…both as an independent cardiovascular risk factor and as a driver of hypertension, diabetes, dyslipidaemia and systemic inflammation. It is also associated with respiratory disorders…

…and symptoms SCAD generally presents as ACS. Symptoms may therefore include acute chest pain or chest discomfort, with associated manifestations of myocardial ischaemia. In pregnancy…

…can present with chest pain, ECG abnormalities, and biomarker elevation; echocardiography and cardiac magnetic resonance imaging may demonstrate inflammatory involvement. Gastrointestinal and musculoskeletal disorders may…

…and cerebrovascular accidents. HELLP syndrome is associated with substantial morbidity and mortality. Pregnancy related hypertension also influences obstetric management. In late preterm preeclampsia between 3

…during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency…

…Predisposing factors The likelihood of SAMS increases with higher statin doses and with several patient and treatment related factors: Age older than 80 years Female…

…sleep disordered breathing, cancer related disease and cardiac amyloidosis among the relevant clinical settings or comorbidities. HFrEF is distinguished from heart failure with mildly reduced…

…Condition Typical Pain Quality/Location Key Modifying Factors Associated Physical/Clinical Clues ACS/Myocardial Ischemia Substernal discomfort, pressure, tightness, or heaviness [7]. Worsens with exertion…

…Brugada syndrome. This disorder is easy to diagnose with a simple blood test and the ST segment elevations resolve after normalization of potassium levels. Brugada…

…Pain that is worse at night or when the limb is horizontal. Improvement when the leg is placed in a dependent position. With advanced disease…

…the most common form of neurally mediated syncope (NMS), a disorder of autonomic reflexes. It typically occurs after attaining an upright posture or following painful…

…hyperkalemia and hypokalemia can induce life threatening arrhythmias and cardiac arrest, with hyperkalemia being the most prevalent electrolyte disturbance observed in cardiac arrest scenarios. Hypocalcemia…

…abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis. ANOCA/INOCA is associated with…

…costochondritis, and gastrointestinal disorders. Radiation of discomfort to the trapezius ridge is not seen in STEMI and suggests pericarditis instead. Pain is not uniformly present…

…trauma. Postoperative pain. Cancer related pain and pain in the palliative phase. Severe breathlessness in the palliative phase (at lower doses than for pain). An…

…it further. Starting doses in acute pain in an opioid naive adult Agent Route Starting dose Comment : : : : Morphine IV 2.5–5 mg, repeated after…

…the pain. Refer to The ischemic cascade for details. History taking in patients with chest pain (chest discomfort) HISTORY PARAMETER QUESTIONS COMMENTS Risk factors for…

…ischemic cascade explains why subjective symptoms (chest pain) always occur after ECG changes during myocardial ischemia. Comparison with previous ECG recordings The ECG must be…

…to skeletal muscle and myocardium. The oxygen consumption – and thus oxygen demand – increases in parallel with the intensity of the exercise. The physiological changes (adaptations…

Procedurer A corticosteroid injection into soft tissue gives rapid but time limited pain relief and rarely alters the natural history of the disease. In lateral…

…an automatic response to chest pain. It is appropriate when the expected information is likely to change management. In patients with a very low probability…

…not 48. The 2024 ESC guidelines and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check…

…Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy…

…gravity and slow movement; those that fail usually do so because the patient tenses up with pain, or because the operator pulls harder rather than…

…Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml of normal saline and…

…disease is stable angina, defined by exercise related chest pain. Patients with stable angina pectoris may develop acute coronary events (acute myocardial infarction, unstable angina)…

…disease is stable angina, defined by exercise related chest pain. Patients with stable angina pectoris may develop acute coronary events (acute myocardial infarction, unstable angina)…

…ischemic cascade describes the sequence of events during myocardial ischemia, beginning with perfusion abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques…

…diagnostic ECG, the ECG must be repeated, particularly with ongoing or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability…

…adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe and more protracted reactions, biphasic courses and fatal outcome…

…of myocardial infarction and stroke. Indications Intermittent claudication, rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of…

…closed circumferential cast , and the patient must leave with clear information about the symptoms that should make them seek help immediately. Indications An undisplaced or…

…standing up, tilting the head backwards. A symptom free interval between attacks, with possible residual unsteadiness. No hearing loss, tinnitus or neurological deficits. In horizontal…

…below apply to adults unless otherwise stated, and paediatric doses are given per kilogram with the stated maximum. Always check against the local guideline and…

…continuously , with a printout every minute and on symptoms. 4. Blood pressure every second minute and on symptoms. 5. Ask actively about chest pain, breathlessness…

…approach also improves the technical quality — a relaxed patient is easier to examine. Indications Symptoms: bleeding outside menstruation, postmenopausal bleeding, discharge, itching, burning, pelvic pain…

…has not been shown to improve the prognosis and can cause hypotension, acute kidney injury, myocardial ischaemia or cerebral hypoperfusion. Pain, anxiety, urinary retention, hypoxia…

…the posterior surface of the patella. The shoulder The patient sits with the arm hanging relaxed and slightly internally rotated. The posterior approach is preferable…

…Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three…

…the tympanic membrane — including a history of grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle…

…where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or when the volume limit is reached. Indications Diagnostic aspiration: a…

…tolerate the pain of transcutaneous pacing. It is a bridge to a permanent pacemaker or to resolution of the underlying cause. Contraindications Hypothermia with a…

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

…duration and completeness of occlusion and on the adequacy of collateral blood flow. Ischaemia initially produces pain and sensory disturbance. With progression, motor dysfunction develops…

…Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of…

…Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest pain unit or another non intensive care…

…BP reduction is required, these patients generally do not need hospital admission or intravenous treatment. Some patients with acute pain, anxiety, or distress have transient…

…the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial ischaemia, dynamic ECG abnormalities…

…acute coronary syndrome and acute myocardial ischaemia. Patients may present with acute chest pain or chest pain equivalent symptoms. The ECG assessment remains necessary even…

…occur when atherosclerotic plaques disrupt, resulting in the activation of thrombocytes and coagulation factors causing the formation of a thrombus. Such a thrombus can cause…

…be used to diagnose myocardial ischemia and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea…

…For instance, administering nitroglycerin to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing ECG signs…

…patient must not have experienced chest pain during the last 12 hours before exercise. Patients with unstable angina pectoris with high risk should not undergo…

…syncope, chest pain, heart failure and cardiac arrest. In cases with intermittent symptoms, it is important to establish a temporal correlation between symptoms and episodes…

…angina (please refer to Approach to Patients with Chest Pain). As in patients with STEMI, those with NSTEMI and unstable angina are at considerable risk…

…The retrosternal chest pain caused by acute pericarditis may be very similar to that seen in patients with STEMI. Moreover, the pain in acute pericarditis…

…chest pain. In contrast, NSTEMI and UA typically involve partial occlusions, resulting in subendocardial ischemia and comparatively milder symptoms. For the same reason, patients with…

…women) and elderly individuals. Clinical characteristics and ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest pain, dyspnea and occasionally hemodynamic compromise…

…patient with fever and systemic upset, suspected necrotising soft tissue infection, a child who cannot tolerate the procedure while awake. Suspected necrotising fasciitis — pain that…

…Onset and time course. Increased dyspnoea compared with usual. Increased sputum volume and new sputum purulence. Fever, rigors and respiratory tract symptoms. Chest pain, haemoptysis…