…than 20% from baseline. Type 4a MI after PCI In a patient with normal baseline cTn, type 4a MI is defined by: cTn greater than…

…embolize systemically. Observational data indicate approximately a fourfold greater risk of embolic events in patients with LV thrombus than in matched patients without thrombus. Factors…

…stenosis greater than 50%—occurred in 20–30% of patients, while clinically evident restenosis, manifested by recurrent angina attributable to the treated segment, occurred in…

…provides a fundamental parameter that cannot be obtained by other imaging methods, namely exercise capacity (and VO2 max , see below). In addition to exercise capacity…

…establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with stent thrombosis present with ACS…

…RR) in SPECT myocardial perfusion imaging is an unusual phenomenon in which a perfusion defect becomes evident or worsens in rest images compared to stress…

…but refrain or adapt in: The patient does not consent — the examination must then not be carried out. Vaginismus or marked anxiety — plan for extra…

…months in carefully selected patients with high ischemic risk and low bleeding risk. These strategies are intended primarily to reduce bleeding rather than to replace…

…through muscle without major vessels or nerves, and the landmark — the posterior corner of the acromion — is easy to palpate even in a large patient…

…lies instead in patient selection. Because implantation entails appreciable cost and procedural risk, the risk benefit balance depends almost entirely on the capacity to identify…

…without exposing the patient to disproportionate bleeding risk. Shortening treatment may reduce bleeding but can increase myocardial infarction or stent thrombosis in some ACS populations…

…on at least 2 days each week. Activities need not be undertaken in bouts of at least 10 minutes; shorter episodes also contribute to health…

…Attributed to an imbalance between myocardial oxygen supply and demand, without the presence of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with…

…is encouraged to define the mechanism rather than relying on angiography alone. Factors associated with restenosis The risk of restenosis after metallic stent implantation is…

…tomography (SPECT) or positron emission tomography (PET) to assess myocardial perfusion and blood flow. These imaging modalities are highly sensitive and specific in evaluating perfusion…

…confirm or rule out CAD in patients with symptoms suggestive of CAD. SPECT imaging is recommended as the initial study in patients with low to…

…or when an individualized post PCI strategy favours P2Y12 inhibitor monotherapy. Clopidogrel Clopidogrel 75 mg once daily is an established alternative to aspirin. In patients…

…abnormalities and ultimately leading to chest pain (angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect perfusion abnormalities early in this sequence…

…worse than in patients who remain in sinus rhythm. Several mechanisms may account for apparent ischaemic electrocardiographic changes during rapid AF. ST segment depression or…

…to TIMI score or similar) may undergo stress testing when their clinical condition is stabilized. This usually takes 2 to 3 days and the patient…

…or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation, chest movement and a blood gas. Ventilate by mask in opioid…

…A D dimer must not be used to rule it out The age adjusted D dimer in patients over 50: the threshold becomes age × 10…

…Target rate in the acute phase: a resting ventricular rate < 110/min is a sufficient initial target in most patients. Doses according to the…

…10⁹/L An expected high risk course Neutropenia expected to last longer than 7 days, or shorter neutropenia with clinical risk factors International guidelines generally…

…mandatory in order to be able to calculate the SAAG. The patient lies supine, preferably with slight rotation towards the left side so that the…

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

…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…

…management: 1. Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms…

…haemoglobin can be normal before fluid has redistributed or been given. In massive bleeding, the decision to transfuse must therefore not be based on the…

…Contraindications Anaemia that can be corrected with iron, B12 or folate in a stable patient. Transfusion given solely to reach a laboratory value without a…

…transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An open fracture or a wound that needs to…

…instrument , for example the 4AT or the CAM according to local protocol. 6. Look for several concurrent causes. In older patients delirium is often multifactorial…

…surgical airway or awake fibreoptic intubation. A difficult airway is anticipated in a stable patient — awake fibreoptic intubation or anaesthetic back up is then the…

…syndrome Exercise ECG may be used in selected patients with suspected chronic coronary syndrome when the result is expected to influence diagnostic strategy or management…

…50% or more in any potential infarct related artery. MINOCA is not a definitive disease diagnosis. It is a descriptive and provisional classification that should…

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

…that emergency physicians be trained in HINTS, Dix Hallpike and the Epley manoeuvre, since otherwise these examinations are easily applied to the wrong patient or…

…every 30 minutes at night , or alternatively every 15 and every 30 minutes respectively. Instruct the patient to stop, keep the arm still and lowered…

…given for absolute eGFR in mL/min , not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average…

…acid on a pledget or as a solution has a good effect in anterior bleeding. Raise the chair so that the patient's nose is…

…angiography, myocardial perfusion scintigraphy, stress echocardiography) has greater diagnostic accuracy. Contraindications Absolute: Acute coronary syndrome within 48 hours, or ongoing unstable angina. Uncontrolled symptomatic arrhythmia…

…toxic dose of a substance that binds to charcoal, when it can be given early and the patient has an intact or a protected airway…

…thumb and index finger, or compress the muscle in a slim patient. 4. Insert the needle perpendicularly , quickly and firmly, to its full length. 5…

…In suspected bacterial meningitis it is the time to antibiotics that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis…

…Ask the patient to flex the head forward and swallow repeatedly , preferably with sips of water if swallowing is safe. Advance the tube in time…

…oxygen but that the prescription has no target — the nasal cannula stays in place for days without anyone asking why, or the patient at risk…

…as not to reduce a fracture dislocation or to miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known…

…test to be interpretable. Procedure 1. Schedule the test in the morning, preferably starting between 08:00 and 09:00 , with the patient fasting or…

…the time of seizure onset, or the time the patient was last known to be well. Protect the patient from injury. Do not restrain the…

…in patients who remain unconscious. The evidence is insufficient to recommend for or against active cooling to 32–36 °C. The HYPERION result means that…

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

…been shown to improve long term cardiovascular outcomes in CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or a…

…or equal to 1.5 mm All patients Other leads Greater than or equal to 1 mm These criteria for the other leads apply in…

…also be preferable in patients aged ≥85 years, those with symptomatic orthostatic hypotension, moderate to severe frailty, or very old or frail patients who may…

…3 For patients with a BMI below 35 kg/m², direct assessments such as waist circumference, waist to hip ratio, or dual X ray absorptiometry…

…probability: greater than 5% to 50% in the chronic coronary syndrome pathway. Coronary CT angiography (CCTA) is generally preferred to exclude obstructive CAD. Intermediate or…

…slope greater than 3 mmHg/L/min from rest to exercise. This response is age dependent and may rarely occur in healthy people older than…

…hypertension is elevated blood pressure attributable to a specific, identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension…

…factor is identifiable in up to one half of cases. Reported precipitants include vigorous physical activity, emotional stress, and an intercurrent medical or surgical illness…

…elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia. The immediate therapeutic objective is restoration of coronary blood flow to…