…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…

…myocardial perfusion SPECT images involves a systematic comparison of rest and stress images to assess myocardial ischemia and infarction. The key steps in this process…

…are more biocompatible than those used in early DES. Fluoropolymer coatings have been associated with reduced vascular injury and inflammation, faster endothelialization, less neointimal proliferation…

…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…

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

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

…is that it is done early and sterilely and that the samples are sent correctly. A corticosteroid must never be injected into a joint in…

…those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no…

…months , irrespective of stent type. The preferred regimen is aspirin plus a potent P2Y12 inhibitor, usually prasugrel or ticagrelor. In patients undergoing PCI for ACS…

…strengthening exercise should additionally be performed on at least 2 days each week. Activities need not be undertaken in bouts of at least 10 minutes…

…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…

…of acute atherothrombosis. Type 3 MI: Describes cardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes, occurring before…

…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…

…rigid scaffold that limits adventitial recoil and constriction; consequently, in stent disease is driven predominantly by tissue accumulation within the stented segment rather than by…

…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…

…in patients with symptoms suggestive of CAD. SPECT imaging is recommended as the initial study in patients with low to moderate risk of CAD. In…

…cardiovascular death, and progression of atherosclerotic disease in patients with established coronary or other atherosclerotic vascular disease. Antiplatelet therapy is a central component because platelet…

…angina). Myocardial perfusion imaging techniques, such as SPECT and PET, can detect perfusion abnormalities early in this sequence, before mechanical dysfunction ( i.e. left ventricular…

Arrhythmias and arrhythmology Critical care Definition and pathophysiology Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and…

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

…than the antidote [1,2]. Telephone your national or regional poison control centre , which in most countries is staffed around the clock for health care…

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

…and several Swedish clinical knowledge resources have tightened the former 48 hour rule for patients with risk factors. Check what applies in your own region…

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

…patient empty the bladder first. Procedure Choice of insertion site The left lower quadrant is the first choice : the abdominal wall is thinner there than…

…a patient alive until a transvenous lead is in place — but only if it is working, and the commonest source of error is believing that…

…Early in a severe attack the patient usually hyperventilates and the pCO₂ is low. A normal pCO₂ may therefore mean that alveolar ventilation is already…

…is limited. In a patient with moderate symptoms the physician must judge the likelihood that the symptoms really are caused by the hyponatraemia. With severe…

…Haematochezia can occur in massive upper bleeding with rapid intestinal transit. Coffee ground vomiting is less specific than fresh haematemesis and can also be seen…

…is rarely the right measure. Contraindications Anaemia that can be corrected with iron, B12 or folate in a stable patient. Transfusion given solely to reach…

…two ways in which casting harms the patient are that it is too tight — the swelling comes after the injury, not before — and that an…

…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…

…two mechanisms that kill patients during airway management , and both are predictable. Indications Inability to protect the airway: reduced level of consciousness, loss of pharyngeal…

…exercise duration, workload or metabolic equivalents, is among the strongest predictors of mortality in patients with cardiovascular disease after accounting for age. Chronotropic response, blood…

…is more frequent in women and in patients presenting with NSTEMI than in those presenting with STEMI. Approximately one third of patients with MINOCA may…

…subacute worsening of dyspnoea, cough and sputum in particular that exceeds the patient's normal variation and requires a change of treatment. Common precipitants are…

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

…more often for practical than for medical reasons: the cuff is in the wrong place, the electrodes come off, the patient has not kept a…

…A short course (no more than 7 days) may be given to selected patients with an eGFR of 30 40 mL/min for lower urinary…

…so often fails is that it is done wrongly: the patient pinches the nasal bone instead of the soft part, and lets go after two…

…note it in the report. Shaving and careful skin preparation at the electrode sites — movement artefact ruins an exercise test more often than anything else…

…ileus or suspected perforation Gastric lavage An unprotected or unsecured airway in a patient with a reduced level of consciousness Gastric lavage Corrosive injury or…

…two commonest errors are that an intramuscular injection in fact ends up subcutaneously in a patient with a high BMI, and that the deltoid injection…

…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…

…of the position that determines whether the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an…

…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…

…dislocations. There is a hollow beneath the acromion, the arm is held in slight abduction and external rotation, and the patient resists internal rotation. Check…

…itself that determines whether the result can be interpreted. What decides that is whether the patient is taking a steroid that cross reacts in the…

…In placebo controlled trials, respiratory depression was no more common — and sometimes less common — after a benzodiazepine than with continued untreated status [3,4]. In…

…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…

…is symptom control rather than modification of long term cardiovascular outcomes. With the important exception of beta blockers in selected patients after acute myocardial infarction…

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

…some patients may benefit from a more individualized selection strategy. When to Initiate Pharmacological Treatment Lifestyle intervention is an essential component of care. In adults…

…evidence clarifies that while the benefits in conditions like osteoarthritis and obstructive sleep apnea primarily reflect the extent of weight loss, the reductions in hard…

…low probability: less than 5% in the European guideline framework. Diagnostic testing should generally be deferred. Low probability: up to 15% in the chest pain…

…most common risk factor for PH. It produces postcapillary PH through elevation of left atrial and pulmonary venous pressure. In some patients, chronic postcapillary pr

…the aorta and renovascular disease are important non endocrine causes, particularly in patients with resistant hypertension. Dietary sodium and potassium abnormalities and commonly used over…

…more frequent in people with diabetes and becomes more common with advancing age. Presentations without pain may include: Sudden breathlessness Syncope or sudden loss of…

…as soon as possible, with a target of less than 10 minutes from STEMI diagnosis to the fibrinolytic bolus. In suitable systems, pre hospital fibrinolysis…