…heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw, upper back, and abdomen…

…manifests as localized, transient swelling of the subcutaneous or submucosal tissues, most frequently involving the face, lips, tongue, and upper airway. Due to the risk…

…ECG changes in takotsubo cardiomyopathy The typical patient presents with severe chest pain, dyspnea and occasionally hemodynamic compromise. The ECG shows localized ST segment elevations…

…characterized by localized fibrinous pericarditis containing polymorphonuclear leukocytes. Important distinction from subacute cardiac rupture A post AMI pericardial effusion is not automatically attributable to Dressler…

…plaque that penetrates through the internal elastic lamina into the media. The lesion may produce a localized medial haematoma and can progress to IMH, pseudoaneurysm…

ECG Myocardial ischemia and infarction Using the ECG to localize myocardial infarction and the coronary occlusion Determining the localization of myocardial infarction and ischemia, as…

…new onset marked weakness rapidly progressive symptoms from several organ systems severe abdominal pain or repeated vomiting after probable allergen exposure sudden hypotension or severe…

…symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen…

…biliary tract disease. There is no contraindication to analgesia in the acute abdomen . The notion that an opioid masks the diagnosis has been disproved — withholding…

…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…

…pain is usually described as pressure, squeezing, or a crushing sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen…

…Other symptoms include dyspnea, pain radiating to the left arm/shoulder/throat, palpitations, back pain and selected cases of upper abdominal pain. An ECG recording…

…stress testing, myocardial ischemia and ischemic symptoms Understanding the basic principles of exercise physiology is essential to conduct and evaluate the exercise stress test. Exercise…

…to joint aspiration and injection. Indications Condition Injection site Comment : : : Subacromial bursitis, rotator cuff syndrome The subacromial space The best documented indication Greater trochanteric pain…

…and infarction Definition and clinical rationale Stable angina, or chronic chest pain attributable to suspected chronic coronary syndrome, is evaluated by estimating the likelihood of…

…ischaemia with chest pain and ECG changes. Acute pulmonary oedema. Impaired consciousness. Synchronised cardioversion under sedation, at an energy level according to the local protocol…

…often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the…

…lies supine or sits. The upper arm is held adducted against the trunk and the elbow is flexed to 90 degrees. The forearm is moved…

…and rostral ventrolateral areas of the medulla result in the blood pressure lowering effect. Effects Potent blood pressure lowering effect. Pain relief. Delivery IV, IM…

…syndromes (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity…

…syndrome (CCS) Stable coronary artery disease (CAD), frequently referred to as stable angina pectoris , has traditionally been defined and managed as a distinct clinical entity…

…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…

…on the upper arm. Locate the brachial signal in the antecubital fossa with the Doppler probe at 45–60° to the skin. Inflate to 20…

…to be treated conservatively. Immobilisation after reduction of a dislocation. Immobilisation of a ligament injury, a tendon injury, or after suturing over a joint. Pain…

…manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a change of position — turning over in bed, lying…

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

…is usually a false positive. Indications Evaluation of chest pain with an intermediate pre test probability of coronary artery disease. Assessment of exercise capacity and…

…patient is easier to examine. Indications Symptoms: bleeding outside menstruation, postmenopausal bleeding, discharge, itching, burning, pelvic pain, dyspareunia. Cervical cancer screening according to the national…

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

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

…cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three to six months during…

…Contraindications Absolute contraindications to irrigation: A known or suspected perforation of the tympanic membrane — including a history of grommets, ear discharge or pain on contact…

…shows the most fluid, usually in the scapular line one to two intercostal spaces below the upper border of the fluid, but never below the…

…clip the hair — small cuts cause burning pain. 2. Position the pads, preferably anteroposteriorly : one anteriorly over the praecordium to the left of the sternum…

…criteria present: haemodynamic instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…Clinical Presentation and Indications CCTA is relevant to several clinical presentations. Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in…

…myocardial injury, demonstrated by a rising and/or falling troponin pattern with at least one value above the assay specific 99th percentile upper reference limit;…

…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 urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial ischaemia Haemodynamic instability or…

…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…

…after 3 minutes of standing to determine if orthostatic hypotension is present. High risk features on history include: New onset of chest discomfort, abdominal pain…

…the thrombus and the plaque. The patient will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are…

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

…stabilized. This usually takes 2 to 3 days and the patient must not have experienced chest pain during the last 12 hours before exercise. Patients…

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

…blood flow and thus more extensive myocardial ischemia (referred to as transmural ischemia). Yet, the pain caused by NSTEMI and unstable angina is considerable and…

…left lateral decubitus position. In this position, the heart comes closer to the thoracic wall, with less lung tissue covering the heart. Some images in…

…about severe chest pain and ST elevations on the ECG. However, as we will discuss below, it is actually rather straightforward to distinguish these two…

…Overview of management Click the diagram to enlarge. Chest pain (discomfort) is the hallmark symptom of myocardial ischemia and is particularly pronounced in patients experiencing…

…Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip) Venous drainage towards the cavernous sinus Surgeon or ENT; often antibiotics Palm, fingers…

…Significance : : Inability to speak in full sentences Marked work of breathing Use of accessory respiratory muscles or paradoxical abdominal breathing Impending muscle fatigue Respiratory rate…

…does not respond to fluid, abdominal pain, vomiting, fever, hyponatraemia, hyperkalaemia, hypoglycaemia. Give hydrocortisone and an isotonic crystalloid. Exact doses according to the local protocol…

…and less controllable depth of freeze). A size 15 scalpel or a pumice stone to pare down hyperkeratotic lesions. A cone or an otoscope speculum…

…all directions; pain on upward gaze may suggest an orbital floor fracture. 4. Topical anaesthesia into the lower fornix. 5. Evert the upper eyelid. Ask…

…an arterial line should be considered. The blood pressure must not be dismissed as caused merely by pain or anxiety. These factors can affect the…

…rigors, abdominal pain or a rapid deterioration in general condition may be the only signs of infection. Corticosteroids and other immunosuppressive treatments can blunt the…

…mass, although absence of a palpable abnormality does not exclude AAA. Plain abdominal radiography has limited sensitivity. A calcified aneurysmal outline may be visible, but…

…refers to the underlying coronary pathology, whereas “syndrome” describes its clinical expression. Clinical presentation and symptoms Clinical presentation is heterogeneous. Patients may have: Chest pain…