

…increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of levosimendan is not affected by the concurrent use…

…This is particularly important in STE ACS (STEMI) and the following parameters on the ECG are assessed: Normalization (return) of ST segment elevations Rapid T…

…angiography or autopsy, where applicable to the relevant infarction category Myocardial infarction results from an imbalance between myocardial oxygen supply and demand. The universal classification…

…is a rise and/or fall in cTn values. An elevated cTn alone does not establish MI, because myocardial injury may occur without myocardial ischaemia…

…simply to enable the cardiopulmonary system to increase its delivery of oxygen to skeletal muscle and myocardium. The oxygen consumption – and thus oxygen demand – increases…

…mouth as needed and place the patient in the recovery position when this is practicable. Give oxygen if hypoxaemic. Use a bag and mask if…

…atherosclerosis, endothelial dysfunction, and distinct coronary functional abnormalities may produce ischaemia without an obstructive epicardial lesion. Once conventional anti ischaemic targets have been exhausted, proposed…

…management and treatment of patients with acute coronary syndromes. Moreover, clinicians must clarify whether the ECG was recorded during chest pain, since an ECG without…

…Image acquisition and evaluation Stress Imaging : Initially performed using exercise or pharmacologic agents to elevate myocardial oxygen demand (or simulate increased demand using vasodilatory agents…

…the atherosclerotic artery. Whenever oxygen demand exceeds oxygen (blood) delivery ischemia occurs and this manifests with chest discomfort referred to as angina pectoris. If the…

Echocardiography Echocardiography in Congenital Heart Disease (CHD) and Grown Up Congenital Heart (GUCH) disease Survival in congenital heart disease (CHD) has increased dramatically over the…

…feels breathless. Excessive oxygen delivery can raise pCO₂. The main mechanisms are impaired ventilation–perfusion matching, increased physiological dead space and the Haldane effect. It…

…1. Assess vital signs and level of consciousness immediately. 2. Check oxygen saturation and capillary glucose. 3. Exclude immediately treatable threats without delay: hypoxia, hypoglycaemia…

…myocardial oxygen consumption and myocardial contractility. Time to onset of action 5 to 10 minutes Duration of action 2 to 4 hours Delivery IV Dose…

…a conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not…

…lowering effect than esmolol and labetalol. Time to onset of action 20 minutes Duration of action 5 to 8 hours Delivery IV Dose 1.25…

…myocardium adapts and downregulates metabolism to avoid developing ischemia. According to this theory, ischemia occurs only if there is an absolute lack of oxygen (Heusch…

…the context of sepsis induced cardiac arrest, consider the following recommendations: Administer 100% oxygen at the maximum flow rate . Hypoxia can precipitate cardiac arrest in…

…equivalent (1 MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg…

…ECG and capnography during sedation, with oxygen and a bag available. Drugs for procedural sedation and analgesia according to local practice and the guidelines of…

…accelerates atherosclerosis, increases myocardial oxygen demand, and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of heart…

…min). Pediatric dosage : 0.01 mg/kg. Administer 100% oxygen promptly and ensure oxygen saturation remains 94%. Provide an intravenous or intraosseous fluid bolus, beginning…

…In the absence of ECMO, both non invasive and invasive rewarming techniques should be pursued. Heated intravenous fluids (crystalloids). Heated and moistened oxygen. Warm covers…