…Differential Diagnosis of Chest Pain: A Clinical Overview The evaluation of acute chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic…

…reperfusion therapy. This approach fails to identify a substantial proportion of patients with acute coronary occlusion (ACO) who present without diagnostic ST elevation, often resulting…

…infarction: a diagnosis based on cardiac troponins A diagnosis of acute myocardial infarction (AMI) is made only after blood analyses confirm elevated levels of myocardial…

…immediately and a defibrillator must be ready. I B Consider connecting leads V7, V8 and V9 in patients with high suspicion of posterior acute myocardial…

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

…a few likely diagnoses. The table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of…

…material. Clinical Presentation and Symptoms Aortic dissection is an uncommon cause of acute chest pain but carries a particularly high mortality when diagnosis is delayed…

Cardiology Diagnosis and treatment of bradycardia (bradyarrhythmia) Acute bradycardia with hemodynamic instability Acute bradycardia with hemodynamic effects is a potentially life threatening condition and should…

…combined with patient denial, often leads to a mistaken impression of indigestion. STEMI pain can simulate pain from acute pericarditis, pulmonary embolism, acute aortic dissection…

…quality of life. Approximately half of all patients with heart failure die suddenly, as a result of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation). Early diagnosis…

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

…that the patient actually has endocarditis (this the probability should be estimated before echocardiography is performed). Among patients with a very high probability of endocarditis…

…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…

…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…

…of patients with Non ST Elevation Myocardial Infarction (NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE ACS (Non ST Elevation Acute…

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

…spectrum of non ST elevation acute coronary syndrome (NSTE ACS). The clinical spectrum includes patients with a confirmed NSTEMI, patients with a working diagnosis of…

…Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes…

…as acute hemorrhage, cough, defecation, laugh, micturition, sneeze, swallow, and postprandial states. In some instances, patients may present with adenosine sensitive syncope, a subtype of…

…Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of these symptoms…

…describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of…

…clinical populations include only a minority with symptoms having all of the traditional aggravating and relieving characteristics of angina; many patients report less characteristic symptoms…

…instability. Posterior infarction may occur in patients with a clinically unstable acute coronary syndrome, but the examination does not reliably establish or exclude the diagnosis…

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

…associated with coronary artery bypass grafting (CABG). Clinical Presentation and Symptoms The diagnosis of an acute MI remains a comprehensive clinical diagnosis based on patient…

…Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus, renal failure, heart failure, hypercoagulability, prior brachytherapy Antiplatelet therapy Nonadherence or discontinuation of clopidogrel…

…Establishing a diagnosis of Q wave infarction requires that pathological Q waves be present in at least two anatomically contiguous leads. In patients with STEMI…

…1 and 3 minutes of standing in older patients, patients with diabetes and anyone with dizziness Definitions White coat hypertension: a raised office reading but…

…myocardial perfusion imaging Diagnosis of coronary artery disease (CAD) : Myocardial perfusion imaging can confirm or rule out CAD in patients with symptoms suggestive of CAD…

…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…

…Patients with previous acute coronary syndromes (ACS) Exercise stress testing is routinely performed after acute myocardial infarction in order to assess the presence of myocardial…

…quality of life. Approximately half of all patients with heart failure die suddenly, as a result of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation). Early diagnosis…

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

…clinical diagnosis, often described as acute brain failure. It is precipitated by somatic illness, drugs, poisoning, withdrawal, surgery or several concurrent factors. A diagnosis of…

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

…or a range of miscellaneous conditions. Because several mechanisms may coexist, diagnosis and classification must integrate haemodynamics with the patient’s clinical context and the…

…Causes of ventricular tachycardia Patients with ventricular tachycardia almost invariably have significant underlying heart disease. The most common causes are coronary heart disease (acute coronary…

…for excluding non ST segment elevation acute coronary syndrome (NSTE ACS) in patients with a low to intermediate likelihood of CAD when cardiac troponin and…

…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…

…presentation of ACS is generally similar to that in non pregnant patients, although symptoms may be atypical. Pregnant patients with SCAD may have a more…

…Prevention of recurrence after a healed venous ulcer. After deep vein thrombosis with post thrombotic syndrome. Differential diagnosis Feature Venous ulcer Arterial ulcer Diabetic foot…

…Differential Diagnosis of ST Elevation Several nonischemic conditions can produce ST segment elevations that mimic acute myocardial infarction. Acute pericarditis is a primary differential diagnosis…

…third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion A large effusion may cause: Diminished heart sounds Disappearance of…

…the patient's baseline cardiovascular state. For instance, a patient with stable CAD may present with clinical manifestations of myocardial ischaemia following an acute gastrointestinal…

…free wall rupture after infarction Anticoagulant associated bleeding Renal failure Systemic inflammatory disease Catheter based electrophysiological and structural cardiac procedures In patients with acute pericarditis…

…the fact that the sickest patients are more often intubated [4]. Intubation is reasonable in: a reduced level of consciousness with inadequate protective reflexes active…

…assessment is required. Patients with NSTE ACS should be admitted for management of acute ischaemia. Those with possible ACS, a non diagnostic ECG, and normal…

…state during treatment with an angiotensin receptor–neprilysin inhibitor. Clinical Applications Natriuretic peptides have three principal roles: Supporting or excluding the diagnosis of HF Estimating…

…disorders frequently present with presyncope or syncope. Diagnosing transient or paroxysmal AV block in these individuals can be challenging. A high suspicion of intermittent infrahisian…

…the required absolute threshold and a rise of more than 20% from baseline. Type 4a MI after PCI In a patient with normal baseline cTn…

…a clinical syndromic diagnosis, not a sufficient explanation for all acute dyspnoea in a patient with COPD. Pneumonia, heart failure, pulmonary embolism, pneumothorax and acute…

…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…

…with continuing ischaemia, shock, serious arrhythmia or acute heart failure. Routine opening of a persistently occluded infarct related artery in a stable and asymptomatic patient…

…L/min — the patient then rebreathes carbon dioxide from the mask Mask with a reservoir 10–15 L/min 60–90 % For acute severe hypoxaemia…

…Wait 10 minutes — insufficient waiting time is the commonest reason for the patient finding the procedure painful. Test with a needle tip before you start…

…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…

…4.0–6.0 mmol/L ≥ 7.0 on two occasions establishes a diagnosis of diabetes HbA1c < 42 mmol/mol 42–47 = prediabetes…

…having UA are now diagnosed with NSTEMI. Consequently, the proportion of NSTE ACS patients with NSTEMI has increased while the proportion with UA has declined…

…Withdraw the needle, apply compression and a dressing. The knee The patient lies supine with the leg extended and the quadriceps relaxed. The superolateral approach…

…be suspected? Anaphylaxis is a clinical diagnosis. Treat as anaphylaxis in any of the following: 1. Acute onset of skin or mucosal symptoms , for example…