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

…surgery in a patient with known lung disease. Follow up of treatment effect and of disease progression. Assessment of pulmonary involvement in systemic disease, for…

…that saves the patient — the puncture must never delay it. Indications Suspected meningitis or encephalitis. Suspected subarachnoid haemorrhage with a normal or non diagnostic CT…

…HFmrEF together account for approximately half of patients with symptomatic HF. The distinction is clinically useful but not absolute. Ejection fraction is a continuous variable…

…stroke is the most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of patients with a central cause. A normal…

…in females, the elderly, or patients with diabetes [4]. Associated Findings: The sudden onset of symptoms coupled with diaphoresis should always raise concern for a…

…pain perception in patients without demonstrable ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis. ANOCA/INOCA is associated with recurrent…

…sufficient to make a diagnosis or identify a few likely diagnoses. The table below shows a systematic history taking in patients presenting with chest pain…

…methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated in patients with severe hypertension, unstable angina, and…

…Among patients with a very high probability of endocarditis, the sensitivity and specificity of the examination will increase, and vice versa. In case of suspicion…

…a long awaited breakthrough. Heart failure is a serious condition with a poor long term prognosis. The 5 year survival rate after hospitalization for heart…

…follows: The patient should remain seated comfortably in a quiet environment for 5 minutes. The back and arm should be supported, with the cuff at…

…segment elevation in the right precordial leads—and a propensity for life threatening polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) in patients with structurally…

…diagnostic pathway. The unstable patient Hypotension (systolic < 90 mmHg for 15 minutes, or a need for a vasopressor), obstructive shock or cardiac arrest with…

…Tissue loss, ulcers and gangrene may develop. In patients with CLTI, early recognition and referral to a vascular team are essential for limb salvage. Acu

…present before the event. Although STEMI may occur at any time, circadian variations have been reported, with clusters occurring in the morning within a few…

…than in HFpEF. The clinical population is heterogeneous because the HFmrEF range includes both patients with recovering systolic function and those with deterioration from a…

…the available material does not establish a significant increase in late morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with…

…The absence of chest pain does not exclude clinically important CCS. Silent or minimally symptomatic disease may occur in patients with diabetes and autonomic neuropathy…

…present with NSTEMI, although STEMI occurs in approximately one third. Patients with MINOCA related STEMI generally do not have a prodrome before infarction. The clinical…

…much less common in the acute phase. The chain of care in acute STEMI Optimal care for patients with STEMI requires a well coordinated system…

…branch block. Cardiac monitoring is indicated for patients with a high pretest probability of arrhythmia causing syncope. In hospital monitoring is reserved for those wit

…identify a substantial subset of patients with acute coronary occlusion (ACO) who do not meet the established ECG criteria for STEMI, leading to delays in…

…of diagnostic tests, and treatment strategies have been updated. For example, exercise stress testing is no longer recommended in the initial evaluation of patients with…

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

…levels of cardiac proteins in the blood. Diagnostic criteria for acute myocardial infarction A diagnosis of myocardial infarction is based on the following three components…

…Assessment for circulatory compromise, haemodynamic instability, or electrical instability. Posterior infarction may occur in patients with a clinically unstable acute coronary syndrome, but the examination…

…approximately 10 years later in females. Untreated HoFH is associated with extensive premature and progressive ASCVD; CAD and aortic stenosis may occur before the age…

…recorder is essential to accurately establish the diagnosis. Electrophysiology In patients with presyncope or syncope—especially older individuals with BBB or intraventricular conduction defects—an…

…although not every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of…

…for patients with narrow complex tachycardia (NCT). Adenosine typically causes a short lasting second or third degree AV block which may be unpleasant to the…

…Infarction (NSTEMI) and Unstable Angina (UA) The focus of this chapter is the diagnosis and management of patients with Non ST Elevation Myocardial Infarction (NSTEMI)…

…A notch is evident in the ascending part of the ST segment. A male patient (Figure 1) presented at age 36 years with an ECG…

…with dizziness Definitions White coat hypertension: a raised office reading but normal readings at home or on 24 hour recording. Masked hypertension: normal in the…

…of symptom onset in patients without contraindications. I A In the absence of ST segment elevation, primary PCI is indicated in patients with symptoms suggestive…

…ECG guides the management of non acute or asymptomatic bradyarrhythmia. In patients presenting with intermittent symptoms of bradycardia, it is fundamental to establish a temporal…

…of morbidity in patients with structural heart disease, VT necessitates a nuanced, multidisciplinary approach to diagnosis and management. Over the past decade, the landscape of…

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

…tolerated doses, including a diuretic appropriate for kidney function. In patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m², an…

…are normal in patients with NSTE ACS, the condition is classified as unstable angina (UA) . Please refer to Diagnostic Criteria for Myocardial Infarction for further…

…considerably lower than the risk among patients with Brugada syndrome. It follows that Brugada syndrome is a likely diagnosis in patients presenting with these symptoms…

…is highest with AV block 2 Mobitz type 2 and AV block 3. The only treatment with a class I recommendation for the management of…

…ACS) in patients with a low to intermediate likelihood of CAD when cardiac troponin and/or the ECG is normal or inconclusive. The principal diagnostic…

…to a specific, identifiable underlying cause. It should be considered in every patient with newly diagnosed or referred hypertension, with particular vigilance when the clinical…

…a long awaited breakthrough. Heart failure is a serious condition with a poor long term prognosis. The 5 year survival rate after hospitalization for heart…

…been used in therapeutic studies of pulmonary arterial hypertension (PAH). The threshold is not absolute: patient phenotype, risk factors for heart failure with preserved ejection…

…Endo A, Kojima M, Hong ZJ, Otomo Y, Coimbra R. Open chest versus closed chest cardiopulmonary resuscitation in trauma patients with signs of life upon…

…is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia. The immediate…

…communities. Late presentation is clinically important: Within 12 hours of symptom onset: reperfusion therapy is recommended for all patients with a working diagnosis of STEMI…

…fundamental for the diagnosis and prognosis of most cardiac diseases, including coronary artery disease, heart failure, arrhythmias, structural heart disease, etc. Over the years, a…

…acidosis despite a normal or only moderately raised glucose, often below 13.9 mmol/L. The condition occurs above all in: treatment with SGLT2 inhibitors…

…a lower threshold for provocation, or symptoms that awaken the patient from sleep. Initial symptoms of NSTEMI and UA may be similar. NSTEMI is diagnosed…

…factors for calcification overlap with risk factors for coronary heart disease (atherosclerosis). The average age at diagnosis of aortic stenosis is 75 years in high…

…with emphasis on ECG diagnosis, definitions, management, and clinical characteristics. Ventricular tachycardia is a highly nuanced arrhythmia that originates in the ventricles. A wide range…

…The clinical spectrum includes patients with a confirmed NSTEMI, patients with a working diagnosis of NSTE ACS and a high probability of unstable angina (UA…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

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

…A history of increasing frequency of hospitalizations and visits for heart failure without disease recognition in the 3 years preceding diagnosis is also a notable…

…mm. Limitations Formulas assume normal body habitus Ethnic variations may require adjusted thresholds Always correlate with imaging measurements Not valid for pediatric patients <15 years

…This culminated in the Universal Definition of Myocardial Infarction Consensus Documents, with the Fourth Universal Definition published in 2018. A fundamental prerequisite for diagnosing any…