…considered unlikely to adhere to medication. However, contemporary data support the use of DES in most PCI procedures, including many patients with high bleeding risk…

…dominant system. Bundle branch blocks Bundle branch blocks may be caused by ischemia/infarction. A new bundle branch block in a patient presenting with chest…

…and reduce systemic output. In this setting, venous congestion is generally treated initially with diuretics, whereas norepinephrine and/or inotropes are reserved for low output…

…Calcification has traditionally been considered a passive degenerative process, but emerging evidence suggests it is propelled by a biologically active process. Risk factors for calcification…

…A markedly raised blood pressure without acute target organ damage should not normally be lowered rapidly with intravenous drugs. Such treatment has not been shown…

…has been validated to predict major adverse cardiac events (MACE) , including mortality, myocardial infarction, and repeat revascularization. For example, in the SYNTAX trial, patients with…

…propagate through gaps between stent struts, and compromise the treated lumen. Conventional angiography has limited sensitivity for detecting coronary thrombus. Drug eluting stents (DES) may…

…This rhythm has been discussed previously in this article. Briefly, accelerated ventricular rhythm (also called idioventricular rhythm) is a benign ventricular rhythm with a heart…

…a more proximal vessel location, are associated with greater clinical risk. Most bridges do not cause important haemodynamic disturbance. Nevertheless, clinically significant bridging has been…

…assessment is required. Patients with NSTE ACS should be admitted for management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal…

…Dyspnea has been reported in patients treated with ticagrelor. Patients with a history of ischemic stroke can be treated with ticagrelor for up to 12…

…has traditionally been described as a follow up diameter stenosis exceeding 50%, whereas clinical restenosis refers to recurrent angina caused by disease in the treated…

…the body temperature to 33 °C has not been shown to improve survival or the neurological outcome compared with keeping the patient normothermic — but fever…

Echocardiography Ventricular ejection fraction (EF) For several decades, ejection fraction (EF) has been the dominating method for assessing left ventricular systolic function. Ejection fraction is…

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

…equipped with an increasing number of methods to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide…

…down in parallel, otherwise hypoglycaemia will follow. Discharge without a plan. Document what has been changed, who is following it up and when. Sources American…

…Exercise stress test Evaluation of the exercise stress test (exercise ECG) The ECG reaction has always been a central component of the exercise stress test…

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

…Inform the patient and agree a hand signal for a pause. Position the patient semi recumbent with the chin slightly towards the chest — an extended…

…test, exercise stress ECG) Exercise stress testing has been used routinely for over 60 years to evaluate cardiopulmonary function and to diagnose cardiovascular disease. The…

…A large bore peripheral cannula — at least 1.3 mm (green) for rapid transfusion, preferably two lines in a bleeding patient. A transfusion set with…

…24 hours for patients with risk factors; cardioversion between 24 and 48 hours without ongoing anticoagulation is then reserved for patients with a CHA₂DS₂ VA…

…has on the contrary been associated with more pneumonia and a longer stay, although the results are influenced by the fact that the sickest patients…

…The interleukin 1β pathway, with downstream effects involving interleukin 6 and C reactive protein, has been a major therapeutic target. This concept is clinically…

…that each arrhythmia has been addressed in isolation, distinguishing between them in clinical scenarios may remain challenging. Effective management of tachycardia requires a comprehensive understanding…

…that 75% of patients have increased plasma levels of catecholamines. References A recent consensus document has been issued by the European Society for Cardiology: Lyon…

…and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk of hypercapnia has been assessed. 3. Take an…

…Assessment of whether residual weakness in a patient with known myasthenia responds to further cholinesterase inhibition. The test has a sensitivity of around 60 % and…

…3. Apply the silver nitrate stick to the vessel with light pressure , rolling it, for 4–5 seconds until a grey eschar forms. Start peripheral…

…taken. A woman who has only been screened with cytology should be offered an HPV tested sample without waiting for the next routine invitation. Self…

…and revascularisation recommendations are not restricted to patients with symptoms. Current guidance supports revascularisation for significant left main stenosis irrespective of symptomatic status or the…

…value has been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with…

…has been recorded at 27%, while for witnessed cardiac arrests, the survival rate stands at 73% (Podsiadlo et al.). A significant majority of these patients…

…distinguish HFpEF from "Heart Failure with improved EF" (HFimpEF). HFimpEF refers to patients with a historical baseline LVEF ≤40% that has subsequently improved to 40%…

…and a dressing. The knee The patient lies supine with the leg extended and the quadriceps relaxed. The superolateral approach has the highest accuracy for…

…optimal initial combination strategy remains uncertain. A beta blocker combined with a dihydropyridine CCB is appropriate for many patients. Long acting nitrates or ranolazine may…

…a COPD exacerbation with carbon dioxide retention for the latter. The treatment is also time limited by its very nature: a patient who has not…

…with severe brain injury in whom total brain infarction is judged possible during ongoing ventilation (DBD). An intensive care patient in whom a decision has…

…rest and on movement . A patient who is pain free lying still but screams when turned has not finished being titrated. Expect an opioid naive…

…value normalized to a standard body surface area of 1.73 m². Advantages of MDRD eGFR Clinical utility: The MDRD equation has been instrumental in…

…to screen a population. The surface ECG is the obvious cheap, standardized, universally available alternative, and it has been mined for predictive features for decades…

…specific patterns Patients with inflammatory rheumatic disease have a higher cardiovascular risk than the general population. This excess risk has been documented across a broad…

…Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not every patient with an initial STEMI pattern has myocardial…

…In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for EMS or…

…phase. A leg that has recently been operated on, is in a cast or has extensive wounds so that the cuff cannot be applied. Place…

…while a distinct evidence base has emerged for coronary microvascular and vasospastic disease using coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR…

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

…provided it is tolerated. Patients with functional loss but preserved independence require a more detailed geriatric assessment. Where functional impairment is accompanied by inability to…

…the mechanism responsible for symptoms and ischaemia. The increasing prevalence of refractory angina reflects population ageing and improved survival among patients with CAD following advances…

…malfunction has been identified. Information should be obtained from the device identification card, the medical record, prior device interrogation, and, when necessary, chest radiography. A…

…or cannot reach it with the instruments available. Do not then try "by feel" — refer to ENT. Relative — a low threshold for referral: Marked swelling…

…in therapy Inclisiran has been approved in several European countries as an adjunct to diet and maximally tolerated statin therapy in patients with heterozygous familial…

…This explains why there has been a 20% increase in NSTEMI and a corresponding decrease in unstable angina in the past two decades (many of…

…marrow — choose the other side). A patient who cannot lie still — plan for sedation rather than abandoning the procedure. Choice of site The posterior superior…

…available evidence described here. Systematic screening of the general population for cardiovascular risk factors has not been shown to improve cardiovascular outcomes, although opportunistic assessment…

…bleeding has not yet been achieved. Penetrating torso injury with shock. A positive FAST scan in an unstable trauma patient. An unstable pelvic fracture with…

…the QRS morphology is compatible with ventricular tachycardia, then the diagnosis is ventricular tachycardia. If no criteria have been fulfilled, a diagnosis of supraventricular tachycardia…

…aspects of optimization of image quality have been discussed previously (refer to Optimization of the Ultrasound Image). Additionally, a number of transducer movements can be…

…the probability that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients with a very high probability…