…involve a surgeon The following locations must not be handled routinely in primary care or in the emergency department without contacting the appropriate specialty: Location…

Cardiology Endocrinology & metabolism Definition and pathophysiology Primary aldosteronism (PA), also termed primary hyperaldosteronism or Conn syndrome, comprises disorders in which aldosterone secretion is inappropriately increased…

…instability or life threatening arrhythmias. Twelve to 48 hours after onset: routine primary PCI should be considered in otherwise stable patients. More than 48 hours…

…intracranial bleeding. Evidence in primary prevention Cardiovascular outcomes Contemporary primary prevention studies and meta analyses show that aspirin can reduce non fatal cardiovascular events, but…

Cardiology Clinical medicine Definition and Scope Primary prevention aims to prevent the clinical manifestation of cardiovascular disease (CVD) in individuals without established clinical CVD. It…

Mitral valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation Vena contracta (cm) < 0,3 0,3 0,69 0,69 EROA (cm²…

Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6 0,6 0,9 0,9 Vena contracta (cm…

…are performed in primary care but interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the cuff is in the…

…the left side. A positive test in the posterior canal is characterised by: A latency of 1–5 seconds before the nystagmus begins. Upbeating and…

…This applies to patients undergoing either primary or delayed percutaneous coronary intervention (PCI). Contraindications Prasugrel should not be used in the following situations: Hypersensitivity to…

…myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble primary dilated cardiomyopathy, particularly when angina or a previous myocardial infarction (MI…

…C), the primary lipid target in contemporary secondary prevention. Statins inhibit hepatic 3 hydroxy 3 methylglutaryl coenzyme A reductase, a key enzyme in cholesterol synthesis…

…should undergo a structured assessment and be referred to a specialized centre because the work up may require expertise and technologies unavailable in primary care…

…diagnoses, evaluation and management Chest pain is one of the most common symptoms in the emergency department, as well as in primary health care. The…

…Recognized as a primary inherited arrhythmia syndrome, BrS is characterized by a distinct electrocardiographic (ECG) signature—coved ST segment elevation in the right precordial leads…

…ECG signs and development of infarction Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source…

…risk factors serve as useful predictors in prediction models. Targeting risk factors has been very successful in the primary and secondary prevention of atherosclerotic cardiovascular…

…a formidable challenge in contemporary cardiovascular medicine. As a primary driver of sudden cardiac death (SCD) and a major cause of morbidity in patients with…

Klinisk kemi & laboratoriemedicin Akutsjukvård Lathundar Basic principle Interpret the blood gas in the same order every time. Skipping a step is a common reason why…

…life produces more marked suppression. Stress dosing in known adrenal insufficiency A patient with primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency or long…

…primary screening test throughout the country. Cytology is used as a triage test on the same liquid based sample when the HPV test is positive…

…radiotherapy. In the "can't intubate, can't oxygenate" situation there are no contraindications — a laryngeal mask is inserted even with a full stomach. Preparation…

…stricture, tumour, primary biliary cholangitis, drugs Mixed Both raised Drug induced liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's…

…treatment. Indications Suspected primary adrenal insufficiency (Addison's disease): fatigue, weight loss, hyperpigmentation, hyponatraemia, hyperkalaemia, postural symptoms. Suspected secondary adrenal insufficiency in pituitary disease, after…

…or a dressing alone. Contraindications Primary closure must be avoided or considered carefully in: Bite wounds — particularly cat and human bites, and all bites on…

…stroke risk in patients with non valvular atrial fibrillation (AF). It is a modification of the widely used CHA₂DS₂ VASc score, with the primary distinction…

…cm 1.5–2.1 2.2–2.5 2.6–2.9 3.0 RV SIZE AND FUNCTION (MEASURED IN A4C) RV diastolic area…

…death: what the new Nature study shows Low risk (blue) versus high risk (red) ECG morphs in lead aVL (adapted from Obermeyer et al 1 )…

…syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw…

…Its primary clinical utility in contemporary practice is late line therapy for patients who remain profoundly symptomatic despite optimal neurohormonal blockade and adequate volume control…

