…requiring an operating microscope. Relative: A patient who cannot keep the gaze still. A deeply embedded body reaching the stroma or deeper. The absence of…

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…

…comorbidities Frailty Liver cirrhosis Cognitive function and life expectancy, especially in older adults Previous sternotomy or CABG Patient preferences and expectations Frailty and liver cirrhosis…

…Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia. Features suggesting systemic embolization. In patients with recurrent chest pain and hemodynamic compromise after MI, mechanical complications should be…

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

…stress testing is utilized to assess whether there is any residual ischemia or angina pectoris. Patients may undergo repeated stress tests to assess symptoms and…

…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…

…very moment the patient swallows — the pharyngeal muscles then guide the tip into the oesophagus rather than into the trachea. Coughing, stridor or an inability…

…renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to…

…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…

…PEF or FEV1 if the patient can manage it without delaying treatment. 10. Call anaesthetics and intensive care early with life threatening features or an…

…deal in a conscious patient. Indications Immediate (transcutaneous) pacing in bradycardia with haemodynamic compromise — hypotension, shock, impaired consciousness, heart failure, myocardial ischaemia or syncope — that…

…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…

Akutsjukvård Lathundar Basic principle Anaphylaxis is a rapidly developing systemic hypersensitivity reaction that can cause life threatening compromise of the airway, breathing or circulation. Skin…

…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…

…pressure, left ventricular dysfunction, contraindications, or intolerance limit escalation of beta blocker or CCB therapy. Nicorandil and trimetazidine are additional options in selected patients. Treatment…

…hypertension Group 2: PH due to left heart disease Group 3: PH due to chronic lung disease, hypoxia, or sleep disordered breathing Group 4: Chronic…

…DCM) refers to idiopathic or genetic dilation of the left ventricle . Patients with DCM typically develop heart failure early in life and a family history…

Echocardiography Hypertrophic cardiomyopathy (HCM): from pathophysiology to echocardiography Hypertrophic cardiomyopathy is a genetic disorder that causes left ventricular hypertrophy under normal loading conditions. Hypertrophic cardiomyopathy…

…can form after transfusion or pregnancy. Check the validity before ordering blood ; an expired type and screen discovered when the patient is already bleeding costs…

…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…

…Correct Second or third degree AV block Depending on the indication Marked anaemia Correct A resting ECG that makes ST interpretation impossible — left bundle branch…

…only after a life threatening ingestion of a highly toxic substance, where the patient arrives within about 1 hour (a liquid preparation) or 2 hours…

…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…

…angiotensin II. By abrogating the effects of angiotensin II, ACE inhibitors stabilize left ventricular remodeling, improve patient symptoms, prevent hospitalization, and prolong life. Furthermore, because…

…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…

…induced global left ventricular dysfunction. Exercise testing also provides physiological information independent of ischaemia. Maximal exercise capacity, expressed by exercise duration, workload or metabolic equivalents…

…The clinical population is heterogeneous because the HFmrEF range includes both patients with recovering systolic function and those with deterioration from a previously preserved LVEF…

…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…

…but it may also be referred to as the posterior wall, or the inferobasal wall. Transmural ischemia located in this area yields an injury current…

…underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical history includes hypokalaemia. Endocrine…

…emotional stress, and an intercurrent medical or surgical illness. Events may occur at any time, although clustering in the morning within several hours of awakening…

…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…

…fraction <55%. This implies that left ventricular pumping capacity is reduced and it is synonymous with heart failure with reduced ejection fraction (HFREF ). Average ejection…

…emergency echocardiography, or any examination without a proper examination table, it may be difficult to acquire images in the left lateral decubitus position. This affects…

…during ongoing ventilation (DBD). An intensive care patient in whom a decision has been made to withdraw life sustaining treatment, in whom total brain infarction…

…and obtain consent if the patient is awake, and scan the vessel with ultrasound before you drape — a thrombosed or non compressible vein changes the…

…vomiting. Haemodynamic instability or a life threatening arrhythmia. Undrained pneumothorax. Facial trauma, facial burns or recent facial surgery that make a seal impossible. Recent surgery…

…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…

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

…the immunosuppressed and patients with renal or hepatic failure can have subtle symptoms. Findings that suggest acute organ dysfunction Organ or system Finding : : CNS New…

…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…

…long as the patient remains unconscious. The evidence Trial Question Result : : : TTM (2013) 33 °C versus 36 °C No difference in mortality or neurological outcome…

…of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5–10%, although some series report 10–20%. Other life threatening…

…depend on left ventricular ejection fraction (LVEF). Heart failure with reduced ejection fraction (HFrEF) is defined by the combination of symptoms, with or without physical…

…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…