Kardiologi Akutsjukvård Lathundar Overview Acute coronary syndrome comprises STEMI, NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable…

…receptor inhibitor. It is central to the prevention of platelet mediated coronary thrombosis after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). Aspirin irreversibly…

…to detect concomitant right ventricular infarction. IIa B Routine blood sampling for serum markers is indicated as soon as possible in the acute phase but…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiology Atherosclerosis and acute coronary syndromes have important inflammatory components. Inflammation contributes to atherothrombosis through activation of…

…to recurrent angina caused by disease in the treated segment. The clinical implications range from asymptomatic angiographic disease to chronic coronary syndrome (CCS), acute coronary…

…Angina occurring after a recent myocardial infarction. UA belongs to the broader spectrum of acute coronary syndromes, which may present with recent changes in symptoms…

…plus a P2Y12 receptor inhibitor. In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other…

…lower limb ischaemia Paraplegia or paraparesis Persistent or recurrent pain Hypertension that remains uncontrolled despite optimal therapy Acute type A dissection has a particularly rapid…

…is the commonest cause of recurrence. Indications Condition Procedure : : Acute paronychia with fluctuance or visible pus Incision and drainage Acute paronychia without pus formation Antibiotics…

Myocardial ischemia and infarction Pharmacology & dosing Definition and pathophysiological basis Secondary prevention after myocardial infarction (MI) encompasses long term interventions intended to reduce recurrent infarction…

…risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart failure presumed to result from ongoing myocardial…

…a spectrum of rhythm disturbances characterized by an inappropriately slow heart rate. Within the context of acute coronary syndromes, particularly ST elevation myocardial infarction (STEMI)…

…grafting (CABG). Definition and Pathophysiology From balloon angioplasty to coronary stents Balloon angioplasty was initially limited by acute vessel closure and later restenosis. Coronary stents…

…in reducing major cardiovascular events. Acute coronary syndromes The period immediately after ACS is particularly vulnerable, with recurrent cardiovascular events concentrated early after discharge. Consequently…

…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…

…myocardial infarction, premature death, recurrent infarction and limb threatening complications. Among patients with established peripheral artery disease, those who stop smoking have approximately twice the…

…of cardiac arrest. Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead to consideration to perform early angiography.

…with stent thrombosis present with ACS. Clinical manifestations therefore commonly include recurrent myocardial ischaemia, recurrent infarction, or acute coronary occlusion. Stent thrombosis may occur within…

…dyslipidaemia, and diabetes mellitus Reduce anxiety and depressive symptoms Facilitate return to work and appropriate recreational or sporting activity Limit recurrent myocardial infarction, cardiovascular morbidity…

…neurohormonal activation. The therapeutic rationale for disease modifying treatment is to reduce mortality, prevent recurrent hospitalization for worsening heart failure, and improve symptoms, functional capacity…

…and prevention of recurrent congestion and hospitalization. Clinical presentation and symptoms Symptoms of congestion Dyspnea is the dominant presenting symptom in acute decompensated heart failure…

…syndrome lipid lowering recommendations. Acute coronary syndrome The period immediately following ACS is associated with particularly high risk of recurrent cardiovascular events. Intensive LDL C…

…ACS cardiopulmonary disease. Patients with persistent or recurrent chest pain require repeat blood sampling even when an accelerated algorithm has already been initiated. Evaluation and…

…combination of an abnormal thrombogenic endocardial surface and blood stasis. During the acute infarction phase, endocardial inflammation and impaired regional contraction create conditions that favour…

…on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG PCI, slow flow or no reflow rates may…

…nondiagnostic tracing therefore does not exclude acute infarction, particularly when the clinical presentation is compatible with acute coronary syndrome. Recurrent or persistent symptoms should prompt…

…anxiety, intense emotion, the sight of blood, unpleasant sights and odors, and orthostatic stress. Situational triggers such as acute hemorrhage, cough, defecation, laugh, micturition, sneeze…

Indications Acute myocardial infarction. Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA…

…Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia in patients with acute coronary syndromes (ACS) and is also a common tachyarrhythmia requiring treatment in…

…thoracic surgery, acute myocardial infarction, pericarditis/myocarditis or pulmonary embolism is often a reversible arrhythmia with low risk of recurrence. Atrial fibrillation in other circumstances…

…lipodermatosclerosis, stasis dermatitis. Prevention of recurrence after a healed venous ulcer. After deep vein thrombosis with post thrombotic syndrome. Differential diagnosis Feature Venous ulcer Arterial…

