…the patient last passed urine. Contact intensive care in circulatory compromise, serious arrhythmia, marked QRS widening, a sine wave pattern, or a need for repeated…

…properly selected patients. Tenecteplase 0.25 mg/kg is a safe and effective alternative to alteplase and is simpler to administer, since the whole dose…

…how acute the condition is. A patient with a chronic plasma sodium of 112 mmol/L may be relatively unaffected, while a rapid fall from…

…in cardiac arrest is highly dependent on the initial rhythm (first recorded rhythm). The initial rhythm is a marker of several crucial events and factors…

…on the healthy side, since a pneumothorax there would be poorly tolerated. A patient who cannot lie flat or cannot cooperate — consider sedation, a different…

…it rarely alters the course and adds a risk of aspiration. Repeated doses of charcoal are given in serious poisoning with agents that undergo enterohepatic…

…elevation but are non ischaemic mimics rather than MINOCA when identified as the final diagnosis. Reported prevalence varies according to the population and diagnostic criteria…

…patients referred to PCI with a suspicion of STE ACS/STEMI, actually have takotsubo. Previous studies reported that 98 out of 100 cases had full…

…that of never smokers for a prolonged period. In heavy smokers, cardiovascular risk falls within five years of stopping but may remain elevated thereafter. The…

…on a single reading. It requires repeated measurements on at least two occasions, and preferably confirmation by home measurement or 24 hour recording — the thresholds…

…full vital signs, level of consciousness, and repeated assessment of the circulation and breathing 2 Assess whether the patient has sepsis, septic shock, or a…

…patient who does not tolerate repeated compression (for example marked thrombocytopenia). Set up and instructions Choose the cuff according to arm circumference ; a cuff that…

…twenty falls outside them . Order twelve tests in a healthy person and the probability is around 46 % that at least one will fall outside. The…

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

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

…treadmill walking or after repeated heel raises. A fall of ≥ 20 % after exercise confirms peripheral arterial disease. Toe brachial index (TBI). The digital arteries rarely…

…patient. An unstable pelvic fracture with circulatory compromise. A ruptured aortic aneurysm or another major vascular bleed. Perioperative bleeding that rapidly fills the suction, the…

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

…particularly in patients with marked tolerance. The most important measures in severe or complicated withdrawal are: 1. A benzodiazepine in a sufficient and repeated dose…

…needed around the clock. A continuous infusion or repeated doses, according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and…

…seizure lasting at least 5 minutes, or repeated generalised tonic clonic seizures without the patient regaining consciousness between them. Five minutes is the practical threshold…

…10 minutes. 3. Attach defibrillator pads if the patient is unstable or at marked risk of arrhythmia. 4. Take a full blood count, electrolytes, creatinine…

…be so efficient that a total occlusion in the main artery may not lead to infarction due to the collaterals. Occasionally, patients with total and…

…families with features that represent a previously unrecognized autosomal dominant syndrome (4). Figure 1 . 12 lead ECG (presented according to Cabrera), recorded at 63 years…

…should remain integrated with the overall risk profile. Measurement Who should be tested? Current recommendations support measuring Lp(a) at least once in every adult…

…complete coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from…

…compared to patients without such disturbances, including those with RBBB and LBBB. This was reported in the Coronary Heart Disease Study,1 which enrolled 10…

…also noted that the syndrome – which was named the Brugada syndrome – appeared to be hereditary, since many patients reported a family history of the same…

Cardiology Definition and Pathophysiology Resistant hypertension is a clinical indicator rather than a distinct disease. It identifies patients whose blood pressure remains uncontrolled despite intensive…

…in the ROC PRIMED trial. These patients were enrolled in a randomized trial that evaluated the efficacy of a CPR adjunct and also recorded the…

…has been reported in patients taking ticagrelor. If suspected, further clinical evaluation is recommended. Creatinine levels may rise during treatment with ticagrelor. The mechanism is…

