Procedurer For many patients a gynaecological examination is associated with a sense of exposure, and technically correct performance is only half the task. The examination…

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…

…Determination of symptom onset time and anticipated time to primary PCI. Patients with STEMI should be monitored in a setting capable of continuous rhythm surveillance…

…Primary prevention refers to individuals without established atherosclerotic cardiovascular disease (ASCVD), coronary artery disease, cerebrovascular disease, or peripheral artery disease. Secondary prevention concerns patients with…

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

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…

Procedurer Two recordings that are performed in primary care but interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the…

…is not a test for BPPV. It is used in the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus, nausea and difficulty walking that has…

…coronary syndromes (ACS), including: Unstable angina (UA) Non ST elevation myocardial infarction (NSTEMI) ST elevation myocardial infarction (STEMI) This applies to patients undergoing either primary…

…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…

…and acute coronary syndromes (ACS). Its principal therapeutic objective is reduction of low density lipoprotein cholesterol (LDL C), the primary lipid target in contemporary secondary…

…more drugs. Screening for primary aldosteronism Screening for primary aldosteronism with renin and aldosterone measurements should be considered in all adults with confirmed hypertension, defined…

…when encountering a patient with chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic…

…syndrome (BrS) has evolved from an obscure electrocardiographic curiosity into a major focus of contemporary cardiac electrophysiology [1] . Recognized as a primary inherited arrhythmia syndrome…

…Like all other cells in the human body, cardiac myocytes use ATP (adenosine triphosphate) as the primary energy source. ATP is produced by metabolizing carbohydrates …

…acute coronary syndromes. An acute coronary syndrome is the result of a perfect storm scenario, where disruption of an atherosclerotic plaque coincides with a pro…

…cardiovascular medicine. As a primary driver of sudden cardiac death (SCD) and a major cause of morbidity in patients with structural heart disease, VT necessitates…

…Pilonidal abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has…

…moment of sampling, but does not by itself identify the cause. The result must always be weighed together with the clinical picture, medication, fluid balance…

…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…

…ventilation is difficult or inadequate. The primary airway in cardiac arrest when the person ventilating is not experienced in intubation. Planned anaesthesia for short procedures…

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

…Addisonian crisis, hydrocortisone must be given immediately — the test must never delay treatment. Indications Suspected primary adrenal insufficiency (Addison's disease): fatigue, weight loss, hyperpigmentation…

…with neuropathy, immunosuppression, and high dose corticosteroids. The time limit and the choice of closure strategy The classical limit of 6–8 hours for primary…

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

…32–60 25–31 18–24 <17 Tricuspid valve Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6…

…by echocardiography. Reduced LVEF reliably identifies a high risk group that derives a large, trial proven survival benefit from primary prevention ICDs. Its dominance, though…

…chest discomfort requires a systematic differential diagnosis, as the syndrome associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness…

…making it a consideration for patients with low blood pressure secondary to a low cardiac output. Its primary clinical utility in contemporary practice is late…

…Clinical indications Suspected chronic coronary syndrome Exercise ECG may be used in selected patients with suspected chronic coronary syndrome when the result is expected to…

… 150 mg/dL (≥1.7 mmol/L) in ESC primary prevention guidance 175–499 mg/dL (2.0–5.6 mmol/L) Severe HTG ≥500…

Cardiology Emergency medicine Surgery & trauma Definition and Pathophysiology Aortic dissection is a major form of acute aortic syndrome (AAS), alongside intramural haematoma, penetrating atherosclerotic ulcer…

…interface between infarcted and viable myocardium. The incidence has fallen substantially with contemporary reperfusion, particularly primary percutaneous coronary intervention (PCI). In a large epidemiological analysis…

…patients with established peripheral artery disease, those who stop smoking have approximately twice the five year survival of those who continue. After acute coronary syndrome…

…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…

…hypotension and bradycardia. However, some patients exhibit a primary cardioinhibitory response with pronounced bradycardia. Most cardioinhibitory events are due to sinus bradycardia, though transient atrioventricular…

…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…

…body's capacity for heat elimination. Hyperthermia can induce an inflammatory state similar to the Systemic Inflammatory Response Syndrome (SIRS). Body temperatures surpassing 40°C (104°F…

…Thromboembolism). There are genetic syndromes that result in the emergence of multiple myxomas. Papillary fibroelastoma Papillary fibroelastoma is benign primary tumors affecting adults. These tumors…

…septicemia (sepsis), osteolytic cancer metastases, abnormal calcium absorption (gastrointestinal) and resorption (from primary urine), renal failure, small bowel syndrome, parathyroid gland surgery, use of bisphosphonates…

…For instance, administering nitroglycerin to alleviate ischemic chest pain may lead to hemodynamic collapse in patients with right ventricular ischemia or infarction. Recognizing ECG signs…

…Lim et al ). Approximately 90–95% of individuals with hypertension have essential hypertension , also referred to as primary hypertension . Essential hypertension is defined as hypertension…

…defect in the left ventricle is more significant, as compared with a defect affecting the right ventricle. This is due to the fact that the…

…is most likely explained by successful primary preventive strategies, such as reduced smoking rates, aggressive lowering of blood lipids with statins and sophisticated treatments for…

…strongly with the risk of potentially life threatening ventricular arrhythmias. Therefore, the QT interval must always be assessed when interpreting the ECG. Long QT syndrome…

…and a small lipid core, the pathophysiology of Acute Coronary Syndromes (ACS) is driven by the sudden destabilization of these lesions, a process known as…

…half of the heart, it is important to familiarize yourself with the principles of hemodynamics and conditions prevailing on the right side. Echocardiography is the…

…branch block (LBBB) , right bundle branch block (RBBB) and pre excitation (WPW syndrome) may all cause ST segment depressions. These are all common conditions in…

…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])…

…choice of reperfusion Primary PCI is the method of choice if PCI can be performed within 120 minutes of the STEMI diagnosis. With a longer…

…below apply to adults unless otherwise stated, and paediatric doses are given per kilogram with the stated maximum. Always check against the local guideline and…

…9 ± 1.5 11.2 ± 1.4 Aortic regurgitation (AR) Primary parameters Mild regurgitation Moderate regurgitation Severe regurgitation Vena contracta (cm) < 0.3 0…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

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

…cardiac death (SCD) in young individuals and during exercise. The risk of ventricular arrhythmias correlates with the degree of hypertrophy, the extent of ventricular fibrosis…

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…

…and arrhythmology Drugs and electrolyte imbalance ECG Definition and Pathophysiology Acquired long QT syndrome (LQTS) is characterised by an abnormal prolongation of the QT interval…

…statin therapy reduced LDL C by approximately 16.5%; the reduction in a subgroup with diabetes was approximately 19.1%. The drug also lowers hsCRP…