…A history of increasing frequency of hospitalizations and visits for heart failure without disease recognition in the 3 years preceding diagnosis is also a notable…

…and mortality The modern concept of rehabilitation has evolved from early post infarction physical activity programmes into a structured centre of secondary cardiovascular prevention in…

…docs Dr Casey Parker's site covers a wide range of topics. The archive is loaded with great articles which physicians should be interested in…

…relation to ACE inhibitor therapy. Biomarkers and Laboratory Findings Monitoring renal function and potassium is a critical component of ACE inhibitor therapy. Blood pressure (including…

…bleeding risk, including oral anticoagulants, clopidogrel, NSAIDs, or fibrinolytics. For patients with active bleeding requiring reversal of prasugrel's pharmacological effect, platelet transfusion may be

…fall into the trap of oversimplification. Physicians, nurses, paramedics and physician assistants who rely on such books will realize their shortcomings at their first encounter…

…time of onset, a late time window, or when thrombectomy can start at the earliest after 6 hours, according to the local protocol MRI of…

…deceased person's own wishes are properly established. Two things determine the outcome — that the confirmation of death is carried out in a formally unimpeachable…

…artery disease and evaluation of treatment effect, the medication is continued — abrupt withdrawal carries a risk of rebound. The referring physician should have made this…

…Hyponatraemia is primarily a disorder of water balance. The plasma sodium reflects the ratio between the body's exchangeable sodium and potassium and the total…

…infectious diseases physician early in a high risk course, in instability, with resistance problems, or with suspected fungal infection 10 Document the times of triag

…personnel Exercise stress testing may be conducted by physicians, nurses, biomedical analysts, or other professionals. A physician is always formally responsible for conducting the test…

…picking, calling out, irritability, hallucinations More easily detected, but accounts for a minority of cases Hypoactive Lethargy, slow responses, reduced speech, immobility, poor food intake…

…EMTs, nurses and physicians in the emergency medical system (EMS), as well as the hospital cardiac arrest team (CAT) and intensive care units and other…

…course and precipitating circumstances , and then selecting a targeted examination. The patient's description of the quality of the dizziness — rotatory vertigo, unsteadiness or faintness …

…lower socioeconomic or uninsured status, a history of angina or diabetes, and consultation with relatives or physicians before contacting emergency services. These factors support the…

…possible. In out of hospital cardiac arrest (OHCA) ACLS is performed by paramedics, nurses or physicians, depending on the design of the pre hospital system…

…3 rd assessment (reliable assessment of pulses requires training and experience). Thus, for laypeople, examinations 1 and 2 are sufficient to confirm a cardiac arrest…

…with reduced left ventricular function (e.g. defined as ejection fraction <40 %) are at high risk of sudden cardiac arrest. Idiopathic ventricular tachycardia (IVT) Ventricular…

…muscular strength, quality of life and psychological well being. Physical inactivity is itself a major cardiovascular risk factor. Sedentary behaviour may confer risk even in…

…and vessels A liquid flowing in a straight cylinder exhibits laminar flow , which implies that the flow velocity is highest at the center of the…

…effects of exercise on coronary arteries, without the need for physical activity. Advantages of regadenoson over adenosine Regadenoson has advantages over adenosine: Regadenoson is a…

…waves, which can propagate through vacuum, sound waves can only propagate through a physical medium. This medium may consist of any matter, e.g air…

…at managing bradycardia and reduced cardiac output. Bradycardia causing hemodynamic instability is a potentially life threatening condition and should be managed urgently. The risk of…

…minute A falling rate, bradypnoea or apnoea Pulse Under 110 per minute At least 110 per minute Bradycardia or arrhythmia PEF Over 50 percent of…

…a missed meal, physical activity and any other precipitating factor. Thresholds The thresholds below are used above all in diabetes. The severity of the symptoms…

…may present with P waves at the onset of the QRS complex. Nonrespiratory sinus arrhythmia may also be observed as a consequence of drug toxicity…

…and physical inactivity. The interaction between these acquired risks and age related cardiovascular remodeling contributes to the high incidence and prevalence of coronary and vascular…

…s requirements, or can do so only at the expense of abnormally high filling pressures. The resulting haemodynamic congestion produces a characteristic clinical phenotype of…

…AVB) may indicate septal involvement in the inflammatory process. A broad spectrum of pharmacologic agents can induce bradycardia or conduction disorders. These include beta blockers…