…including in patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolaemia. The broader therapeutic principle is that LDL C reduction is associated with cardiovascular…

…whereas approximately 10% of patients in registries and routine clinical practice report muscle symptoms. This discrepancy reflects, at least in part, the nocebo effect : negative…

…and meta analyses show that aspirin can reduce non fatal cardiovascular events, but does not reduce cardiovascular or all cause mortality. Reported relative effects include…

…have been reported. In the consensus report by MacFarlane et al it was noted that roughly 5% to 13% of all individuals in a Western…

…al, JAMA Cardiology (2020). Guo et al reported that 27.8% (52 of 187 patients) had myocardial injury, defined as elevated troponin T levels (TnT)…

…reflex syncope that manifests without a prodrome and usually features a nonrevealing cardiac workup. Evaluation and Physical Examination The initial evaluation of a patient with…

…actually questions that patients tend to ask nowadays and therefore I will make an effort to clarify the issues. Is high cholesterol levels a true…

…Some patient groups have a two to three fold greater prevalence of asymptomatic atherosclerotic cardiovascular disease (ASCVD) than the general population. The evidence for premature…

…The condition is more prevalent in Japan and South Korea than in Western populations, and multiple vessel spasm during provocation testing is also reported more…

… reported proportions vary by population and region. Intramural haematoma IMH is haemorrhage within the aortic media without an identifiable communication between the aortic lumen and…

…The reported hazard ratio was 0.83, with a 95% confidence interval of 0.72–0.95 and an absolute risk reduction of 2.4…

…restenosis. Coronary stents provided a scaffold that tacked down dissection flaps, counteracted elastic recoil, reduced emergency vessel closure and decreased the need for emergency CABG…

…With contemporary imaging, LV thrombus has been reported in as many as 15% of patients after ST segment elevation myocardial infarction (STEMI), with rates approaching…

…to demonstrate an intramural haematoma or double lumen Type 1 is reported in fewer than one third of cases in the pregnancy related source material…

…in high risk LQTS patients, emphasizing a comprehensive risk assessment that includes genetic factors and QTc duration. Risk Stratification and the 1 2 3 LQTS…

…in high risk LQTS patients, emphasizing a comprehensive risk assessment that includes genetic factors and QTc duration. Risk Stratification and the 1 2 3 LQTS…

…The risk is also greater when several predisposing factors coexist, rather than being determined by contrast exposure in isolation. Estimated glomerular filtration rate Reported estimates…

…is reported in up to approximately one third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion A large effusion…

…Reported precipitants include vigorous physical activity, emotional stress, and an intercurrent medical or surgical illness. Events may occur at any time, although clustering in the…

…angina that has become more frequent, more prolonged, or provoked by less exertion. Angina occurring after a recent myocardial infarction. UA belongs to the broader…

…in the control group. In another randomized trial involving 1002 patients with established coronary disease, a Mediterranean diet was associated with more than a one…

…pain is a broad clinical syndrome rather than a narrowly defined symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and…

…both the area and radiographic density of coronary calcification. CAC therefore functions primarily as an imaging biomarker of coronary atherosclerotic burden rather than as a…

…A total of 500 cases of fatal myocardial infarction were examined. The authors reported that 60–70% of all cases had no myocardial disease or…

…DES) may prolong the period of susceptibility because their antiproliferative agents can inhibit endothelialization. Very late thrombosis after contemporary DES has been reported at approximately…

…patients. Serious events such as stroke and myocardial infarction occur in fewer than 1%, while mortality is generally below 0.1% in contemporary series. Reported…

…asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14.6%, and revascularisation may be beneficial in appropriately selected patients…

…is less common but more malignant than an anomalous right coronary artery. Anomalous origin of a coronary artery from the pulmonary artery can result in…

…be useful in patients with symptomatic or asymptomatic peripheral arterial disease, in whom AAA has been reported with a substantial cumulative incidence. The source material…