…These two measures – i.e switching to anaerobic metabolism and discontinuing the contractions – enables the myocardium to endure 20 to 30 minutes of severe ischemia…

…in older patients and those exhibiting a bundle branch block (BBB) or an intraventricular conduction defect. In severe cases, bradycardia may progress to hemodynamic instability…

…a reduction in global LVEF and transient LV cavity dilatation during stress. Stress echocardiography can also provide information beyond regional wall motion, including: Global and…

…no isolated BP value is sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent…

…can also occur. The physiologic response to orthostatic stress is incompletely understood, but redistribution of blood volume and increased ventricular contractility occur consistently. Exaggerated activation…

…C reduction, including modulation of inflammation, oxidative stress, endothelial function, plaque stability, thrombogenic responses and immune activity. Statin intolerance refers to adverse effects attributed to…

…precludes safe and adequate testing Relative contraindications Known obstructive left main coronary artery stenosis Moderate to severe aortic stenosis with uncertain relation to symptoms Tachyarrhythmias…

…Pharmacologic stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic…

…will alleviate the ischemia, improve myocardial function and increase resistance to episodes of more severe myocardial ischemia. Collateral circulation may be very effective in reducing…

…chronic mental stress. Fibromuscular dysplasia (FMD), which may produce arterial wall abnormalities and intramural haematomas. Inherited connective tissue disorders, including Marfan syndrome and Ehlers–Danlos…

…progressive multisystem reaction Intramuscular adrenaline immediately Severe anaphylaxis Hypoxia, marked bronchospasm, stridor, hypotension, collapse or impaired consciousness Adrenaline, oxygen, intravenous access, fluid and early contact…

…A history of a severe transfusion reaction: contact transfusion medicine before transfusing again. Preparation and equipment Compatibility testing Test What it involves When it is…

…mortality is generally below 0.1% in contemporary series. Reported risks vary according to the population and definitions used. Complication Reported risk (%) Mortality 0.11…

…treatment; biphasic reactions occur. Everyone must go home with an adrenaline auto injector and written instructions. Patients taking beta blockers may respond poorly to adrenaline…

…heparin). Patients with gastrointestinal disorders. Patients with severe kidney disease (glomerular filtration rate < 30 mL/min). Patients with mild to moderate heart failure, kidney…

…conversion between drugs is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough…

…zero, and several syndromes can overlap [1,4]. Time after a clear reduction or the last intake Common clinical picture : : 4 to 12 hours Tremor…

…conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe…

…referred to as myocardial stunning . This is a protective mechanism since the cessation of contractions leads to a marked reduction in cell metabolism and thus…

…ischaemia. Motor dysfunction ranges from weakness to paralysis and is a particularly important marker of threatened limb viability. Paralysis generally indicates severe and persistent ischaemia…

…s exchangeable sodium and potassium and the total body water. In hypotonic hyponatraemia the amount of water is too great in relation to the amount…

…Condition Overall strategy Common first choices : : : Acute aortic syndrome Immediate rate control and rapid reduction of the systolic blood pressure towards 100 to 120 mmHg…

…generally defined as a diameter reduction of at least 50%. Severe proximal disease of both the proximal left anterior descending and proximal left circumflex arteries…

…with symptomatic orthostatic hypotension, moderate to severe frailty, or very old or frail patients who may not tolerate rapid blood pressure reduction. Initial Combination Therapy…

…producing an acute left to right shunt. Ventricular free wall rupture, producing haemopericardium and cardiac tamponade. Papillary muscle rupture, producing acute severe mitral regurgitation (MR…

…rhythm and a heart rate above 70 beats/min. The reduction in the combined outcome of cardiovascular death or heart failure hospitalisation was related to…

…18% to 52%. They frequently occur in patients with severe coronary artery disease, defined in the source material as stenosis greater than 70%, and are…

…body temperature to below 35°C. The lowest recorded body temperatures from which patients have been successfully resuscitated are 11.8°C for accidental hypothermia and 4…

…A reduction in size of 40% within four weeks predicts healing — failure to shrink should prompt reconsideration of the diagnosis. 3. Palpate the pulses and…

…relationship between triglyceride concentrations and aortic disease is less clearly defined, although triglycerides may contribute to the development and progression of aortic pathology. Severe HTG…