…cause, 4. prevent recurrence and secondary brain injury. The doses in the treatment ladder below follow the Swedish local sequence given in the original article…

…The emergency evaluation of non traumatic chest discomfort is structured around three principal diagnostic categories: Myocardial ischaemia , particularly acute coronary syndrome (ACS). Other cardiopulmonary causes …

…heart disease (coronary artery disease) as the underlying cause. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, early repolarization…

…Heart failure (HF) symptoms may result from several overlapping processes: Recurrent or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction…

…and from secondary prevention, which addresses patients with established disease to reduce recurrent events and mortality. Risk factor modification is therefore directed at identifying individuals…

…Indications Ongoing epistaxis that has not stopped spontaneously. Recurrent bleeding from a visible vessel on the septum (cautery). Continued bleeding despite compression and cautery (packing…

…atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an amplitude the surface ECG can never achieve, and…

…Before audiometry or the fitting of a hearing aid. Recurrent otitis externa in which the wax retains moisture. Contraindications Absolute contraindications to irrigation: A known…

…early satiety or respiratory compromise. Diuretic refractory or diuretic intolerant ascites, as recurrent treatment. Contraindications There are in practice no absolute contraindications; suspected spontaneous bacterial…

…haemothorax, a symptomatic or large pneumothorax, recurrent malignant effusion (often combined with pleurodesis), and in chest trauma and postoperatively. Emergency needle decompression: a clinical suspicion…

…miss a posterior dislocation. The exceptions are an obvious recurrent dislocation in a patient with known instability and a low energy mechanism, and a neurovascularly…

…risk—such as those with a history of cardiac arrest, recurrent syncope despite beta blocker therapy, or markedly prolonged QT intervals—the implantation of an…

…risk—such as those with a history of cardiac arrest, recurrent syncope despite beta blocker therapy, or markedly prolonged QT intervals—the implantation of an…

…of cholesterol than LDL cholesterol. Clinical implications High Lp(a) is independently associated with first and recurrent atherosclerotic cardiovascular disease events. The strongest observed associations…

…Moreover, ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia) can also cause this cardiomyopathy. The duration of the tachyarrhythmia appears to be a stronger risk…

…performed to assess for glottic inflammation, which can be a manifestation of recurrent reflux to the level of the throat, though it remains a nonspecific…

…when treatment decisions remain uncertain. Secondary prevention Individuals with established clinical ASCVD require LDL C lowering to reduce recurrent major cardiovascular events, including myocardial infarction…

…ischaemia. The absence of obstructive disease therefore does not establish a benign diagnosis. ANOCA/INOCA is associated with recurrent symptoms, impaired quality of life, repeated…

…maximally tolerated statin therapy and ezetimibe. For patients with a recurrent atherothrombotic event while receiving maximally tolerated statin therapy, an LDL C goal below 1…

…Presentation and Symptoms The dominant manifestation is chronic, recurrent angina or an anginal equivalent caused by reversible ischaemia. Symptoms may remain present daily or weekly…

…neurological injuries. 30% die from hemodynamic failure and multiorgan dysfunction. 10% die from recurrent arrhythmias. To monitor and evaluate the victim after ROSC, the following…

…fibrillation (VF). ECG 6 . Delivery of shock, followed by asystole. ECG 7 . Asystole after shock. ECG 8 . Recurrence of supraventricular rhythm. ECG 9 . Supraventricular rhythm.

…tachycardia. ECG 3 . Spontaneous termination of the ventricular tachycardia. ECG 4 . Recurrence and spontaneous termination of ventricular tachycardia. ECG 5 . Polymorphic ventricular tachycardia, self terminating…

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…10 . Recurrence of supraventricular complexes (red arrows). ECG 11 . Relapse of VF and new shock. ECG 12 . Sinus rhythm. ECG 13 . Recurring VT. ECG 14…

…markedly enlarged left atrium, marked hyperthyroidism or an untreated underlying cause make recurrence all but certain and argue against elective cardioversion. Anticoagulation before cardioversion After…

…low risk of recurrence vancomycin 125 mg × 4 PO 10 days Clostridioides difficile, high risk of recurrence fidaxomicin 200 mg × 2 PO 10 days In…

…a pause. Position the patient semi recumbent with the chin slightly towards the chest — an extended neck directs the tube towards the larynx. Procedure 1…