…syndrome – appeared to be hereditary, since many patients reported a family history of the same symptoms and events. Perhaps the most distinguishing feature was the…

…history of grommets, ear discharge or pain on contact with water. A history of ear surgery in which the middle ear may be open (a…

…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…

…In patients presenting with angioedema, a rapid assessment of the airway is paramount to evaluate for impending respiratory compromise. Diagnostics The diagnosis of ACE inhibitor…

…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…

…VA can occur as part of a more generalized vasospastic syndrome with migraine or Raynaud phenomenon. Associations have also been described with aspirin induced asthma…

…particularly important in determining management. The benefit of carotid revascularisation is greatest in patients with a recent TIA or stroke, particularly when the event occurred…

…with several patient and treatment related factors: Age older than 80 years Female sex Low body mass index Asian ancestry Previous muscle disease or a…

…been fraught with controversies, particularly regarding the risk stratification of asymptomatic patients, the prognostic utility of electrophysiological studies (EPS), and the transition from a purely…

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

…myocarditis) or non cardiac conditions (such as renal failure). To establish a diagnosis of MI, acute myocardial injury must be coupled with clinical evidence of…

…or a combination of these symptoms. The diagnosis requires elevated levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms…

…Chest pain or discomfort remains the cardinal symptom of CCS, but presentations are frequently non classical. Contemporary clinical populations include only a minority with 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…

…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…

…and signs of right sided heart failure may predominate. Pericardial effusions associated with post infarction pericarditis are commonly mild. A rapidly developing or large effusion…

…conscious patients who experienced a brief cardiac arrest. Post resuscitation care is an integral component of the chain of survival. It includes diagnosis of post…

…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…

…regardless of profession, must be able to diagnose ventricular tachycardia. Causes of ventricular tachycardia Patients with ventricular tachycardia almost invariably have significant underlying heart disease…

…A diagnostic pitfall arises because typical circuits occurring in diseased atria—most frequently following surgery or extensive ablation, or under the influence of antiarrhythmic drugs…

…1, not 200%). Conclusion Echocardiographic calculation of Qp/Qs is a cornerstone in managing patients with intracardiac shunts. By integrating anatomical measurements and Doppler hemodynamics…

…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…

…one: with an indication, a route of administration and a target range for the saturation . What usually goes wrong is not that the patient gets…

…An unclear arthritis, as part of the diagnostic work up. Haemarthrosis after trauma. A symptomatic effusion causing pain or restricted movement (therapeutic aspiration). Intra articular…

…equipped with an increasing number of methods to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide…

…absolute contraindications, but be cautious and consider referral in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the…

…majority of cases can be characterized by echocardiography. In comparison with adult subjects, the echocardiographic evaluation in pediatric patients requires a different approach, with more…

…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…

…the hemodynamic significance of a coronary lesion, with anatomic and functional assessment discordant in a substantial minority of intermediate lesions. Over the past three decades…

…little or no consistent effect on cardiovascular complications in T2DM. Cardiovascular benefit depends substantially on comprehensive risk factor management and, in appropriate patients, selection of…

…patients with a very high clinical likelihood of obstructive CAD, defined in the source material as greater than 85%, particularly when one or more of…

…initiation of ACE inhibitors, especially in patients with preexisting azotemia, hypotension, hyponatremia, diabetes mellitus, or in those taking potassium supplements. When managing albuminuria or CKD…

…40%. Ongoing or newly recognized LV systolic dysfunction. A patient may also present because of complications of the underlying infarction or LV remodeling, including heart…

…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…

…hypertrophy, or echocardiographic evidence of impaired filling, make the diagnosis more likely. HFpEF and HFmrEF together account for approximately half of patients with symptomatic HF…

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

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

…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…

…is required. Patients with suggestive symptoms, signs or a medical history indicating possible secondary hypertension should undergo appropriate screening for an underlying secondary cause. Evaluation…

…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…

…and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic claudication…

…A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when interpreting a current LVEF of 41–49%. Diagnostic…

…is not uniformly present. The proportion of painless or silent STEMIs is greater in patients with diabetes mellitus and increases with age. STEMI may present…

…conditions. Disruption of an atherosclerotic plaque or injury associated with PCI exposes thrombogenic material, promoting platelet activation, aggregation, and fibrin formation. Within a stented segment…

…patients with carotid bruits, possible or known plaques, or stenosis. Diagnostics Electrocardiogram and Cardiac Monitoring An ECG should be performed if there is suspicion of…

…than patients with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial…

…management of patients with acute STEMI. Although ECG changes in acute STEMI have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction), a…

…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…

…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 family history of premature myocardial infarction, vascular disease or marked hypercholesterolaemia. Physical findings related to cholesterol deposition. Untreated or inadequately treated patients may develop…

…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…

…cause of acute chest pain but carries a particularly high mortality when diagnosis is delayed. The typical presentation is sudden onset, severe chest, back or…

…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…

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

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

…surgery or several concurrent factors. A diagnosis of delirium is therefore the beginning of the investigation, not the end. In a frail older patient an…

…provide a more accurate assessment of atherogenic burden than LDL cholesterol alone in patients with diabetes. Insulin resistance is accompanied by compensatory hyperinsulinaemia and, with…

…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…

…with a working diagnosis of STEMI. More than 12 hours after onset: primary PCI remains indicated when there are ongoing ischaemic symptoms, haemodynamic instability or…