…every patient with an initial STEMI pattern has myocardial infarction as the final diagnosis. The underlying process usually involves acute thrombotic obstruction of an epicardial…

…detection of prescribed medications in blood or urine samples. In patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m2, an…

…identify specific hemodynamic profiles: the presence of hypotension, end organ hypoperfusion, shock states, and pulmonary congestion. In pregnant patients presenting with suspected acute heart failure…

…electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT interval on the surface electrocardiogram …

…end organ injury. Eclampsia is the occurrence of new onset seizures or coma in a pregnant woman with preeclampsia. HELLP syndrome—haemolysis, elevated liver enzymes…

…pediatric patients, and young adults with congenital heart disease. Initiation Strategies Because of its ability to significantly prolong the QT interval and cause torsades de…

…In the critically ill patient, AF may be pre existing, newly detected for the first time, or newly developed during management of an acute illness…

…glomerular filtration rate Reported estimates include a rate of approximately 0–2% in patients with an eGFR of 30–44 mL/min/1.73 m2…

…doubling the dose produces an additional reduction of approximately 6%. Clinical indications and treatment goals Established atherosclerotic cardiovascular disease Patients with established ASCVD are at…

…anticipated current pathway. In a pacing dependent patient, inhibition of pacemaker output may result in clinically important pauses. In an ICD patient, EMI may be…

…treatment of patients with acute coronary syndromes. Moreover, clinicians must clarify whether the ECG was recorded during chest pain, since an ECG without signs of…

…risk varies considerably according to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment without…

…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…

…the syndrome. Epidemiology and clinical phenotype Heart failure with an LVEF greater than 40%—comprising HFmrEF and HFpEF—accounts for approximately half of patients with…

…presentation in which the patient has symptoms suggestive of acute coronary syndrome (ACS), biochemical evidence of myocardial injury with corroborating evidence of infarction caused by…

…this figure rises steeply with age, exceeding 10% in individuals over 70 years [48] . The lifetime risk of developing HF for an individual at age…

…may influence treatment selection and tolerability. Whether the patient has persistent or progressive disease suggestive of an advanced phenotype. Particular attention should be paid to…

…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…

…to clopidogrel; reducing the dose of prasugrel; extending DAPT beyond 12 months in carefully selected patients with high ischemic risk and low bleeding risk. These…

…individualized with respect to the delay to coronary angiography (PCI). The majority of patients should undergo angiography within 24 hours, but high risk patients should…

Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

…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…

…skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle of 30…

…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…

…suspicion of another or an additional cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with…

…failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension…

…failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension…

…retention. Chronic urinary retention with renal impairment or a large residual volume. A need for accurate measurement of urine output in a critically ill patient…

…arrests, the survival rate stands at 73% (Podsiadlo et al.). A significant majority of these patients exhibit satisfactory neurological function upon discharge. Figure 1 . Expected…

…quarter of aneurysms are not calcified and therefore cannot be identified reliably by radiography. Assessment should include consideration of associated vascular disease. In patients with…

…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…

…cases of upper abdominal pain. An ECG recording costs approximately $10 (10€) and may reduce morbidity and mortality substantially in patients with acute coronary syndromes…

…What determines the outcome of an emergency intubation is rarely the laryngoscopy itself but what was done before it: how well the patient was preoxygenated…

…cent. An sPESI of 0 indicates low risk. Anticoagulation A DOAC is the first choice in pulmonary embolism without malignancy and without antiphospholipid syndrome. The…

…with an independent cohort of 1,689 patients from the International LQTS Registry in Rochester, NY, USA. The validation study reported a C index of…

…analysis of primary prevention trials involving individuals with an estimated 10 year cardiovascular risk of 10%. Approximately 12% reduction in non fatal myocardial infarction with…

…examine the patient, with particular attention to the mouth, throat, skin, perianal region, vascular access, lungs, abdomen, urinary tract and neurology 7 Give an intravenous…

…angina (UA) is an acute coronary syndrome characterized by myocardial ischaemia occurring at rest or with minimal exertion, without evidence of acute cardiomyocyte injury or…

…associated with extensive anterior or transmural infarction, apical dysfunction, LV aneurysm formation, and reduced LV systolic function. The principal mechanisms are the combination of an…

…adequately increase heart rate Chronotropic incompetence is an independent predictor of overall and cardiovascular mortality. The condition is very common among individuals with heart failure…

…studied patients with ROSC who did not display ST segment elevations and randomized them to urgent angiography. These trials did not show any benefit of…

…Adenosine is an endogenous nucleoside present throughout the body that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells…

…as women, and men also display the highest risk of experiencing malign ventricular arrhythmias. Brugada syndrome is hereditary with an autosomal dominant inheritance pattern, meaning…

…Prasugrel, administered in combination with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS), including…

…dose combination with ezetimibe 38% Pooled analyses across different background therapies 17%–25% In patients with atherosclerotic vascular disease or familial hypercholesterolaemia, addition of bempedoic…

…presentation is determined primarily by the ACS syndrome and the haemodynamic consequences of the culprit lesion. Patients may present with ST segment elevation myocardial infarction …

…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…

…defects and waveform changes Digoxin may be used in patients with heart failure, atrial fibrillation, atrial flutter, and in selected cases of paroxysmal supraventricular tachycardia…

…Derived from the original SYNTAX Score, which evaluates the complexity of coronary lesions. Clinical Variables : Age : Older patients have a higher risk. Sex : Females may…

…is an exceptionally effective treatment, with a very low number needed to treat (NNT), indicating high effectiveness. Although BLS is primarily developed for out of…

…and does the patient need an anticoagulant? The unstable patient Immediate electrical cardioversion, without delay, in any of the following: A systolic blood pressure <…

…with an independent cohort of 1,689 patients from the International LQTS Registry in Rochester, NY, USA. The validation study reported a C index of…

…prevention of atherothrombotic events in adult patients with acute coronary syndrome (ACS) or a prior heart attack and a high risk of developing an atherothrombotic…

…hours in patients with RVI. The ECG should therefore include right sided precordial leads when RVI is suspected in the setting of an inferior infarction…

…undergoing urgent non cardiac surgery or those with an unstable clinical condition. In patients with suspected or established non ST segment elevation acute coronary syndrome…

…dosing of rate controlling drugs (e.g beta blockers) without the risk of worsening the bradycardia. Persons with sick sinus syndrome should receive an artificial…

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

…widely recognized and validated tool used to assess the one year risk of major bleeding in patients with atrial fibrillation (AF) who are taking anticoagulants…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…