…novel potentially life threatening cardiac arrhythmia syndrome identified with ECG The ECG may be used to diagnose several cardiac genetic disorders, such as Brugada syndrome…

…Myocarditis and takotsubo syndrome can produce myocardial injury and troponin elevation but are non ischaemic mimics rather than MINOCA when identified as the final diagnosis…

…regarded as a discrete disease; rather, it is an indicator of increased cardiovascular risk and a setting in which secondary hypertension is relatively common. Patients…

…renal failure, and heart failure have been identified as important risk factors. Severe atherosclerosis of the axillary or subclavian arteries may increase the risk of…

…haemodynamic instability — stabilise the patient first. Marked septal deviation towards the bleeding side (relative). Preparation and equipment Personal protective equipment (gloves, a visor, an apron)…

…presentation fits an exacerbation A COPD exacerbation is an acute or subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's…

…coronary calcification. CAC therefore functions primarily as an imaging biomarker of coronary atherosclerotic burden rather than as a direct measure of luminal obstruction. Calcified plaque…

…LVEF reliably identifies a high risk group that derives a large, trial proven survival benefit from primary prevention ICDs. Its dominance, though, owes as much…

…an adult with bridging and a substantial proximal atherosclerotic burden should be considered and treated in the same broad category as a patient with coronary…

…and identified during angiography performed for another indication. When clinically significant, it may present with chronic angina, an anginal equivalent or exertional dyspnoea. Patients may…

…a pacing dependent patient, inhibition of pacemaker output may result in clinically important pauses. In an ICD patient, EMI may be interpreted as ventricular tachyarrhythmia…

…particularly MYH7 and MYBPC3. Approximately 40–60% of tested patients have a single variant identified as the cause of disease, although the yield varies by…

…hemodynamically and respiratory) and fully conscious patients who experienced a brief cardiac arrest. Post resuscitation care is an integral component of the chain of survival…

…assess image quality and patient motion. Alignment : Ensure proper alignment of rest and stress images to accurately compare corresponding myocardial regions, as misalignment can lead…

…and are identified either during routine abdominal examination or incidentally on imaging performed for another indication. When palpable, an AAA may present as a pulsatile…

…has shifted toward an oligogenic or polygenic architecture. Genome wide association studies (GWAS) have identified common single nucleotide polymorphisms (SNPs)—such as those near SCN10A…

…FMD was identified in 86% of patients with SCAD. SCAD should therefore prompt consideration of systemic arteriopathy rather than being regarded solely as an isolated…

…Donation after circulatory death Starting point A ventilated patient who develops total brain infarction An intensive care patient in whom life sustaining treatment is withdrawn…

…Consequently, posterior infarction should not be regarded as an isolated electrocardiographic pattern in every case; it may represent the posterior component of a broader infarct…

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

…a distinct disease. It identifies patients whose blood pressure remains uncontrolled despite intensive antihypertensive treatment and who therefore require assessment for pseudo resistance, secondary hypertension…

…Penetrating torso injury with shock. A positive FAST scan in an unstable trauma patient. An unstable pelvic fracture with circulatory compromise. A ruptured aortic aneurysm…

…tachycardia may be classified as idiopathic if no cause can be identified. Idiopathic ventricular tachycardia has a more favorable prognosis, as compared with other forms…

…The PPV is 59.5%, indicating that slightly over half of the cases identified as STEMI by EMS are true positives. Negative Predictive Value (NPV…

…may influence treatment selection and tolerability. Whether the patient has persistent or progressive disease suggestive of an advanced phenotype. Particular attention should be paid to…

…treatment. The presence of ST segment changes or a positive troponin assay identifies patients in whom an invasive strategy is generally preferred over selective angiography…

…Stable chest pain CCTA is recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of…

…Clinical Indications PCSK9 inhibitors are used as additional lipid lowering therapy in patients whose LDL C remains above the recommended goal despite maximally tolerated statin…

…Therefore, these patients must be managed as STE ACS/STEMI until angiography has been performed. Note that troponins may be elevated but the elevation is…

…or identified only by implanted or wearable devices as subclinical AF. Some patients have frequent symptomatic episodes, whereas others have brief or asymptomatic episodes that…

…atrial fibrillation. Consequently, alcohol should not be initiated as a cardiovascular preventive strategy. A drink equivalent contains approximately 12–14 g of ethanol. Representative quantities…

…is therefore not an automatic response to chest pain. It is appropriate when the expected information is likely to change management. In patients with a…

…an anginal equivalent caused by reversible ischaemia. Symptoms may remain present daily or weekly despite multiple antianginal agents and prior revascularization procedures. In many patients…

…agents initially developed for glucose lowering in type 2 diabetes mellitus (T2DM). The principal drugs identified in the source material are canagliflozin, dapagliflozin and empagliflozin…

…be addressed, particularly in patients with established atherosclerotic disease. Readiness and behavioural context A brief, structured intervention should be used whenever smoking is identified. During…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…85%). Many patients appreciate the exercise test because it offers them an opportunity to evaluate their performance and symptoms under the supervision of their clinician…

…Basic principle Manage the patient, not the list of poisons. Stabilisation according to ABCDE, the plasma glucose, a blood gas and an ECG all come…

…Large fluid volumes worsen an already strained right ventricle. Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs…

…An anticoagulant is given as soon as possible, but must not delay cardioversion in an unstable patient. Rate control in the stable patient Drug Situation…

…neutropenic patient who is clinically unwell must be managed as an emergency even at a lower temperature. Suspect neutropenia in anyone who has received cytotoxic…

…Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy…

…support is given as an infusion of isoprenaline, adrenaline or dopamine according to local practice, and does not replace pacing when the patient is markedly…

…drugs, and how many doses, has the patient taken? Is the patient on an inhaled corticosteroid or other anti inflammatory treatment? Previous intensive care, intubati

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

…peripheral cannulae. Consider an arterial line if the patient is unstable or frequent blood gases are needed 3 Blood grouping and cross matching. Order red…

…the validity before ordering blood ; an expired type and screen discovered when the patient is already bleeding costs precious time. Exact validity periods and the…

…which casting harms the patient are that it is too tight — the swelling comes after the injury, not before — and that an edge or a…

…the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new sedative drug, for example…

…well the patient was preoxygenated, whether the difficulties were anticipated, whether the position and the equipment are in order, and whether there is an explicit…

ECG Exercise stress test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually…

…a change in medication or an exposure Concussion, temporal bone injury, dissection, aminoglycoside toxicity, antiepileptic drugs, alcohol or sedatives Trauma and medication directed workup This…

…arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set…

…times daily See note Do not use Do not use Nitrofurantoin: as a general rule the drug is contraindicated at an eGFR <45 mL/min…

…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…

…chemical pneumonitis as a consequence Medicinal charcoal Bowel obstruction, ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

Procedurer Injection technique is treated as self evident and is therefore often done wrongly. The two commonest errors are that an intramuscular injection in fact…

…quoted as the threshold, but the threshold varies between regions. Infection of the skin over the puncture site. Marked haemodynamic instability — stabilise the patient first…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…