…recurrent chest pain, pulmonary congestion, a new cardiac murmur, or jugular venous distension in the days after MI should prompt immediate consideration of a mechanical…

…status, the ASA class and the airway beforehand. Procedure Anterior shoulder dislocation The commonest of all dislocations. There is a hollow beneath the acromion, the…

Myocardial ischemia and infarction Definition and Clinical Significance In stent restenosis (ISR) is recurrent narrowing within a previously implanted coronary stent. It represents a form…

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…

…In the setting of acute coronary syndrome (ACS), DAPT is used to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography…

…Recurrent or extensive MI with necrosis and scar formation Diffuse myocardial fibrosis Reversible ischemic dysfunction Chronic hypoperfusion with hibernating myocardium Post ischemic stunning Adverse left…

…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…

…diagnostic ECG, the ECG must be repeated, particularly with ongoing or recurrent pain [1,3,4]. This quick reference gives internationally established doses. Drug availability…

…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…

…a bloodless field one works by feel, and by feel nail spicules are left behind — which is the commonest cause of recurrence. Indications Condition Procedure : …

Procedurer The oesophagus runs directly behind the left atrium. An electrode placed in the oesophagus at the right level therefore records atrial depolarisation with an…

Procedurer Cerumen should be removed when it causes symptoms or obscures the tympanic membrane — not routinely . The wax has a protective function, and the commonest…

…commonest error in paracentesis is not performing it. Every patient admitted with ascites should undergo a diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal…

…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…

…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 STEMI remain at substantial risk of recurrent cardiovascular events. Long term prognosis is influenced particularly by: Resting left ventricular function The amount of residual…

…IV HFrEF. Advanced or refractory heart failure should be considered when there is recurrent clinical deterioration despite careful follow up and appropriate therapy. In this…

…recurrent symptoms, myocardial infarction, or other major adverse cardiovascular events. Complete revascularization is therefore considered an important therapeutic objective, particularly in patients with left ventricular…

…of patients, while clinically evident restenosis, manifested by recurrent angina attributable to the treated segment, occurred in 10–15% during the first year. The dominant…

…in this setting. The duration of therapy requires an individualized balance between: Ischaemic risk, including recurrent myocardial infarction and stent thrombosis. Bleeding risk, particularly major…

…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…

…several clinical manifestations that indicate particularly high risk and should influence the urgency of management: Recurrent or ongoing chest pain despite medical treatment Acute heart…

…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.

…the main cause of left ventricular dysfunction among patients with atrial fibrillation and other supraventricular tachyarrhythmias. Moreover, ventricular tachyarrhythmias (including recurrent episodes of ventricular tachycardia…

…logistics Management Recommendation Level of evidence The pre hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch…

…point toward gastroesophageal reflux. Physical examination should include a speculum examination of the nose to look for excess mucoid or purulent secretions, inflamed and edematous…

…drug overdose, hypothermia, and hyperkalemia. For recurrent symptomatic bradycardia, temporary or permanent pacing may be required. However, transcutaneous pacing in the setting of cardiac arrest…

…despite optimal or maximally tolerated guideline directed therapy, or when recurrent cardiovascular events occur despite such treatment. The trials did not establish a mortality benefit…

…are elevated. Consequently, congestion may occur across the full range of left ventricular ejection fraction and may result from systolic dysfunction, diastolic dysfunction, or both…

…syndrome The period immediately following ACS is associated with particularly high risk of recurrent cardiovascular events. Intensive LDL C lowering should therefore begin early rathe

…recurrent chest pain require repeat blood sampling even when an accelerated algorithm has already been initiated. Evaluation and Physical Examination Patients with suspected ACS should…

…aorta. Type III: originates in the descending aorta, usually just distal to the left subclavian artery. Type IIIa: remains confined to the descending thoracic aorta…

…associated with increased risk, and HDL C should therefore be interpreted as a risk assessment variable rather than a therapeutic objective. LDL C as the…

…be diagnosed reliably by examination alone. Assessment should include evaluation for: Hemodynamic instability or cardiogenic shock. Clinical heart failure. Recurrent ischemia or reinfarction. Ventricular tachyarrhythmia…

…with recurrent cardiovascular events concentrated early after discharge. Consequently, lipid lowering treatment should be initiated as soon as possible after admission rather than deferred until…

…Structural CMD: resting vascular tone is increased, potentially reflecting capillary rarefaction, fibrosis, or left ventricular hypertrophy. Hypertension, diabetes, and elevated NT proBNP are more frequent…

…Possible manifestations include: Persistent or recurrent myocardial ischemia Deterioration in ventricular function Hemodynamic instability Periprocedural myocardial infarction Cardiogenic shock Cardiac arrest The severity may be…

…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…

…Recurrent or persistent symptoms should prompt repeat ECG acquisition and consideration of additional leads. Evaluation and Physical Examination At first medical contact, assessment should occur…

…and its treatment options have been addressed. ANOCA/INOCA should not be labelled refractory before further diagnostic evaluation. The underlying endotype must first be defined…

…used for type 1 myocardial infarction are fulfilled. The temporal relationship to stent implantation should always be specified. Coronary arterial thrombi are predominantly platelet rich…

…assessment should establish whether the presentation represents ACS and whether the patient is clinically unstable. Particular attention is required for evidence of: Ongoing or recurrent…

…syncope and in patients older than 40 years with recurrent syncope of unknown etiology. This test should be performed under continuous ECG and blood pressure…

…the system of care and patient status. The absolute majority of patients should be managed in the ICU. Post resuscitation care requires expertise and resources…

…Unstable coronary artery disease. Stable angina pectoris. Secondary prophylaxis to prevent recurrence of cerebrovascular diseases, such as: Transient ischemic attacks (TIA). Stroke Contraindications Cross reactivity…

…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…

…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…

…access without any recurring costs. Purchasing this membership grants you permanent access to the website and there are no additional costs and no recurring costs…

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

…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…

…Known left atrial thrombus. A markedly enlarged left atrium, marked hyperthyroidism or an untreated underlying cause make recurrence all but certain and argue against elective…

…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…

…stricture or a known diverticulum Relative Recent nasal or pharyngeal surgery Signs that should raise the suspicion of a base of skull fracture: periorbital bruising…

…bottles. Intravenous fluid and a vasopressor prepared. The patient is positioned semi recumbent, at 30–45 degrees — the fluid then collects anteriorly and inferiorly, which…

…Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg ultrasound first. CT pulmonary angiography or lung…

…recurrence is frequent while the precipitating haemodynamic and sympathetic abnormalities persist. Immediate cardioversion is reserved primarily for instability. Evaluation and physical examination Initial assessment should…