…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…

…abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination findings before the dose. A plan for…

…and APS. Some patient groups have a two to three fold greater prevalence of asymptomatic atherosclerotic cardiovascular disease (ASCVD) than the general population. The evidence…

…prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity: Do not administer to patients with a history of asthma…

…A maintenance dose of 10 mg is not recommended due to higher exposure to the active metabolite and increased bleeding risk compared to patients weighing…

…get through the day of the test can therefore be given dexamethasone. That is the practical key: the patient does not have to be left…

…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…

…of a secondary cause The medical and medication histories should specifically assess drugs or substances that may increase blood pressure. The source material does not…

…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…

…patient who declines blood transfusion. The decision must be documented and alternatives (iron, tranexamic acid, cell salvage, haemorrhage control) planned in advance. A history of…

…variable expression A pathogenic variant does not invariably result in clinical disease. Penetrance is incomplete and age dependent, and the severity and manifestations of disease…

…ulcer A proton pump inhibitor with concomitant NSAID use or a history of ulcer, not routinely Infection Consider Pneumocystis prophylaxis with high doses over a…

…History taking, physical examination, ECG and laboratory tests are the cornerstones of management of patients with chest pain. A 12 lead ECG recording must be…

…those with a family history of high Lp(a); individuals with cardiovascular disease that is not explained by major conventional risk factors; patients at moderate…

…et al have presumably identified a novel familial (autosomal dominant) cardiac syndrome. The underlying genetic abnormality is yet to be discovered. Diagnosis of this syndrome…

…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…

…assessment. A carotid bruit is an important marker of cardiovascular risk, although the source material does not provide diagnostic sensitivity or specificity for bruit detection…

…distinguish a pharmacological SAMS effect from a nocebo response. Predisposing factors The likelihood of SAMS increases with higher statin doses and with several patient and…

…A family history of premature myocardial infarction, vascular disease or marked hypercholesterolaemia. Physical findings related to cholesterol deposition. Untreated or inadequately treated patients may develop…

…in patients with symptomatic or asymptomatic peripheral arterial disease, in whom AAA has been reported with a substantial cumulative incidence. The source material does not…

…angina may diminish or disappear. Others have no recognized history of angina or MI, making the distinction from primary dilated cardiomyopathy particularly difficult. When present…

…a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R wave amplitude, note the slurred terminal portion of…

…a few centimetres away from them Full bladder Have the patient void, or catheterise, before puncture Pregnancy, previous extensive abdominal surgery Ultrasound guidance; choose a…

…does not indicate how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a…

…cause life threatening compromise of the airway, breathing or circulation. Skin symptoms may be absent, and circulatory shock does not have to be present for…

…residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and is not specific:…

…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…

…of sinoatrial arrest/pause Sinus arrest/pause due to increased vagal tone does not necessitate treatment but it might be wise to observe the patient…

…pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available. Exercise ECG is not recommended as a rule out…

…and asystole can all occur in one patient. The typical depiction of sudden cardiac death as a gradual transition from sinus rhythm to ventricular tachycardia …

…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…

…Approximately 30% of all ischemic strokes are caused by cardiac embolism. This figure does not include paradoxical embolism (discussed below) and emboli from the proximal…

…is a common reason why mixed acid base disorders are missed. The blood gas describes the physiology at the moment of sampling, but does not…

…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…

…markedly from that of HFrEF. Patients are predominantly older (frequently 65 years of age) and there is a strong female predominance. Women have a substantially…

…Clinical Presentation and Symptoms The source material does not provide specific information on the clinical presentation and symptoms of the underlying conditions for which ACE…

…longer episodes, a lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI…

…resulted from acute myocardial ischaemia. Thus, a patient may have acute myocardial injury without having an infarction. The degree of troponin elevation does not by…

…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…

…Contraindications The laryngeal mask is a compromise and does not protect the airway completely. Relative contraindications: A high risk of aspiration: a non fasted patient…

…a stable dialysis patient with a plasma potassium of 6.6 mmol/L and an unchanged ECG. Both, however, need rapid assessment and an active…

…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…

…location of excess adiposity. 2 Clinical guidelines now emphasize that a BMI within the conventional "normal" range (up to 25 kg/m²) does not necessarily…

…does not describe specific physical signs of CTO or a dedicated physical examination algorithm. Diagnostics Non invasive assessment of ischaemia and viability Objective evidence of…

…time of onset when MRI is immediately available and does not delay treatment Saturation Give oxygen in hypoxia, not routinely to a normoxic patient Temperature…

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

…lower leg in a patient with peripheral arterial disease or diabetes — the wound may not heal. Over superficial nerves (the lateral aspects of the fingers…

…assess the consequences of extensive myocardial ischaemia, including heart failure, haemodynamic compromise and rhythm disturbance. The source material does not provide a specific examination profile…

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

…and a sense of impending doom. When pain begins during exertion, it does not usually subside with cessation of activity, distinguishing it from angina pectoris…

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

…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…

…or exclusion of thrombus — the most important relative contraindication to elective cardioversion. It does not apply in haemodynamic instability. Digitalis toxicity — a risk of refractory…

…third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion A large effusion may cause: Diminished heart sounds Disappearance of…

…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…

…symptoms and other therapies have failed. Patients with structural heart disease or reduced left ventricular function are not eligible. Effects of propafenone and flecainide on…

…thrombolytic factors varies from one minute to another, which may cause variations in the size of the thrombus. This means that a patient who experienced…

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

…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…