…diabetes mellitus Atherosclerotic cardiovascular events HF and atrial fibrillation Obesity therefore acts both as an independent cardiovascular risk factor and as a driver of hypertension…

…Although outside the principal scope of primary prevention, secondary prevention provides an important contrast. Patients with manifest clinical disease are at high risk of progression…

…phase of the action potential. This action potential prolongation exhibits reverse use dependence, meaning the repolarization time is extended to a greater degree at slower…

…physical examination, ECG and laboratory tests are the cornerstones of management of patients with chest pain. A 12 lead ECG recording must be registered and…

…the arrhythmia is a wide complex tachycardia (WCT) . This initial distinction will guide the rest of the thinking needed to arrive at a final diagnosis…

…The patient's perceived exertion is a way of estimating the intensity of the physical activity. It is based on the subjective physical sensations experienced…

…the energy cost of physical activity. One metabolic equivalent (1 MET) is defined as the amount of oxygen consumed while sitting at rest and is…

…it is a very rare condition. Several formulas have been suggested to calculate corrected QT intervals. Some of these formulas follow: Bazett's formula for…

…and exercise (functional) capacity. Functional capacity is a strong predictor of both cardiovascular and overall mortality, offering incremental prognostic data beyond perfusion imaging and ECG…

…physical activity, but an atherosclerotic plaque may prevent oxygen supply from increasing in parallel with oxygen demands. Depending on several factors– including the severity of…

…means that the automaticity is diminished). Chronotropic incompetence (inability of the sinoatrial node to adequately increase its automaticity during physical activity). Sinus arrest & sinus pause…

…increased rate of depolarization (i.e increased automaticity) in the sinoatrial node. This simply means that the sinoatrial node discharges electrical impulses at a higher…

…occurs after an abrupt reduction or cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration…

…Moisture completes a circuit across the mucosa, hydroxide ions are generated at the negative pole of the battery and produce a liquefactive necrosis that can…

…1 hour Vigorous physical exertion 30 minutes A large meal 2 hours Withholding applies only to diagnostic spirometry with a reversibility test. At follow up…

…may justify consideration of repair at a smaller diameter than would otherwise be used. Women have growth rates similar to men but a substantially higher…

…point toward gastroesophageal reflux. Physical examination should include a speculum examination of the nose to look for excess mucoid or purulent secretions, inflamed and edematous…

…Evaluation and Physical Examination A comprehensive evaluation is mandatory for patients presenting with sudden cardiac arrest (SCA) if the underlying cardiac disease is unknown or…

Emergency medicine Myocardial ischemia and infarction Definition and pathophysiology Acute coronary syndrome (ACS) comprises a spectrum of clinical presentations caused by suspected acute myocardial ischaemia…

…the likelihood of successful limb salvage. Evaluation and physical examination ALI requires immediate clinical assessment by a vascular specialist or urgent transfer to a facility…

…The presence of haemodynamic instability places the patient in the high risk category and requires urgent evaluation for reperfusion treatment. Evaluation and physical examination Initial…

…CCS. General strategy For most patients, initial therapy consists of a beta blocker and/or a calcium channel blocker (CCB). If symptoms remain inadequately controlled…

…self measurement at home, generally with a validated upper arm oscillometric device. Ambulatory blood pressure monitoring (ABPM): automated measurement, usually over 24 hours, at predefined…

…newly developed during management of an acute illness. The clinical relationship between AF and acute deterioration is often bidirectional. AF with a rapid ventricular response…

…failure and stroke; the lifetime risk for a 40 year old woman has been estimated at approximately one in two for CVD, one in three…

…sufficiently high for targeted screening to be cost effective. For asymptomatic stenosis of at least 70%, the reported 5 year ipsilateral stroke risk is 14…

…stress. Palpitations associated with physical activity, a large meal, emotional upset, or cold exposure. The absence of chest pain does not exclude clinically important CCS…

…and a dedicated multidisciplinary Shock Team. Evaluation and physical examination Assessment should establish: The ACS presentation and its urgency. The presence or absence of haemodynamic…

…is listed as a differential diagnosis for chest pain [2]. 2. Musculoskeletal Conditions Examples: Costochondritis and general musculoskeletal pain are common causes of chest pain…

…toxicity. Several underlying conditions increase a patient's sensitivity to digitalis related arrhythmias. The clinician must evaluate for the presence of worsening renal function, advanced…