…Collectively, they affect approximately 5–15% of pregnancies worldwide and are major contributors to maternal, fetal, and neonatal morbidity and mortality. Their incidence has increased…

…and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and initial…

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

…a genetic mutation in the RYR1 receptor, resulting in persistent muscle contraction upon administration of halogenated anesthetic agents. As an idiosyncratic response to substances such…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Refractory angina is a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options…

Info This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST segment elevations (i.e STEMI, ST segment…

…electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest…

…limiting epicardial coronary stenosis. It is therefore a disorder of coronary microvascular perfusion rather than persistent obstruction of the treated epicardial segment. The phenomenon occurs…

…elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment elevation…

…STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic…

…of AF—paroxysmal, persistent, long standing persistent and permanent—and is not determined solely by the apparent frequency or duration of documented episodes. The central…

…implantation of a pacemaker. When considering a permanent pacemaker for bradyarrhythmia, it is important to distinguish persistent, reversible and intermittent bradycardia. The pathophysiology and prognosis…

…with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has formed. Ultrasound settles the question when…

…Assess airway, work of breathing, level of consciousness and circulation. 2. Give controlled oxygen with a target of 88 to 92 percent until the risk…

…excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent atrial fibrillation where rhythm control is the aim. Atrial flutter…

…of the ST segment. A male patient (Figure 1) presented at age 36 years with an ECG showing deep and persistent, concave upward ST segment…

…these agents. The cough is characteristically nonproductive and dry. Patients may describe a persistent tickle or sensitivity in the throat. In recent years, the concept…

…adverse influences disturb these functions. The resulting endothelial dysfunction promotes inappropriate vasoconstriction, adhesion of circulating cells, inflammatory cell entry into the intima, and thrombus formation…

…end stage renal failure Consider renal replacement therapy Hypoperfusion with persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative care Right ventricular…

…and Pathophysiological Basis High sensitivity cardiac troponin (hs cTn) assays detect circulating troponin released from injured cardiomyocytes at substantially lower concentrations than earlier generation assays…

…resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with an ACE inhibitor or ARNI, a beta blocker and a mineralocorticoid receptor…

…patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk…

…function is impaired. Inadequate adherence to medication or dietary sodium restriction may therefore mimic pharmacological resistance or contribute directly to persistent hypertension. Resistant hypertension is…

…permit vascular remodelling and renal impairment to develop, leaving persistent hypertension despite correction of the initiating disorder. Earlier diagnosis is associated with a greater likelihood…

…incomplete apposition, or persistent disease at the inflow or outflow edges. The contemporary incidence of stent thrombosis is approximately 1% during the first year after…

…protocols. Note that while cardioversion restores sinus rhythm in up to 95% of patients, long term maintenance (particularly in persistent AF) remains the greater challenge.

…commonly called vestibular neuritis, but posterior circulation stroke is the most important dangerous differential diagnosis. Clear focal neurological findings are absent in roughly half of…

…3]. The first five minutes 1. Assess airway, breathing and circulation. 2. Assess the neurological symptoms and at the same time exclude other acute causes…

…ergotism, hypercoagulable states or iatrogenic vascular injury. Acute occlusion may also occur in an artery with established collateral circulation, particularly an occluded bypass graft; in…

…initiation and after each adjustment. Persistent symptoms despite appropriately titrated medical therapy should prompt consideration of coronary angiography and possible revascularization. Revascularization may be selected…

…directly attributable to CVD. Excess mortality becomes apparent approximately 7–10 years after diagnosis and is associated with persistent disease activity, rheumatoid factor and anti…

…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…

…may produce cardiorenal syndrome. Worsening renal function in the presence of persistent congestion is particularly associated with elevated central venous pressure, which is transmitted to…

…increased expression of low density lipoprotein receptors (LDLRs), which enhances removal of circulating LDL particles. Its principal clinical effect is therefore reduction of LDL cholesterol…

…occur because elevated left sided filling pressures are transmitted to the pulmonary circulation. Persistent pulmonary vascular disease can lead to right ventricular strain and dysfunction…

…mesenteric or lower limb ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that remains uncontrolled despite optimal therapy Acute type A dissection has a…

…Stent malapposition Stent fracture or collapse Residual edge dissection Incomplete lesion preparation Persistent stenosis within the treated segment Mechanical factors are particularly important because correction…

…ischaemic burden. In chronic coronary syndrome, revascularisation is particularly indicated when functionally significant disease produces persistent, lifestyle limiting symptoms despite guideline directed medical treatment. Neither…

…syndromes. Clinical suspicion should be heightened after: Anterior STEMI. A large or transmural infarction. Persistent apical akinesis or dyskinesis. LV aneurysm formation. LVEF below 40%…

…0.80. Demonstration of reduced CFR and/or inducible microvascular spasm. The microvascular circulation cannot be directly visualized in vivo in humans. Consequently, diagnosis depends…

…hypoperfusion and is consistent with inducible ischaemia. A persistent defect on stress and rest images may represent scar, although interpretation must account for attenuation and…

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At…

…severe right sided failure and cardiogenic shock. The haemodynamic disturbance results from impaired right ventricular contraction and reduced forward flow through the pulmonary circulation. Consequently…

…clinical spectrum of ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest, electrical or haemodynamic instability…

…examination include: Unexplained systolic blood pressure < 90 mmHg Suggestion of gastrointestinal hemorrhage Persistent bradycardia (< 40 beats/min) Undiagnosed systolic murmur Carotid sinus massage…

…embolism : Paradoxical embolism occurs when thromboembolic material is transported from the venous circulation to the arterial circulation, e.g via a persistent foramen ovale (PFO)…

…left ventricular function. Persistent or non persistent ventricular tachycardia or frequent premature ventricular contractions that cause pronounced symptoms and other therapies have failed. Patients with…

…Asystole occurs if no escape rhythm awakes. It is uncommon that sinus arrest leads to persistent asystole; latent pacemakers virtually always awake and salvage the…

…Definition and pathophysiology Familial hypercholesterolaemia (FH) is an inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…while awaiting the antidote and specific treatment. Bradyasystole during and after cardiac arrest with persisting electrical activity. Overdrive pacing in bradycardia dependent torsades de pointes…

…those individuals genuinely at risk of arrest. This predictive problem has proven persistently resistant to resolution. Known predictors of cardiac arrest The only risk biomarker…

…from a previous value of at least 50%. A patient with persistently mildly reduced systolic function. This dynamic nature makes prior imaging particularly important when…

…By contrast, chronic hypoperfusion may result in hibernating myocardium: a persistently dysfunctional but potentially recoverable state. The chronically dysfunctional myocardium in ischemic cardiomyopathy is therefore…

…as compared with atrial fibrillation, atrial flutter is not capable of persisting for longer periods of time. This is due to the fact that atrial…

…embryological remnants within the atrial myocardium. These residual tissues, persisting from cardiac embryogenesis, are capable of exhibiting markedly increased automaticity, thereby serving as ectopic pacemaker…

…meal; that thus excited, it is accompanied with a sensation, which threatens instant death if the motion is persisted in; and, that on stopping, the…

…attach continuous rhythm monitoring, secure intravenous access, assess the circulation and the bleeding risk, and exclude dangerous differential diagnoses [1,2]. STEMI and other ECG…

…but rousable patient, while ventilation, circulation and underlying disease are monitored [3]. The management of complicated withdrawal varies between regions and units. Follow the local…