…require the larger effect of a PCSK9 inhibitor. Place in lipid lowering therapy General treatment sequence High intensity statin therapy remains the foundation of lipid…

…improves the resolution in a particular area. Alternatively, it is possible to place the focus at the level of the region of interest. The difference…

…are placed proximally on the upper arm. Placement of chest (precordial) electrodes are not changed but additional leads may be attached in children under the…

…the dramatic physiological and anatomical changes that take place during infancy and childhood. The most dramatic changes occur during the first year of life. The…

…the dramatic physiological and anatomical changes that take place during infancy and childhood. The most dramatic changes occur during the first year of life. The…

…causes prolapse to be underestimated. Offer a chaperone according to local procedure; this is recommended for all examinations of the breasts, the genitalia and the…

…in the foot or leg, or a non healing distal ulcer. Before compression treatment of a leg ulcer — compression in arterial insufficiency can cause necrosis…

…seizure, repeated doses of benzodiazepine, aspiration, hypoventilation, circulatory failure or an anticipated need for anaesthesia. Consider a 12 lead ECG when the acute situation allows…

…may affect hemodynamics and the underlying cause is often serious (e. g. malignancy, amyloidosis). In case of suspicion of pericardial disease, in the first place…

…pillow to place under the shoulders as an alternative to a hanging head. Frenzel goggles or video Frenzel if available — small beats of nystagmus can…

…look for the cause instead. Conditions in which the highest possible oxygen concentration is given irrespective of the saturation Carbon monoxide poisoning. The pulse oximeter…

…permanent pacemaker or to resolution of the underlying cause. Contraindications Hypothermia with a body temperature below about 30 °C — the hypothermic myocardium is irritable and…

…and 7 night time values, and with a measurement interval of no more than 30 minutes throughout the 24 hours. Phenotype Office blood pressure ABPM…

…duration; it is safe even on the fingers, toes, nose and ears), a 27 G needle, a 2–5 mL syringe. Punches of 2, 3…

…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…

…confirms that the injection has gone to the right place — immediate pain relief is a diagnostic finding — and appears to reduce the risk of a…

…although the clinical importance of improved adherence remains dependent on sustained follow up and administration. Clinical indications and place in therapy Inclisiran has been approved…

…vegetations are attached to the endocardium and, accordingly, less mobile. Echocardiography is the first place method for detecting vegetation in case of suspicion of endocarditis…

…the puncture went. Indications Unexplained cytopenia in one or more cell lines. Suspected acute leukaemia, myelodysplastic syndrome or myeloproliferative neoplasm. Work up and staging of…

…the soft part , and held continuously for at least 10 minutes without letting go to look. Compression can be preceded by a dose of decongestant…

…stabilise first The induction of vomiting has no place in the modern treatment of poisoning. Charcoal also does not bind every poison. With the following…

…Locate the centre of the fluctuance, preferably with ultrasound if available. Mark the direction of the incision. 2. Clean and drape. Place a field block…

…in the hub: lower the angle to close to the plane of the skin and advance a further 1–2 mm so that the catheter…

…commonest cause of pressure sores. 4. Dip the plaster in tepid water and squeeze out the excess without wringing. 5. Put the slab in place…

…that the deltoid injection is placed too high — which causes the shoulder injury known as SIRVA. Both are avoided with the right landmark and the…

…arthritis must be distinguished from crystal arthritis — the most important indication and an emergency procedure . An unclear arthritis, as part of the diagnostic work up…

…time. Opioids in abdominal pain of unclear cause do not delay the diagnosis and should be given, but document the examination findings before the dose…

…a therapeutic objective. LDL C as the primary treatment target Current lipid management frameworks place LDL C at the centre of treatment. Lifestyle intervention is…

…The sample volume (SV) should be placed between the leaflet tips (1–3 mm axial length of SV) and sweep speed is set to 50…

…or fracture of the leads. External causes are less common and include electrolyte disorders, metabolic disorders, hypoxemia, antiarrhythmic drugs, or electromagnetic disturbance caused by other…

