…of patients with STEMI or other very high risk features. Noninferiority studies designed mainly around bleeding outcomes may not reliably exclude clinically important differences in…

…reach their maximal heart rate. Ultimately, the specificity of exercise stress testing is lower in the elderly, as compared to younger individuals. Sensitivity, on the…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical attention due to chest discomfort or…

…often check pupil size and reactivity as part of initial and ongoing evaluations of patients in cardiac arrest or after return of spontaneous circulation (ROSC)…

…At a creatinine clearance <20 mL/min, consider an alternative treatment In aminoglycoside treatment of obese patients, an adjusted body weight is used: adjusted weight…

…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…

…They are contraindicated in patients with bronchospastic lung disease, or a history of significant reactive airway disease. Contraindications also include second degree or third degree…

…myocardial perfusion on the microvascular level. This is presumably explained by distal microembolization and dysfunctional microcirculation. Indeed, studies show that 15–35% of patients with…

…therefore the beginning of the investigation, not the end. In a frail older patient an apparently small insult — sleep deprivation, urinary retention or a new…

…or damp textiles. Administer cardiopulmonary resuscitation (CPR) following standard protocols, emphasizing concurrent rapid rewarming of the patient. Consider extracorporeal membrane oxygenation (ECMO) in unstable patients…

…disease, or peripheral artery disease. Secondary prevention concerns patients with established vascular disease, in whom aspirin has a substantially more favourable benefit–risk profile. Aspirin…

…to either the primary or secondary outcomes. Primary outcome events occurred in 49% of patients in the milrinone group and 54% in the dobutamine group…

…Lane DA, Lip GYH. Evaluation of the HAS BLED, ATRIA, and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin. Am J Med . 2016…

…and may worsen ischemia in patients with obstructive coronary disease. It is also the most prevalent antecedent of heart failure—particularly heart failure with preserved…

…The strongest established predictors of ischaemic stroke and systemic embolism are previous stroke or TIA and mitral stenosis. In patients with AF and previous ischaemic…

…table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above…

…plus ezetimibe. Consider bempedoic acid in selected patients, particularly those with statin intolerance or persistent failure to reach goal. For statin intolerant patients, ezetimibe may…

…g (8 mmol) IV in torsades or hypomagnesaemia 25–50 mg/kg, maximum 2 g Calcium chloride 10 mL of 100 mg/mL in hyperkalaemia…

…examination or general evaluation of patients with bradycardia. Diagnostics Electrocardiographic assessment is fundamental to the diagnosis and management of bradyarrhythmias. In the setting of cardiac…

…Patients with inflammatory rheumatic disease have a higher cardiovascular risk than the general population. This excess risk has been documented across a broad range of…

…6% of patients discharged with presumed non ischaemic chest pain were subsequently found to have had an infarction. Pathophysiological Considerations The central pathophysiological concern in…

…primarily on hemoglobin A1c (HbA1c) reduction, blood pressure, lipids and smoking cessation. Weight loss was considered extremely difficult across patient categories. However, the emergence of…

…e. septal bulging ). Bedside echocardiography allows for immediate recognition of tamponade. Typically, acute tamponade arises from aortic dissection, and survival among such patients is, unfortunately…

…objective, particularly in patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic…

…consequences in frail patients. Clinical Assessment Frailty and Functional Status Treatment decisions should not be based on age alone. Assessment should include: Degree of frailty…

…1β inhibition Canakinumab reduced inflammatory biomarkers without affecting lipids or other major coronary risk factors. In patients with previous myocardial infarction and residual inflammation…

…period of anticipated EMI. The perioperative strategy should also recognize that CRT patients may rely on continuous biventricular pacing for haemodynamic stability. In patients with…

…expression on ECG. Therefore, ischemic ST T changes (ST elevations, ST depressions, T wave changes) are typically concealed in the setting of LBBB. A patient…

…change in weight. Assessment should integrate the history, physical examination, laboratory data and diagnostic testing. Examination for congestion Useful bedside indicators of persistent or improving…

…Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. Crit Care…

…prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on…

…Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form of arterial hyperplastic disease…

…prevent or treat acute and subacute ventricular arrhythmias. The Singh Vaughan Williams classification fails to clarify that the majority of these agents exert effects on…

…NNT) for interventions in cardiopulmonary resuscitation. AED = automatic external defibrillator. The Number Needed to Treat (NNT) is the number of patients you need to…

…much less effective in terms of the number needed to treat (NNT). The Number Needed to Treat (NNT) is the number of patients you need…

…Their greater analytical sensitivity improves diagnostic accuracy and negative predictive value in patients with suspected acute coronary syndrome (ACS). Cardiac troponin is a marker of…

…In cardiac amyloidosis, BNP or NT proBNP may be markedly elevated even when overt congestion is not apparent. Such a discrepancy should prompt consideration of…

…skeletal muscle damage or inflammation may result in elevated cTnT levels. Although both troponin T and I may be chronically elevated in patients with renal…

…and on treatment assessment. In most studies, its association with cardiovascular risk is at least as strong as, and often stronger than, that of LDL…

…the cause of disease, although the yield varies by cohort. A causative variant is more likely to be found in a young patient with a…

…exclude patients presenting with asystole or PEA. Duration of cardiac arrest : In cases where cardiac arrest is caused by myocardial ischemia, myocardial infarction, or primary…

…block on arrival ECG is 6% and 7%, respectively. A proportion of these patients have a new bundle branch block, which in the case of…

…In patients with a high probability, testing may add little diagnostic value and invasive coronary angiography may be more appropriate when symptoms, risk or anatomical…

…and contraindications to prolonged dual antiplatelet therapy Patient preferences, local expertise and operator or institutional experience Assessment of coronary complexity The SYNTAX score is used…

…slightly simplified. In reality, the course in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are…

…renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient. Perioperatively and postoperatively in longer…

Info This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…

Cardiology This drug manual is provided for use in patients with hypertensive emergency (also referred to as hypertensive crisis or malignant hypertension ). Hypertensive emergency is…

…their right ventricle is located to the right of sternum. The anatomical location for V3R and V4R are identical to V3 and V4, but on…

…catheterization. Principles of management of congenital heart disease and GUCH Complex malformations often require intervention (surgical or catheter based intervention). In addition to the malformation…

…waves) do not affect the management of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead…

…recommend the use of validated risk models to estimate the risk of acute myocardial infarction, 30 day and 1 year mortality in patients with NSTE…

…Nitroglycerin is similar in action and pharmacokinetics to nitroprusside, although the latter is more potent. Effects Antihypertensive. Antianginal. Time to onset of action 2 to…

…of thrombosis, myocardial infarction, or death. Treatment for up to 12 months is recommended unless clinically indicated to discontinue earlier. Patients ≥ 75 years Use in…