…are cells with pure automaticity around the atrioventricular node. These cells are capable of spontaneous depolarization (i.e they display automaticity) and can therefore act…

…begins with assessment and management of reversible causes. Because the prognosis is described as benign, treatment is directed primarily at symptom relief and may not…

…These factors interact and vary over time. Some factors vary from second to second (e.g. degree of ischemia, parasympathetic and sympathetic tone) while others…

…Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid ventricular rate. Elective or subacute: Symptomatic persistent atrial fibrillation where…

…vertical axis) and its positive inotropic effect (horizontal axis). Grey = pure vasopressors, orange = phosphodiesterase inhibitors, blue/turquoise = calcium sensitisers and a beta…

…and, if the patient has suffered a stroke/TIA, to assess whether the embolic source is the most likely cause of the event. Echocardiographic assessment…

…markedly impaired renal function [3]. Urine output can change before creatinine but is not a pure marker of filtration. Oliguria may be due to hypovolaemia…

…and the sodium and volume load becomes pure harm. Dialysis is then the way forward. Heart failure, pulmonary oedema and other conditions with a high…

Echocardiography Pericardial diseases: effusion and tamponade A long series of conditions can affect the pericardium (pericardium). The most common of these are acute pericarditis (perimyocarditis…

…Clinical assessment and estimation of pre test probability Symptoms and clinical context The assessment begins with the clinical presentation, including the character and stability of…

…Figure 2. Pre excitation in a 25 year old woman. There are numerous leads showing ST segment depression and T wave inversion. There is very…

Cardiology Clinical medicine Definition and clinical classification Hypertensive disorders of pregnancy comprise chronic or pre existing hypertension, gestational hypertension, and preeclampsia. Collectively, they affect approximately…

…Assessment of chronotropic function and pacemaker settings. Preoperative functional assessment before major surgery. At a low pre test probability most positive results are false positives…

…evidence of coronary ischaemia. These findings determine the urgency and type of intervention. The assessment should also clarify: Whether AF is pre existing, newly detected…

…AVNRT, AVRT (pre excitation, WPW), junctional tachycardia. These tachyarrhythmias arise in the atria and are very rarely life threatening. Causes of tachyarrhythmia with wide QRS…

…acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood pressure is often at least 180/120 mmHg, but no absolute threshold…

Clevidipine Drug Clevidipine Brand names Cleviprex ® Indications Hypertension and hypertensive emergency. Treatment of postoperative hypertension. Mechanism of action Ultra short acting calcium channel blocker…

…emergency is defined as significantly elevated blood pressure (systolic pressure ≥180 mmHg and/or diastolic pressure ≥120 mmHg) with concurrent signs of acute organ damage…

…point and the terminal part of the T wave. PR interval 0,22 s : first degree AV block. PR interval <0,12 s : Pre excitation…

…time dependent inward currents. This process creates early afterdepolarisations (EADs) that generate premature ventricular contractions (PVCs) and increases transmural dispersion of repolarisation, thereby facilitating reentry…

…focal neurological symptoms. Asymptomatic disease may be discovered during targeted duplex ultrasound (DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening…

…postcapillary PH (IpcPH) 20 mmHg 15 mmHg ≤2 Wood units Combined pre and postcapillary PH (CpcPH) 20 mmHg 15 mmHg 2 Wood units Unclassified PH…

…rupture with tamponade, and less common causes such as severe pre existing valvular disease or excessive beta blocker or calcium channel blocker exposure. The incidence…

…right ventricular involvement Pre existing abnormalities such as prior infarction, left bundle branch block, Wolff–Parkinson–White patterns or ventricular pacing STEMI and non ST…

…and routine clinical practice report muscle symptoms. This discrepancy reflects, at least in part, the nocebo effect : negative expectations, contextual cues and attribution of pre…

…reperfusion is determined by patient recognition and help seeking, pre hospital assessment and transport, diagnostic and treatment delays, and the time required for the selected…

…Paroxysmal supraventricular tachycardia (PSVT), which includes forms that are caused by pre excitation. Myocardial perfusion scintigraphy. Contraindications Asthma and COPD. Adenosine has caused mild to…

…obstructive sleep apnea and chronic obstructive pulmonary disease (COPD). Moreover, certain other tachyarrhythmias predispose to developing atrial fibrillation: atrial flutter, AVNRT and AVRT (pre excitation…

…such as pre syncope or syncope. Definition of Paroxysmal Supraventricular Tachyarrhythmia (PSVT) The arrhythmias AVNRT, AVRT (Pre excitation, Wolff Parkinson White syndrome) and ectopic atrial…

