…term prediction of sudden cardiac arrest. The constraint does not lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of…

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

…as a plasma sodium below 135 mmol/L. The biochemical grade alone does not indicate how acute the condition is. A patient with a chronic…

…Skin symptoms may be absent, and circulatory shock does not have to be present for the condition to be serious [1]. Intramuscular adrenaline (epinephrine) is…

…A negative test does not exclude myasthenia gravis. Today the test plays a marginal role in Sweden. Edrophonium is available only as a named patient…

…and a systemic steroid given early [2,3]. Grading Grade the severity by the most serious finding. A patient does not have to meet every…

…after every dose, otherwise the dose does not arrive until the next flush. Assess the pain both at rest and on movement . A patient who…

…the sinoatrial node does not discharge an impulse for ≥2 seconds. Failure to discharge an impulse within <2 seconds is defined as a sinoatrial pause…

…A major limitation is that CAC does not measure total plaque burden or stenosis severity directly. A patient may have little or no calcium despite…

…rehabilitation, ablative or surgical interventions The test does not define the structure or composition of coronary atherosclerotic plaque, identify plaques at high risk of rupture…

…has deteriorated into PEA or asystole, and therefore the worse the prognosis. This does not always hold true. For example, in cardiac arrest due to…

…have tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region. The time limit is not a…

…central. A simple check is to ask the patient to recite the months of the year backwards. A normal result does not exclude delirium, however…

…strokes are caused by cardiac embolism. This figure does not include paradoxical embolism (discussed below) and emboli from the proximal aorta. Stroke and TIA (Transient…

…anion gap, is there a further metabolic disturbance? Calculate the delta gap or delta ratio 6 Does the result fit the patient? If not, check…

…slope does not itself distinguish precapillary from postcapillary disease. A PAWP/cardiac output slope greater than 2 mmHg/L/min may help identify a postcapillary…

…be used to quantify sodium and potassium intake, preferably while the patient is receiving a stable diuretic dose. Other clinical contexts Secondary causes should be…

…with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage…

…criterion underscores that "preserved" ejection fraction does not equate to normal cardiac function, but rather to a state where stroke volume is maintained only at…

…involves a reduction in intraglomerular hyperfiltration and hypertension by disproportionately reducing glomerular efferent arteriolar vasoconstriction. Clinical Presentation and Symptoms The source material does not provide…

…cardiac troponin release that does not fulfil the criteria for ischaemic myocardial infarction. It may be acute, when serial troponin values show a dynamic change…

…Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by itself establish the mechanism. Increased…

…while recognising that pattern does not determine the anticoagulation indication. Previous stroke or TIA. The presence of mitral stenosis, a mechanical heart valve or hypertrophic…

…inflate to a seal and check that the cuff pressure does not exceed 60 cmH₂O . Gel cuffed masks of the i gel type have no…

…symptoms mean a high risk even if the plasma potassium is below 6.5 mmol/L. Conversely, patients with chronic renal failure may have very…

…does not fit the clinical picture, repeat the sample and send a venous plasma glucose, but do not delay treatment of a neurologically compromised patient…

…a BMI within the conventional "normal" range (up to 25 kg/m²) does not necessarily equate to optimal cardiovascular health. 2 Evidence suggests that a…

…factors and anticipated outcomes. The supplied material does not describe specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics Non invasive assessment…

…MRI is immediately available and does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature Treat fever and look…

…Not giving a stress dose to a patient with adrenal insufficiency during acute illness. Confusing dexamethasone 0.75 mg with prednisolone 0.75 mg. A…

…be given dexamethasone. That is the practical key: the patient does not have to be left unprotected for the test to be interpretable. Procedure 1…

…longer have a right of veto based on their own view . Their role is to convey what the deceased person themselves thought. This does not…

…European guidelines. However, a concave ST segment does not rule out ischemia, it merely reduces the probability of ischemia as the underlying cause. Concave ST…

…with poor circulation, above all the lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over superficial nerves…

…haemodynamic compromise and rhythm disturbance. The source material does not provide a specific examination profile or diagnostic physical signs for LMCAD. Diagnostic Assessment Coronary angiography…

…high risk patients. The strategy may, however, increase peri procedural complications and bleeding. Clinical presentation The available source material does not provide a detailed description…

…the occipital area but does not radiate below the umbilicus. It is often accompanied by sweating, nausea, vomiting, anxiety, and a sense of impending doom…

…of follow up in a prospective study of patients with acute coronary syndrome. Thus, an individual plaque’s morphology does not reliably establish that it…

…useful for estimating risk. Pathophysiology and genetic principles Penetrance and variable expression A pathogenic variant does not invariably result in clinical disease. Penetrance is incomplete…

…ECG is a better marker of reperfusion than angiography itself. Studies have shown that angiographic blood flow does not always correlate with myocardial perfusion on…

…most important relative contraindication to elective cardioversion. It does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory ventricular arrhythmias. Therapeutic digoxin levels…

…up to approximately one third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion A large effusion may cause: Diminished…

…Ejection fraction is routinely examined at rest, which does not reveal the functional (maximum) capacity of the left ventricle, as this would require measuring the…

…Paroxysmal atrial fibrillation in patients with severe symptoms, provided that first line therapies have failed and the patient does not have structural heart disease or…

…of men display ST segment elevations that are not caused by ischemia and a significant proportion have ST T changes caused by other pathological conditions…

…respectively. A proportion of these patients have a new bundle branch block, which in the case of left bundle branch block should lead the clinician…

…did the patient first note the symptoms and how have the symptoms developed over time? In stable ischemic heart disease, symptoms are typically not present…

…not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient, with similar ST segment changes, experienced syncopal episodes, ventricular tachycardia (including torsades des…

…Associations have also been extended to peripheral arterial disease, ischaemic stroke, abdominal aortic aneurysm, and calcific aortic valve stenosis. Lp(a) is not associated with…

…heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient is by contrast not recommended [1,5]. STEMI…

…more than a hundred clinically relevant interactions. What determines whether the treatment is safe is not the starting dose but the system around the patient …

…decompensated heart failure, but worsening renal function does not necessarily indicate reduced cardiac output or impaired renal perfusion. Many patients have preserved cardiac output; increased…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

…Patients with stable or chronic atherosclerotic coronary disease, many of whom have a previous acute coronary syndrome. The available evidence supports consideration of low dose…

…The patient need not have fever, leucocytosis or a positive culture. Older people, the immunosuppressed and patients with renal or hepatic failure can have subtle…

…effective only when the patient is in sinus rhythm. Its role in atrial fibrillation remains uncertain, although it may have a rate reducing effect in…

…antihypertensive drugs from different classes at maximally tolerated doses, including a diuretic appropriate for kidney function. In patients with an estimated glomerular filtration rate below…

…Obesity may be a particularly important cause of HF with preserved ejection fraction (HFpEF). Obese patients with HFpEF can have pathophysiological characteristics that differ from…

…trials have not directly established that upfront combination therapy is superior to upfront monotherapy for every patient with isolated hypertension. Single Pill Combinations Fixed dose…

…STEMI) without ST segment elevations on 12 lead ECG This chapter covers situations in which the 12 lead ECG does not exhibit ST segment elevations…