…The increasing prevalence of refractory angina reflects population ageing and improved survival among patients with CAD following advances in anti ischaemic treatment and coronary revascularization…

…the heart cannot provide blood flow commensurate with the body’s requirements, or can do so only at the expense of abnormally high filling pressures…

…peritonitis or pancreatic ascites. Therapeutic paracentesis: Tense ascites with abdominal discomfort, early satiety or respiratory compromise. Diuretic refractory or diuretic intolerant ascites, as recurrent treatment…

…step 2 Refractory status: contact anaesthesia, intensive care and neurology; intubate as needed and start anaesthetic treatment with EEG After clinical cessation of the seizure…

…role of sensitized sensory nerve endings and afferent neural pathways in causing chronic refractory cough, akin to chronic neuropathic pain. This syndrome presents with a…

…instability and represents approximately 5–10% of cases. Intermediate high risk PE occurs in haemodynamically stable patients with both RV dysfunction on imaging and elevated…

…antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure, including lower extremity edema, ascites…

…will be blocked at that point. The length of the refractory period (see Basic Cardiac Electrophysiology) varies with heart rate. The length is shortened as…

…during the refractory period. Figure 6. Tachyarrhythmia with ventricular pacing. Failure to capture Definition : pacing does not result in myocardial activation. Two types of failure…

…and early contact with anaesthesia or intensive care Refractory anaphylaxis Persisting airway, respiratory or circulatory compromise despite two adequate intramuscular doses of adrenaline and initial…

…least three weeks of adequate anticoagulation before cardioversion — an INR ≥ 2.0 checked weekly on warfarin, or documented well managed DOAC therapy with no missed…

…light sedation with a daily wake up trial shortens the time on the ventilator. See the article on confusion for the management of delirium in…

…cause — warm the patient instead. Refractory shock in which the bradycardia and reduced contractility of hypothermia are not tolerated. A decision to withhold further life…

…instability or cardiogenic shock recurrent or ongoing chest pain refractory to medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction…

…mechanical circulatory support Refractory advanced disease Consider palliative care Right ventricular failure is characterized by increased right atrial and right ventricular pressures with systemic congestion…

…refractory pain and hypertension despite treatment. A related entity is non A non B dissection , which involves the arch without involvement of the ascending aorta…

…arteries. It frequently coexists with left main coronary artery disease, diabetes mellitus, left ventricular dysfunction, peripheral vascular disease and other manifestations of diffuse atherosclerosis. Percutaneous…

…symptoms are severe, refractory to guideline directed medical therapy, occur at a low level of exertion, or are associated with high event risk. The apparent…

…detection of prescribed drugs in blood or urine. The terms “controlled resistant hypertension,” referring to blood pressure controlled with four or more medications, and “refractory…

…drugs or “refractory hypertension” for blood pressure above target despite five or more drugs. Screening for primary aldosteronism Screening for primary aldosteronism with renin and…

…and young adults with congenital heart disease. Initiation Strategies Because of its ability to significantly prolong the QT interval and cause torsades de pointes or…

…are still refractory. If an atrial impulse reaches the atrioventricular node when there are two pathways, one being refractory and the other capable of conducting…

…al it was reported that early repolarization was associated with 3–5 times as great a risk of idiopathic ventricular fibrillation and sudden cardiac arrest…

…randomized trial, the effects of extracorporeal cardiopulmonary resuscitation (ECPR) was compared to conventional CPR in patients with refractory out of hospital cardiac arrest. Patients aged…

…appearance), as compared with the sinus P wave. The appearance depends on the location of the ectopic focus from which the impulse is discharged. If…

…and more refractory) each time until it is completely refractory and blocks the atrial impulse. This manifests on the ECG with gradual prolongation of the…