…even in patients with left ventricular dysfunction, though those with depressed ejection fraction should receive it with great caution due to the risk of hypotension…

…systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in…

…centers and is generally reserved for meticulously selected cases. Extracorporeal Life Support (ECLS) encompasses several extracorporeal systems designed to assist in cases of cardiac or…

…both legs acutely increases preload. Untreated deep vein thrombosis in the acute phase. Septic phlebitis, ongoing soft tissue infection with systemic involvement. Relative: Condition Adaptation…

…the midbrain may receive enough oxygen to preserve some pupillary reflex. Importantly, pupillary size and reactivity are influenced by factors beyond neural activity. Systemic catecholamines…

…failure and occurs in more than 90% of patients presenting with the syndrome. Its severity and temporal pattern vary considerably. Symptoms of systemic venous congestion…

…Difficulties identifying R waves and T waves may result in incorrect recordings. Patient data Gender, age, weight and height are required to evaluate the examination…

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

…the course of treatment. Even transient, self terminating AF during ST elevation myocardial infarction may indicate an increased long term risk of stroke. In patients…

…anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia…

…measure in decontamination, and gastric lavage is today a rare procedure reserved for very serious poisonings in which the patient reaches hospital early. The benefit…

…confined to the ECG. Ischaemia may also produce angina, impaired exercise capacity, an abnormal blood pressure response or ventricular arrhythmias. A fall in systolic blood…

…pacing with normal conduction to the ventricles via the AV system. The ventricles are depolarized via the His Purkinje network, resulting in normal QRS duration…

…to contrast alone difficult. In patients with normal renal function, the occurrence of contrast induced AKI is negligible or very low. Risk rises substantially with…

…contractions leads to a marked reduction in cell metabolism and thus prolongs survival. Myocardial stunning starts to normalize within minutes after the hypoxia is relieved…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…fold higher in affected adults. True, apparent, and pseudo resistant hypertension The term resistant hypertension should be reserved for patients in whom the diagnosis has…

…who has received cytotoxic chemotherapy in the past three weeks, even before a blood count is available. The nadir often occurs 7 to 14 days…

…Evidence in acute coronary syndromes and recent myocardial infarction COLCOT The COLCOT trial enrolled 4745 patients within 30 days of myocardial infarction. Participants received colchicine…

…dose combination therapy generally produces faster and more consistent blood pressure reduction than monotherapy. It may also reduce treatment inertia, in which patients remain on…

…interaction with the hepatic LDL receptor. They lower LDL C by approximately 50–60%, including in patients receiving background statin therapy and in those unable…

…All patients with severe acute heart failure who receive levosimendan should be monitored invasively (e.g. arterial line, PiCCO, central venous catheter). The hemodynamic effects…

…it might be wise to observe the patient for 24 hours (including ECG monitoring). In all other situations, the underlying condition should be targeted and…

…is then reserved for patients with a CHA₂DS₂ VA score of 0–1. Check what applies in your own region. Duration above the threshold or…

…performed, fibrinolytic therapy is recommended within 12 h of symptom onset in patients without contraindications. I A In the absence of ST segment elevation, primary…

…drug therapy. It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia; in such…

…therapy (SAPT), most often aspirin. In selected patients, P2Y12 inhibitor monotherapy may be used as a de escalation strategy after a period of DAPT. The…

…defibrillation (unsynchronized shock) is reserved for ventricular fibrillation, where urgent reversion to sinus rhythm is required. The rationale for electrical therapy over drugs is that…

…particularly in patients with microvascular dysfunction or vasospasm. Angina associated with microvascular disease or vasomotor abnormalities may not be predictably exertional or relieved by rest…

…Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar with the special challenges…

…In salicylate poisoning, intubation with an inadequate minute ventilation can rapidly worsen the acidaemia and increase the entry of salicylate into the central nervous system…

…out The age adjusted D dimer in patients over 50: the threshold becomes age × 10 micrograms/L (FEU). Check which unit and which reference system…

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…

…about 30 °C — the hypothermic myocardium is irritable and pacing can precipitate ventricular fibrillation. Prioritise rewarming. Bradycardia in a patient with a normal circulation and…

…ipratropium in more severe attacks, and a systemic steroid given early [2,3]. Grading Grade the severity by the most serious finding. A patient does…

…gait instability The specificity of the symptoms is limited. In a patient with moderate symptoms the physician must judge the likelihood that the symptoms really…

…although the results are influenced by the fact that the sickest patients are more often intubated [4]. Intubation is reasonable in: a reduced level of…

…deficiency, folate deficiency — transfusion is rarely the right measure. Contraindications Anaemia that can be corrected with iron, B12 or folate in a stable patient. Transfusion…

…circumferential cast in a fresh injury, before surgery, or while swelling is progressing. Take care in impaired sensation (neuropathy, spinal cord injury) — the patient does…

…Delirium in older adults: quick reference A quick reference for ward and on call physicians: recognise hypoactive delirium, stabilise the patient, work systematically through the…

…what was done before it: how well the patient was preoxygenated, whether the difficulties were anticipated, whether the position and the equipment are in order…

…to the population and diagnostic criteria. MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients presenting…

…acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute coronary syndrome must be actively considered [1]. Do the following…

…posterior circulation stroke is the most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause…

…lymphoedema or a dialysis fistula in both arms, an arm circumference too large for the available cuffs, and in a patient who does not tolerate…

…73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the critically ill patient. Intravenous antibiotics…

…effect in anterior bleeding. Raise the chair so that the patient's nose is at your eye level. The patient sits upright and tilts the…

…physician available. Patient preparation: A light meal is permitted; no large meal, no coffee and no nicotine in the preceding 2–3 hours. Comfortable clothing…

…are no absolute contraindications, but refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked…

…in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5. Aspiration is not needed for vaccination in the…

…how the patient is positioned, which needle is chosen, and that the tubes go to the right place. In suspected bacterial meningitis it is the…

…drug administration when the patient cannot swallow safely, for example after a stroke. Sampling of gastric contents and evacuation in poisoning (see the separate text…

…in a patient who is not hypoxaemic. Breathlessness without hypoxaemia is not an indication for oxygen — look for the cause instead. Conditions in which the…

…oxide Rapid onset and offset; the patient cooperates Intra articular local anaesthesia Lidocaine into the glenohumeral joint in shoulder dislocation, with an effect equivalent to…

…that is whether the patient is taking a steroid that cross reacts in the cortisol assay, whether the samples were taken at the right times…

…the patient was last known to be well. Protect the patient from injury. Do not restrain the limbs and do not put anything in the…

…shock. Already marked hypothermia from another cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated…

…determines whether the treatment is safe is not the starting dose but the system around the patient : that the weekly dose is adjusted in small…

…lie in therapy: implantable cardioverter defibrillators (ICDs) are highly effective, terminating well over 99% of the ventricular arrhythmias they detect. It lies instead in patient…

…uncomplicated acute coronary syndrome when LVEF is 40% is not definitive. Observational studies have yielded conflicting results, and the appropriate duration of therapy in p