…than a narrowly defined symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest…

…The table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed…

…recent stroke or TIA in the vertebrobasilar territory. Retinal detachment. Relative: Marked cervical restriction of movement or pain — use the Semont manoeuvre or the side…

…Material for immobilisation: a shoulder sling, a dorsal backslab, and a colleague to help. Analgesia and sedation The options, in ascending order: Method Comment : : A…

…as in STEMI, radiate to the neck, shoulders or back. However, acute pericarditis is more likely if inspiration and supine position worsens the chest pain…

…after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular corticosteroid injection in verified inflammatory or osteoarthritis related joint disease. Contraindications…

…grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle ear may be open (a mastoid cavity…

…cardiac specific troponin elevation above the 99th percentile. The clinical presentation should not be interpreted in isolation. The initial diagnosis and triage depend on integration…

…up and leans forward. Pain may be retrosternal or left precordial and can radiate to the neck, arms, or left shoulder. It may occasionally be…

…opioid at the same time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination…

…stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the…

…probability: less than 5% in the European guideline framework. Diagnostic testing should generally be deferred. Low probability: up to 15% in the chest pain pathway…

…therefore requires individualized balancing of ischemic and bleeding hazards. High bleeding risk (HBR) should be assessed in a structured manner. Within the ARC HBR framework…

…results should not be interpreted in isolation because myocardial injury is also encountered in non ACS cardiopulmonary disease. Patients with persistent or recurrent chest pain…

…or after suturing over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal…

…error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain…

…from apical windows. The patient's left arm should be placed under the patient's head. This stretches in the chest wall, such that the…

…with a fluid level in the anterior chamber, best seen with the patient sitting up. 3. Ocular movements in all directions; pain on upward gaze…

…corticosteroid and the lidocaine in the same syringe. The anaesthetic confirms that the injection has gone to the right place — immediate pain relief is a…

…Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and symptoms in known heart disease…

…blood pressure lowering effect. Pain relief. Delivery IV, IM, PO, transdermal Dose Injection IV: • 150 μg in 1 ml vial. Dilute with 10 ml…

…Symptom duration Under 12 hours: reperfusion is indicated in persisting STEMI. 12 to 48 hours: primary PCI should be considered even if symptoms have subsided…

…dilution instructions and the local protocol before prescribing. Basic principles of treatment The patient should be managed in an emergency department, an intensive care unit…

…in walking distance before claudication, accompanied by moderate pain or paresthesia, while sensory and motor function remain preserved. The duration and progression of symptoms should…

…rest pain in the foot or leg, or a non healing distal ulcer. Before compression treatment of a leg ulcer — compression in arterial insufficiency can…

…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…

…infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but should not delay reperfusion treatment…

…cough, akin to chronic neuropathic pain. This syndrome presents with a dry or minimally productive cough and a tickle or sensitivity in the throat, and…

…coronary intervention capable hospital. The initial ECG should be interpreted in conjunction with the clinical presentation and previous tracings when available. A prior ECG can…

…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…

…bridging; myocardial metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis…

…an unstable course, an arterial line should be considered. The blood pressure must not be dismissed as caused merely by pain or anxiety. These factors…

…intramuscularly [2,3]. When should anaphylaxis be suspected? Anaphylaxis is a clinical diagnosis. Treat as anaphylaxis in any of the following: 1. Acute onset of…

…three to six months during ongoing compression therapy, and always in the event of new or increasing pain. Preparation and equipment Doppler for the ankle…

…flow limiting epicardial disease, and alternative causes should remain under consideration. Acute chest pain and suspected NSTE ACS CCTA may be used as an alternativ

…delay. In contrast, haemodynamically stable patients without ST segment elevation after successful resuscitation from out of hospital cardiac arrest should not routinely undergo immediate angiography…

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

…In many patients, the burden is sufficiently severe to limit ordinary activities and substantially impair quality of life. The clinical impact should be assessed in…

…during pregnancy or after delivery. The clinical context is particularly important. SCAD should be considered in a young or middle aged woman with ACS and

…Statins inhibit 3 hydroxy 3 methylglutaryl coenzyme A reductase, the rate limiting enzyme in cholesterol synthesis. Reduced hepatic cholesterol production increases hepatic LDL receptor expression…

…must be avoided in patients with carotid bruits, possible or known plaques, or stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if…

…it should be interrogated (if possible) to determine whether it has recorded any shockable rhythms. In in hospital cardiac arrest (IHCA) 20 30% of victims…

…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…

…ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins. In addition…

…investigated. Pain, infections, medications, fever, hypovolemia, dehydration, anemia, hyperthyroidism and myocarditis are common etiologies. Treatment of the underlying cause should resolve the sinus tachycardia. Sinus…

…Expansion may produce pain in the abdomen, chest, lower back or scrotum. Aneurysmal pain is clinically important because it may herald rupture and constitutes a…

…postmenopausal bleeding, discharge, itching, burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national programme. Checking an intrauterine device or a pessary. Assessment of…

…may not be predictably exertional or relieved by rest or nitroglycerine. Symptoms should therefore be described in detail, followed by objective evaluation for obstructive disease,

…chest pain, dyspnoea, dizziness, and neurological deficits. Neurological involvement Hypertensive encephalopathy may present with somnolence, lethargy, tonic–clonic seizures, cortical blindness, and, in advanced cases…

…HF), atrial fibrillation and cardiovascular events. In clinical practice, obesity is conventionally defined by a body mass index (BMI) of ≥30 kg/m2. Severe obesity…

…used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich…

…clinical assessment should establish: The nature and stability of symptoms Exercise capacity The presence of active chest pain or other evidence of ongoing ischaemia Symptoms…

…Reduced exercise tolerance. Excessive fatigue. These non chest pain manifestations are reported more frequently in females, older adults and people with diabetes. Ischaemic heart disease…

…It should be noted that the ECG features of Brugada syndrome are fairly specific to the disorder, provided that the clinical characteristics are in line…

…intense emotional stress, acute pain or other stimuli that increases vagal tone. In all other situations, sinus arrest/pause should be considered abnormal, and the…

…Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise after MI, mechanical complications should be considered. Transthoracic echocardiography (TTE) can help…

…recurrent chest pain, pulmonary congestion, a new cardiac murmur, or jugular venous distension in the days after MI should prompt immediate consideration of a mechanical…

…Chest pain rated as 6 or above (according to the 10 point scale) should prompt termination of the stress test (refer to Termination criteria during…