…a drill, a lawnmower, or in the wind. Suspected corneal abrasion. A red eye where the diagnosis is not obvious. Suspected acute glaucoma (tonometry). Contraindications…

Echocardiography Methods for assessing systolic function (contractile function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods elucidate slightly different aspects…

…in Figure 1. The ultrasound system automatically calculates RWT (Relative Weight Thickness), provided that the patient's weight, height and sex are entered. RWT is…

…substantial changes in left ventricular depolarization and repolarization, which result in secondary ST T changes. Such ST T changes may mimic (simulate) or mask ischemia…

…For patients with LBBB and a left ventricular ejection fraction (LVEF) $< 35%$, the implantation of a defibrillator or a CRT D is indicated…

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

…infarction Definition and pathophysiology Left ventricular (LV) thrombus is an intracavitary clot attached to the LV endocardium, typically overlying an akinetic or dyskinetic myocardial segment…

…S V1 or S V2 ≥30 mm R V5 or R V6 ≥30 mm 3 Discordant ST T change in a patient not on digoxin…

…score or similar) may undergo stress testing when their clinical condition is stabilized. This usually takes 2 to 3 days and the patient must not…

…haemodynamic status Whether heart failure is present and whether left ventricular systolic function is depressed or preserved Whether hypotension is present Whether an accessory pathway…

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

…Extracorporeal Life Support (ECLS) encompasses several extracorporeal systems designed to assist in cases of cardiac or respiratory failure by means of an extracorporeal pump and…

…investigation is diagnostic, not therapeutic. An unstable patient should be cardioverted, not investigated. Contraindications Haemodynamic instability — hypotension, shock, impaired consciousness or pulmonary oedema. Treat the…

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…

…a potential interaction, and that there is a ready made plan for what happens when the INR runs away or the patient bleeds. In Sweden…

…and can guide resuscitative efforts. If the patient presents with hypotension or has a lactate level exceeding 4 mmol/l, commence an intravenous fluid resuscitation…

…patients with risk factors. Check what applies in your own region. The time limit is not a guarantee. Where the stroke risk is high or…

…A patient does not have to meet every criterion in a column. Clinical deterioration or a poor response to treatment carries more weight than a…

…conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that has not responded…

…for investigating left ventricular function — e.g ejection fraction (EF), fractional sorting (FS), etc — do not elucidate regional variations in contractile function, or the effectiveness…

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

…a patient's condition over time. For instance, an increase in left atrial size or the development of NSVT may warrant closer surveillance or a…

…in the fifth decade of life in several family members. Imaging studies did not reveal structural cardiac abnormalities, nor coronary artery disease. Another male patient…

…not been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or…

…is not absolute: patient phenotype, risk factors for heart failure with preserved ejection fraction, echocardiographic findings, and left atrial size must also be considered. Patients…

…Clearly, not all DCM genes have been discovered. Genetic testing for DCM Genetic testing of patients with confirmed or likely dilated cardiomyopathy can be recommended…

…disproportionate response to increased ventricular loading. The presence of systemic hypertension or aortic stenosis does not rule out hypertrophic cardiomyopathy. Epidemiological aspects of hypertrophic cardiomyopathy…

…preferably two lines in a bleeding patient. A transfusion set with a filter. Blood components must not be given through a set without a filter…

…half life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or…

…lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart rate response, arrhythmias and recovery. A patient…

…Seizures or an unstable patient — stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind…

…why, or the patient at risk of carbon dioxide retention is given 15 litres on a reservoir mask and drifts off into a respiratory acidosis…

…risk. Clinical Applications Personalized Decision Making : SYNTAX Score II helps determine whether a patient should undergo PCI or CABG based on their risk profile. Predicting…

…et al 1 ). Representative single beat morphs for a low risk patient (blue) and the corresponding high risk morph (red). Beyond the difference in R…

…symptomatic hypotension. Diagnostics The source material does not cover specific diagnostic modalities such as ECG, imaging, or electrophysiology in relation to ACE inhibitor therapy. Biomarkers…

…patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in the absence of left ventricular hypertrophy or…

…patients with low or moderate pre test likelihood of obstructive CAD, CCTA or functional imaging should generally be preferred when available. Exercise ECG is not…

…thyroid or hepatic disease may produce a similar symptom complex; in the absence of cardiac dysfunction, these conditions do not fulfil the definition of heart…

…left ventricular function and other comorbidities Surgical risk and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment…

…V3 in patients with NSTE ACS/NSTEMI are almost invariably accompanied by ST segment depressions in other leads (particularly V5) and that is not consistent…

…or substances that may increase blood pressure. The source material does not provide an exhaustive list of such agents. Resistant hypertension Resistant hypertension is not…

…or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently develop myocardial necrosis and cardiac troponin elevation, although not…

…of death in Western countries, and ultrasound studies are now performed in the majority of patients with stroke or TIA. The purpose of performing an…

…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…

…the heart. Therefore, most images in adult TTE are obtained with the patient positioned in the left lateral decubitus position. In this position, the heart…

…tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according to the current transmission risk assessment. In DCD: patients in whom…

…and does not interfere with ongoing CPR or airway management, no risk of pneumothorax Highest risk of thrombosis and contamination, immobilises the patient The right…

…of consciousness not attributable to hypercapnia, marked swallowing difficulty, vomiting. Haemodynamic instability or a life threatening arrhythmia. Undrained pneumothorax. Facial trauma, facial burns or recent…

…dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest with suspected hyperkalaemia, advanced life support…

…rarely the needle itself. It is the decision whether to perform it now or after imaging, how the patient is positioned, which needle is chosen…

…feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision and…

…or respiratorily unstable patient. Contraindications In tension pneumothorax and in empyema there are no absolute contraindications — the procedure is life saving and necessary respectively. Otherwise…

…sepsis Suspected or confirmed infection together with new organ dysfunction must raise the suspicion of sepsis. The patient need not have fever, leucocytosis or 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…

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

…objective is not simply to establish whether the patient has ACS. It is to determine whether the patient is clinically unstable, identify life threatening diagnoses…

…does not depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or…

…lesion may not identify the patient most likely to benefit from intervention. Conversely, apparently mild lesions may rupture and precipitate myocardial infarction or sudden death…

…worsen when the patient lies flat or moves [2], [5]. Localization: While often retrosternal, the pain may be localized to the left anterior chest and…

…or evidence of low output despite relatively limited elevation of left sided filling pressure. Evaluation and physical examination Initial assessment should establish whether the patient…