…determine afterwards whether a nerve injury was caused by the injury or by the treatment. Indications A clinically or radiologically confirmed dislocation of the shoulder…

…and less pronounced on the treadmill. Leg fatigue is, as compared with chest pain and dyspnea, a poor predictor of cardiovascular and all cause mortality…

…wave in lead II). If the atrial lead is placed distally in the atrium, activation may proceed in the opposite direction, which results in negative…

…Zipes et al . Main causes of cardiac arrhythmias Arrhythmias arise if the impulse formation is abnormal, if the impulse transmission is abnormal, or if both…

…substantially worse survival than cases occurring in public places, where there are people who can provide CPR, alert the ambulance and use a public defibrillator…

…leads in the frontal plane. This format of displaying the ECG leads is referred to as the Cabrera format and it has been the existing…

…genesis of these waves and although it has been discussed previously a brief rehearsal is warranted. Figure 7 illustrates the vectors in the horizontal plane…

…of myocardial muscle fibers results in longitudinal, radial and circumferential shortening (contraction). Longitudinal, radial and circumferential shortening occur simultaneously. This results in the AV plane…

…diameter of the valve is measured in diastole in apical four chamber view. VTI is obtained in the same view with the sample volume placed…

Procedurer Almost all the complications of pleural aspiration arise from two errors: the needle is placed in the wrong site, and too much is drained…

…a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : …

…the suture is placed. The commonest cause of wound infection is retained contamination, not poor suture technique — and the commonest cause of permanent loss of…

…The operator should have an elbow rest, and also avoid bending the back during the examination. Work related musculoskeletal disorders are a common cause of…

…capable of recording these flow variations with high precision. To calculate flow across a valve, the Doppler line is placed in the valve orifice. The…

…for the electrode. A glass of water with a straw, a vomit bowl, tissues, suction. Monitoring with ECG, blood pressure and saturation throughout the investigation…

Echocardiography Color Doppler Velocities recorded in a sample volume of the pulsed wave Doppler can be presented with a color. A color scale from blue…

…article will deal with the physiology of exercise and emphasis will be placed on myocardial oxygen consumption and the development of myocardial ischemia during exercise…

…compensatory mechanism) its contribution to the P wave will be enhanced. Enlargement of the left and right atria causes typical P wave changes in lead…

…how the frequency of reflected sound waves are modified by the direction of movement of the sound source. Figure 1 presents three trumpets; one placed…

…The sample volume (in apical view) is placed at the tips of the mitral valve leaflets (Figure 2, top right). The rapid blood flow from…

…valves. Table 1 presents common causes of pulmonic stenosis. Table 1. Causes of pulmonic stenosis. Tetralogy of Fallot Transposition of the great arteries) Dysplastic, bicuspid…

…Suspected base of skull fracture or a marked midfacial fracture — the tube can pass through a fracture in the cribriform plate into the cranium Absolute…

…of the transducer, the orientation of the index marker and the scanning plane through the heart. Figure 2. PLAX, Parasternal Long Axis View. Position of…

…shift of the ECG axis [2] Causes of Left Axis Deviation: Left ventricular hypertrophy [11] Left heart disease, which may be suspected in the differential…

…myocardial segmentation for echocardiography and cardiac imaging Cardiovascular imaging modalities have developed rapidly in the past few decades. The repertoire of available methods includes echocardiography…

…to the point of measurement. Figure 2. Tissue Doppler where velocity is measured in four points. Tissue Tracking Tissue tracking is used to calculate the…

…is particularly important as a marker of potentially severe disease. The presence of haemodynamic instability places the patient in the high risk category and requires…

…is the predominant cause. Other mechanisms include thrombosis, embolism, vasculitis, fibromuscular dysplasia, arterial entrapment, cystic adventitial disease and trauma. Atherosclerotic PAD is a manifestation of…

…inferobasal) transmural ischemia causes reciprocal ST segment depressions in V1–V3 (occasionally V4). Leads V7–V9 must be placed to reveal the ST segment elevations…

…using TAPSE (Tricuspid Annular Plane Systolic Excursion). Study the movement and opening of the aortic valve. Study the movement and opening of the mitral valve…