…interventricular septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac…

…are due to partial (incomplete) coronary artery occlusions , which implies that there remains residual blood flow in the artery. Moreover, management of NSTEMI and unstable…

…Dose reduction in renal failure and in old age Amiodarone In severe haemodynamic compromise where the above cannot be used It also has a rhythm…

…or electrophysiology in relation to ACE inhibitor therapy. Biomarkers and Laboratory Findings Monitoring renal function and potassium is a critical component of ACE inhibitor therapy…

…ICP) and reduction in cerebral blood flow. Caution • Used cautiously in patients with high intracranial pressure or azotemia. • Should not be given to pregnant women…

…disease, with symptoms similar to seasonal flu (influenza) and other viral respiratory infections. However, in some individuals the infection may be severe and deadly. Importantly…

…while an anatomically severe lesion may not identify the patient most likely to benefit from intervention. Conversely, apparently mild lesions may rupture and precipitate myocardial…

…stable, asymptomatic patients without severe ischaemia. Evaluation and Physical Examination The initial evaluation should be structured to establish a working diagnosis of STEMI rapidly, identify…

…condition. It is associated with a two to four fold increase in lifetime cardiovascular disease (CVD) risk and approximately doubles cardiovascular risk on average. Its…

…will experience severe chest pain due to the abrupt reduction of coronary blood flow. Acute coronary syndromes are subdivided into STE ACS and NSTE ACS…

…collection with initially limited symptoms because the pericardium has had time to adapt. Hypotension and muffled heart sounds are important when present but are relatively…

…despite manifest heart failure and severe symptoms. These individuals exhibit pronounced hypertrophy, resulting in a reduction of ventricular volume and subsequently an increase in ejection…

…liver disease. Interpretation of the Agatston Score The score should be interpreted both by its absolute value and in relation to age and sex. A…

…LOF) mutations in SCN5A lead to a reduction in the inward sodium current ($I {Na}$) and are identified in 20% to 30% of probands…

…reactive pupil generally indicates an intact brainstem and adequate cerebral perfusion, whereas fixed, dilated pupils can signal severe global ischemia or even herniation of the…

…imaging methods, namely exercise capacity (and VO2 max , see below). In addition to exercise capacity, stress testing also provides information on electrocardiographic (ECG) reaction, the…

…the eyelids, conjunctiva, cornea and anterior chamber. Note the pupil size, shape and reaction to light. A teardrop shaped or peaked pupil suggests perforation. Look…

…of the correct term exercise stress test . However, the ECG is only one of the parameters that must be evaluated and the final result of…

…identifiable underlying cause. Researchers previously believed that this form of hypertension was a physiological reaction that was necessary to maintain normal hemodynamics, hence the term…

…and stress conditions. MPI uses radiotracers in combination with single photon emission computed tomography (SPECT) or positron emission tomography (PET) to assess myocardial perfusion and…

…the impulse from reaching the atria. Disturbed automaticity and blocked impulses lead to arrhythmias that characterize sinus node dysfunction. The conditions encircled by the term…

…time to diplopia on upward gaze, or the number of seconds the patient can hold the head lifted off the couch. Filming before and during…

…the chair to your eye level. A head lamp or another directable light source, an operating otoscope, a magnifying loupe. A nasal speculum and otoscope…

…to reach the deltoid muscle. With a 25 mm needle the dose ends up subcutaneously, which gives a poorer immune response and more local reaction…

…infarction. Sinus Node Dysfunction (SND) – Sinus node dysfunction implies that the cells of the sinoatrial node are defective and fail to generate electrical impulses. Side…

…food allergies, insect stings, and drug induced reactions. Approximately 90% of anaphylactic cardiac arrests present with pulseless electrical activity (PEA) as the initial rhythm, while…

…distinguishing it from classic allergic reactions. Clinical Presentation and Symptoms ACE Inhibitor Induced Cough ACE inhibitor induced cough occurs in 5% to 30% of patients…

…due to increased Vagus nerve activity caused by digoxin. Increased Vagus activity diminishes the automaticity in the sinoatrial node (which lowers heart rate) and also…

…used. Risk in these circumstances appears to track more closely with apoB. Discordantly high apoB is especially associated with metabolic syndrome and mildly elevated triglycerides…

…the reliability and thus usefulness of the test will be inadequate. The whole purpose of the exercise ECG is to provoke physiological reactions that are…