…partial rupture into a complete one. Contact the urologist or the surgeon on call for urethrography and suprapubic drainage. Preparation and equipment A sterile catheterisation…

…in older people and in patients with diabetes. The haemodynamic consequences depend on lesion location, severity, length, the presence of multilevel disease and collateral circulation…

…to the rectus sheath, and a cell count plus albumin on the sample. Indications Diagnostic paracentesis: Newly detected ascites — always. Every admission of a patient…

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

…the time of medical evaluation, because transient or evolving ischaemia may still require urgent reperfusion assessment. Posterior myocardial infarction may be electrically subtle on the…

…strong association between the early repolarization pattern and sudden cardiac arrest due to idiopathic ventricular fibrillation. The combination of early repolarization pattern on ECG and…

…NSTE ACS has profound implications for management and treatment of patients with acute coronary syndromes. Moreover, clinicians must clarify whether the ECG was recorded during…

…ST segment elevations on the conventional 12 lead ECG. These situations are as follows: Transmural ischemia located in the posterolateral portion of the left ventricle…

…much of the evidence for shortened regimens derives from selected populations, frequently with low or intermediate ischemic risk and under representation of patients with STEMI…

…is recommended for all examinations of the breasts, the genitalia and the rectum. Ask about pregnancy, menstrual status, previous smear results and any previous conisation…

…the 12 lead ECG (conventional ECG) be used for interpretation of ischemia. All available ECG criteria for acute myocardial infarction and ischemia are based on…

… 2. Is the patient hypovolaemic, adequately filled or fluid overloaded? 3. Is there, or is there approaching, an indication for dialysis? AKI occurs in about…

…by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of office blood pressure Category Systolic Diastolic :…

…ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure by inhibiting ACE. Effects • The hypotensive effect of enalaprilat depends on plasma…

…be beneficial, whereas triglyceride levels seem to be of little or no importance for atherosclerosis. When discussing atherosclerosis, the focus is on LDL cholesterol. Virtually…

…ester) of enalapril, an angiotensin converting enzyme (ACE) inhibitor. Enalaprilat lowers blood pressure by inhibiting ACE. Effects • The hypotensive effect of enalaprilat depends on plasma…

…for the Management of Heart Failure. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the…

…represents amplitude of the electrical signals generated in the myocardium. The same ECG grid is used in children and adult patients. Recommendations for ECG recording…

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

Infektionssjukdomar Akutsjukvård Lathundar Purpose and scope A quick reference for the doctor on call faced with suspected sepsis in adults: rapid recognition, microbiological sampling, empirical…

…in patients with atrial fibrillation (AF) on anticoagulation therapy. Its purpose is to guide clinicians in balancing estimating the risks of bleeding. Components of the…

…clustering of cardiometabolic abnormalities centred on abdominal adiposity, insulin resistance, dyslipidaemia, elevated blood pressure and impaired glucose regulation. Diagnosis is based on the coexistence of…

…estimating the extent of ischemia. After revascularization procedures, stress testing is utilized to assess whether there is any residual ischemia or angina pectoris. Patients may…

…since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease…

…seconds. Case reports have indicated that the risk of high degree AV block and ventricular arrhythmias is greater in patients on digoxin or verapamil, although…

…supplied by the disease artery. Thus, vasodilators replicate the effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over…

…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…

…based solely on gender. This aims to prevent unnecessary anticoagulation in low risk female patients, thereby reducing the potential for bleeding complications. The CHA₂DS₂ VA…

…or a reduced requirement for antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure…

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

…metabolic abnormalities; and abnormal pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis. ANOCA/INOCA…

…its reliance on ST segment elevation as the key trigger for emergent reperfusion therapy. This approach fails to identify a substantial proportion of patients with…

…digoxin has been ousted repeatedly from the standard of care for these conditions. However, digoxin is still used in patients who do not achieve satisfactory…

…aggravate any ventricular arrhythmia, such as ventricular tachycardia, ventricular fibrillation, torsade de pointes etc). Hypokalemia is likely to predispose to the pro arrhythmic effects of…

…and the extent of endocarditis. Endocarditis gives three typical findings on echocardiography: Vegetations. Abscesses. Prosthetic detachment. These three findings constitute the main criteria for diagnosing…

…Under such circumstances, the efficacy of compressions and defibrillation diminishes considerably. Extracorporeal Life Support (ECLS) emerges as the sole therapeutic alternative for such situations. Presently…

…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…

…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…

…The doses and Swedish thresholds below are based on the national guideline for the management of reperfusion treatment in ischaemic stroke, Nationell arbetsgrupp Stroke (the…

…coma may occur Mixed picture of DKA and HHS Overlap is common. Treat as mixed DKA and HHS if the patient has marked hyperosmolality together…

…mL/kg/h for ≥ 12 h 3 ≥ 3.0 × the baseline, or a creatinine ≥ 354 µmol/L, or the start of dialysis < 0.3…

…Definition of aortic aneurysm Sinus of Valsalva 45 mm. Any other segment 40 mm in diameter. Thresholds for surgery Threshold for surgery Relevant patient category…

…the maximum dose per 24 hours is 1000 mL. Adverse effects Headache. Nausea. Fever. Atrial fibrillation. Worsening of heart failure. Caution • Used cautiously in patients…

…maintain a high index of suspicion for drug induced arrhythmias in patients receiving agents known to alter the electrical properties of the heart (inducing QRS…

…hypertension and atherosclerotic coronary disease In patients with heavy alcohol use, left ventricular dilation may precede the development of increased left ventricular hypertrophy and mass…

…of typical flutter. Furthermore, typical flutter frequently emerges in patients undergoing pharmacological treatment for AF with class IC drugs or amiodarone. In these instances, the…

…and assessment for advanced therapies may be required. Evaluation and physical examination Assessment begins by establishing that the patient has a clinical heart failure syndrome…

…Symptoms In the management of heart failure, digoxin improves hemodynamics without increasing heart rate or decreasing blood pressure, making it a consideration for patients with…

…most consistent contemporary role is therefore the assessment of functional capacity, symptoms, haemodynamic responses, arrhythmias and prognosis, with diagnostic interpretation reserved for appropriately selected patients…

…Addition of a PCSK9 inhibitor when the target remains unmet despite maximally tolerated statin therapy and ezetimibe. For patients with a recurrent atherothrombotic event while…

…which seeks to prevent the development of cardiovascular risk factors themselves, and from secondary prevention, which addresses patients with established disease to reduce recurrent events…

…or surgical illness. Events may occur at any time, although clustering in the morning within several hours of awakening has been described. Atypical and painless…

…the diagnosis is uncertain, cardiogenic shock is present, or symptoms have been present for more than 2–3 hours. Patients with a working diagnosis of…

…of obstructive CAD is moderate or high, generally greater than 15% and less than 85% Baseline ECG abnormalities make exercise ECG interpretation unreliable The patient…

…diabetes; systematic screening for diabetes is therefore recommended in patients with CVD. The clinical consequences of diabetes may present through any major cardiovascular phenotype: CAD…

…protocols. Note that while cardioversion restores sinus rhythm in up to 95% of patients, long term maintenance (particularly in persistent AF) remains the greater challenge.

…cause occlusion of the artery. The occlusion may be complete or partial, depending on the size of the thrombus and the plaque. The patient will…

…Most modern devices are capable of transmitting ECG tracings continuously to cloud based platforms, which enables the clinician to examine intracardiac ECGs at any time…

…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…

…predictor of survival and for elevated left ventricular filling pressures (Lam et al). PASP is elevated in pulmonary arterial hypertension (PAH). Valve area The continuity…