…the smaller the current used. Software settings The pacemaker software includes pre programmed algorithms and settings, which can be tailored to the patient's needs…

…roughly ten times as often as women, and men also display the highest risk of experiencing malign ventricular arrhythmias. Brugada syndrome is hereditary with an…

…Pneumothorax is characterized by the presence of free air in the thoracic cavity. While this can occasionally be benign and manifest even in healthy individuals…

…emergency is defined as significantly elevated blood pressure (systolic pressure ≥180 mmHg and/or diastolic pressure ≥120 mmHg) with concurrent signs of acute organ damage…

…follow up after one month, and at least annually thereafter, more often in impaired renal function. Red flags and pitfalls Atrial fibrillation with pre excit

…least two occasions, and preferably confirmation by home measurement or 24 hour recording — the thresholds for which are lower than for office measurement. Classification of…

…remains. 3. Pare down any hyperkeratosis with a scalpel; nitrogen does not penetrate thick keratin. 4. Protect the surroundings with petroleum jelly and, where necessary…

…300 ms may become haemodynamically significant. Pre excitation: PR < 120 ms with a delta wave and QRS 110 ms. Brugada pattern type 1: ST…

…orthopnoea and new sweating. Oliguria, dark urine or rapidly developing swelling. Pregnancy, gestational week and recent delivery. Pre eclampsia can present postpartum. Known hypertension and…

…for the balloon, a drainage bag and a catheter valve, and lubricant containing a local anaesthetic (lidocaine gel) in a pre filled syringe. Catheter size…

DICTrank: The Largest Reference List of 1318 Human Drugs Ranked by Risk of Drug Induced Cardiotoxicity Using FDA Labeling . Drug Discovery Today. 2023. DICT =…

…B In patients with inferior myocardial infarction, consider connecting V3R and V4R to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum…

…the presence of substantial pre existing CKD, particularly when congestive heart failure or other causes of ischaemic AKI coexist. Risk assessment Patient related risk factors…

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…

Cardiology Emergency medicine Definition and Pathophysiology A hypertensive emergency is severe blood pressure elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European…

…as isoproterenol and/or procainamide. EPS with isoproterenol is also recommended for risk stratification in specific populations, such as asymptomatic patients with pre excitation who…

Cardiology Pharmacology & dosing Definition and pathophysiology Lipid lowering therapy is a central component of cardiovascular prevention, particularly in patients with established atherosclerotic cardiovascular disease (ASCVD…

…particularly when combined with metabolic imaging. Contribute to assessment of cardiac inflammation, infective endocarditis, and cardiac amyloidosis using appropriate radiopharmaceuticals. Functional perfusion imaging primarily identifies…

…therapy. Furthermore, acute heart failure and cardiogenic shock can present de novo in pregnant women without pre existing heart disease, such as in peripartum cardiomyopathy…

…Assessment Before Prescription Physical activity should be assessed and prescribed using the components of: Frequency Intensity Time or duration Type Progression The prescription should be…

…min Explanation: The QT interval corrected for heart rate is ideally measured using Bazett's formula with heart rates between 60 and 90 beats/min…

…is particularly appropriate when: The pre test likelihood of obstructive CAD is moderate or high, generally greater than 15% and less than 85% Baseline ECG…

…pulmonary valve stenosis). Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior fascicular block…

…pulmonary valve stenosis). Lateral ventricular infarction. Pre excitation. Switched arm electrodes (negative P and QRS T in lead I). Situs inversus. Left posterior fascicular block…

CPR This chapter discusses interventions and evaluations performed during advanced cardiovascular life support (ACLS). While basic life support (BLS) can be delivered by virtually anyone…

…which therefore contracts without pre load (the ventricle is empty or nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend…

CPR Hypoxia and asphyxiation Hypoxia refers to a reduced partial pressure of oxygen in the blood. Asphyxia is characterized by insufficient ventilation, leading to hypoxia…

…and the habit of the investigator. As with the clinical labor test (working ECG) , the value of echocardiographic examination depends on the pre test probability…

…to follow and it can be carried out by anyone. The reader will gradually notice that ECG interpretation is markedly facilitated by using an algorithm…

…fatigue and exercise intolerance to sudden cardiac arrest. The most common acute symptoms are dizziness (pre syncope), hypotension (chock), syncope, chest pain, heart failure and…

…RBBB) and pre excitation Left ventricular hypertrophy (LVH) , right ventricular hypertrophy (RVH) , left bundle branch block (LBBB) , right bundle branch block (RBBB) and pre excitation…