ECG Exercise stress test Definition and clinical role Exercise electrocardiographic testing is a standardized assessment in which a patient performs progressively increasing external work, usually…

…relevant medications. Cardiovascular risk category and the adequacy of LDL C lowering treatment. In severe primary HTG, whether specialist lipid assessment is required. A comprehensive…

…the true lumen, whereas disruption of the adventitia can result in rupture. An alternative proposed mechanism is primary rupture of the vasa vasorum, followed by…

…Free wall rupture is more common after fibrinolytic therapy than after PCI in the reported clinical profile, whereas primary PCI appears to reduce its risk…

…a proportional reduction in cardiovascular harm. Complete cessation is therefore the preferred therapeutic endpoint. The cardiovascular benefits of cessation extend across primary and secondary prevention…

…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…

…vasovagal syncope is reported to occur in over 40% of females and 30% of males due to a lack of effective reflex response to posture…

…onset, is of paramount importance. The primary concern in correcting hyponatremia is the prevention of osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis…

…of adult in hospital cardiac arrest. Resuscitation 2016;98:10511. Saarinen S, Nurmi J, Toivio T, et al. Does appropriate treatment of the primary underlying…

…that result in the emergence of multiple myxomas. Papillary fibroelastoma Papillary fibroelastoma is benign primary tumors affecting adults. These tumors most often occur in the…

…Rare ECG changes Increased QRS amplitude. Diminished T wave amplitude Osborn like waves. ST segment elevation in leads V1–V2. All degrees of AV block…

…one" – is used to denote the occluded coronary artery. In the majority of cases, it is only possible to determine the ischemic/infarct area (and…

…90–95% of individuals with hypertension have essential hypertension , also referred to as primary hypertension . Essential hypertension is defined as hypertension without an identifiable underlying…

…against greater resistance and any disturbance in ventricular activation will reduce the efficiency of the pumping function. The primary ECG manifestations of conduction defects are…

…in the 1970s and have declined steadily ever since. The marked decline in death rates and case fatality is most likely explained by successful primary…

…interval. The primary hazard lies in long QTc intervals because they induce a very unstable polymorphic ventricular tachycardia referred to as torsade de pointes . Abnormally…

…thrombogenic surface occurs via three primary mechanisms: Plaque Rupture: Accounting for 60 70% of ACS presentations, plaque rupture typically occurs in thin cap fibroatheromas (TCFAs…

…primary problem. Among the causes are pulmonary embolism, pulmonary hypertension, septum defects, etc. Right ventricular load is thus an issue that is raised both in…

…In NSTE ACS the ST segment depressions are the primary ischemic ECG changes. ST segment depressions in NSTE ACS are frequently accompanied by T wave…

…Myocardial oxygen demand Myocardium can only function under aerobic conditions (oxygen is required for ATP synthesis [ATP is the primary energy source in all cells])…

…primary PCI and fibrinolysis, not an acceptable routine target. The shorter the ischaemic time, the more myocardium can be salvaged. Call the PCI service in…

…in an adult, 1 J/kg in a child (2 J/kg at the second attempt). Vasoactive infusions Drug Dose range Primary effect Used in…

…22 36 mm Descending aorta 20 30 mm ​Indexing means that the value is adjusted for body surface area (BSA), given in square metres. Aorta…

…and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret. Skin and soft tissue Diagnosis Agent…

…9 ± 1.5 11.2 ± 1.4 Aortic regurgitation (AR) Primary parameters Mild regurgitation Moderate regurgitation Severe regurgitation Vena contracta (cm) < 0,3 0…

[calc_hcmrisk] Predicting Sudden Cardiac Death in Hypertrophic Cardiomyopathy (HCM) Hypertrophic Cardiomyopathy (HCM) is a genetic cardiomyopathy characterized by left ventricular hypertrophy. It is the…

…Reperfusion is indicated in all patients with symptoms of ischaemia of <12 h duration and persistent ST segment elevations. I A Primary PCI is recommended…

…ECG is the primary diagnostic tool for evaluating acquired QT prolongation. The upper 99% limits of normal for corrected QT (QTc) values in the general…

…who were unable or unwilling to take statins. Approximately 70% were in secondary prevention and 30% in primary prevention; 23% were taking a small dose…