…In older patients delirium is often multifactorial. 7. Start non pharmacological treatment immediately , in parallel with the investigation. 8. Document the diagnosis and communicate it…

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

…in haematological malignancy. Investigation of dementia with biomarkers (amyloid, tau, phospho tau). Measurement of the opening pressure in suspected idiopathic intracranial hypertension. Therapeutic drainage in…

…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]…

…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…

…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…

…Myocardial ischemia and infarction Approach to patients with chest pain: differential diagnoses, evaluation and management Chest pain is one of the most common symptoms in…

…conventional hypertension threshold. The traditional diagnostic threshold of 140/90 mmHg derives from epidemiological observations associating pressures above this level with increased mortality. Contemporary management…

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…

…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…

…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…

…VF) in patients with structurally normal hearts [2] . Epidemiologically, BrS is responsible for up to 20% of sudden cardiac deaths in patients without structural heart…

…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…

…of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis on causes of…

…patients with high suspicion of posterior acute myocardial infarction (e.g due to reciprocal ST segment depressions in V1, V2, V3). IIa B In patients…

…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…

…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…

…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…

…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…

…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…

…threatening ischaemia (CLTI). Clinical presentation and symptoms Asymptomatic and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking…

…interpreted within a target of 10 minutes. Prehospital ECG acquisition can shorten the time to diagnosis and facilitate triage of patients with suspected ST segment…

…unexplained drop in arterial pressure. Silent or unrecognized infarction occurs more often in patients without antecedent angina and in those with diabetes and hypertension. Of

…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…

…can be used to diagnose endocarditis. With 2D and later 3D ultrasound, the technology has been greatly refined. Similarly, the development of transesophageal echocardiography (TEE…

…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…

…For the same reason, patients with STEMI are at higher risk of life threatening ventricular arrhythmias in the acute phase. Ventricular tachycardia (VT) and ventricular…

…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…

…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…

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

…population and diagnostic criteria. MINOCA accounts for approximately 1–14% of ACS presentations in different series and approximately 5–10% of patients presenting with myocardial…

…deposition. Untreated or inadequately treated patients may develop premature CAD. Symptoms therefore depend on the vascular territory involved and may include manifestations of coronary, cerebral…

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

…morbidity or mortality attributable to these events. Clinical presentation and symptoms Most patients with stent thrombosis present with ACS. Clinical manifestations therefore commonly include recurrent…

…group is associated with high mortality when malperfusion or rupture develops; surgery or endovascular treatment is therefore generally favoured within 14 days of symptom onset…

…the mean of the last two Orthostatic testing after 1 and 3 minutes of standing in older patients, patients with diabetes and anyone with dizziness…

…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…

…help determine expected normal values based on body surface area (BSA), aiding in the diagnosis of aortic root dilation. Key Formulas BSA Calculation (Mosteller formula): [ …

…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…

…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…

…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…

…COPD. Adenosine has caused mild to moderate exacerbation of asthma symptoms. Adenosine should be used with caution in patients with obstructive lung disease or asthma…

…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…

…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…

…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…

…oxidative stress. Metabolic dysfunction associated fatty liver disease affects approximately 10% of non obese individuals and up to 65% of patients with metabolic syndrome. A…

…Genetic testing of patients with confirmed or likely dilated cardiomyopathy can be recommended. There are several commercially available gene panels, which enables testing of over…

…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…

…segment elevations that mimic acute myocardial infarction. Acute pericarditis is a primary differential diagnosis and presents with distinct characteristics compared to transmural ischemia [4, 5]…

…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…

…infarction (STEMI) is a working diagnosis based on persistent ST segment elevation or an equivalent electrocardiographic pattern in a patient with symptoms of myocardial ischaemia…

…Mixed picture of DKA and HHS Overlap is common. Treat as mixed DKA and HHS if the patient has marked hyperosmolality together with significant ketosis…

…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…

…strongly with total and cardiovascular mortality ( Curtis et al ). Among patients with coronary heart disease, left ventricular function is actually a stronger predictor of death…

…spectrum of clinical presentations caused by suspected acute myocardial ischaemia. It includes patients with recent changes in symptoms or clinical signs, with or without diagnostic…

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

…Brugada syndrome. This disorder is easy to diagnose with a simple blood test and the ST segment elevations resolve after normalization of potassium levels. Brugada…

…recommended as an initial test for diagnosing CAD in stable patients with: Low clinical likelihood or no previous diagnosis of CAD Characteristics suggesting that good…

…Prognosis in aortic stenosis according to type of stenosis. The patients with low flow (stroke volume index <35 ml/m²) and low gradient (<40 mmHg…

…The diagnosis requires elevated levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms or ECG changes consistent with myocardial…