…Factors associated with stent thrombosis Clinical Acute myocardial infarction, diabetes mellitus, renal failure, heart failure, hypercoagulability, prior brachytherapy Antiplatelet therapy Nonadherence or discontinuation of clopidogrel…

…of renal glucose reabsorption. The remaining glucose is reabsorbed by SGLT1 in the S3 segment. SGLT2 also mediates proximal tubular sodium reabsorption, with chloride following…

Cardiology Key points Levosimendan alleviates heart failure symptoms, increases cardiac output, and lowers pulmonary artery pressure without increasing myocardial oxygen consumption. The inotropic effect of…

…in individuals without comparable renal impairment. The cardiovascular burden of CKD extends beyond CAD to peripheral arterial disease, cerebrovascular disease, valvular heart disease, heart failure…

…beta blocker Digoxin In heart failure or hypotension, or as an add on Slow onset. Dose reduction in renal failure and in old age Amiodarone…

…is often warranted, particularly in an acute rise, renal failure, symptoms or continued potassium administration Severe At least 6.5 mmol/L, or hyperkalaemic ECG…

…A continuous infusion or repeated doses, according to the local protocol Renal failure The insulin requirement falls . Reduce the dose and measure more frequently Acute…

…result in elevated cTnT levels. Although both troponin T and I may be chronically elevated in patients with renal failure, this is more pronounced for…

…heart failure, older age, vascular disease and renal dysfunction. The commonly used CHA2DS2 VASc score incorporates the following variables: Risk factor Points Congestive heart failure…

…alone is an entity in itself and may arise from non ischaemic cardiac conditions (such as myocarditis) or non cardiac conditions (such as renal failure)…

…scleroderma, and rheumatic fever. Aortic dissection rupturing into the pericardium. Idiopathic pericardial effusion. Renal failure, hypothyroidism, and hypercholesterolemia. Dressler syndrome. Iatrogenic damage to the pericardium…

…Active gastric or duodenal ulcers. Liver cirrhosis. Severe heart failure. Doses 100 mg/day during the third trimester of pregnancy. Dosage Acute myocardial infarction: Initial…

…onset atrial fibrillation to sinus rhythm. Vernakalant is used in the following settings: Non surgery patients: atrial fibrillation ≤7 days duration. Post cardiac surgery: atrial…

…thrombolysis regimens, renal function thresholds and the division of work between the ambulance service, the emergency department and the PCI laboratory may differ between Swedish…

…Common manifestations are hypertensive encephalopathy, intracerebral haemorrhage, acute coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis…

…amputees, patients with hepatic cirrhosis — creatinine based eGFR substantially overestimates renal function. Staging of chronic kidney disease Stage eGFR Description : : : G1 ≥ 90 Normal or high…

…regarded as a series of completely discrete diseases. Heart failure extends across the full range of LVEF, and echocardiographic measurement is subject to meaningful variability…

…stage renal failure Consider renal replacement therapy Hypoperfusion with persistent organ injury Consider mechanical circulatory support Refractory advanced disease Consider palliative care Right ventricular failure…

…lactic acidosis). Fatal outcomes are rare. Renal failure increases risk of cyanide toxicity. Cyanide toxicity requires doses 2 μg/kg/minute. Use the lowest…

…Children, pregnant women and patients with advanced renal failure, marked heart failure or circulatory shock require a specific protocol and early specialist involvement. DKA and…

…is incomplete: reduce the calculated equianalgesic dose by 25–50 per cent and titrate. At a high dose, in old age or in renal failure…

…diagnostic paracentesis , because spontaneous bacterial peritonitis often lacks abdominal pain and peritonism and instead presents as encephalopathy, renal failure or simply deterioration. The procedure itself…

…Pathophysiology The precise mechanism of contrast induced AKI is incompletely defined. In many cases, the renal injury probably represents acute tubular necrosis arising from the…

…Contraindications • Contraindicated in pregnancy, severe renal artery stenosis, severe hyperkalemia. • Avoid in acute heart failure and acute myocardial infarction. Enalaprilat doses and administration in hypertension…

…Definition and Pathophysiology Angiotensin converting enzyme inhibitors (ACE inhibitors) constitute a cornerstone in the management of cardiovascular disease, heart failure, and chronic kidney disease (CKD)…

…and papilloedema. Associated complications may include encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe…

…and excess cardiovascular risk. The European definition requires failure to reduce office systolic and diastolic blood pressure to below 140 mmHg and 90 mmHg, respectively…

…field. Cardiac function is also dependent on circulatory, pulmonary, renal and neurohormonal factors. These factors, which influence cardiac function primarily by affecting ventricular function, include…

…but organ damage or high risk. Treatment resistant hypertension. Suspected nocturnal hypertension or absent nocturnal dipping (diabetes, renal failure, sleep apnoea). Suspected hypotension: dizziness, syncope…

…or with continued glucose administration adapted to the cause. 8. Identify drugs, renal failure, alcohol, a missed meal, physical activity and any other precipitating factor…

…and in patients with diabetes or renal failure the index may be falsely normal because of medial sclerosis — in that case add toe pressure measurement…

…event, where DOACs have proved inferior. Atrial fibrillation with marked renal failure or on dialysis, where DOACs lack documentation or have only weak evidence. Venous…

…Catapress TTS 3 (0.3 mg/24hrs) Dosage in renal failure and renal replacement therapy: Dose as in normal renal function Adverse effects Excessive sedation…

…and requires emergency operation or endovascular repair. AAA may also be associated with mesenteric ischemia or acute renal failure, either through atherosclerotic or atherothrombotic disease…

…after severe or prolonged ischaemia may be accompanied by rhabdomyolysis, with potential renal failure and increased mortality. Clinical presentation and symptoms Symptoms commonly develop rapidly…

…causes are immobilization, sarcoidosis, thyrotoxicosis, familial hypocalciuric hypercalcemia, Addison's disease, renal failure, tamoxifen, lithium, thiazide diuretics, D vitamin and calcium overdose. ECG changes due…

…together with the clinical picture, medication, fluid balance, renal function, electrolytes and supplemental oxygen [1]. Distinguish between: Acidaemia and alkalaemia , which describe the current pH…

…is made without reduction for incomplete cross tolerance. Indications Acute severe nociceptive pain where paracetamol and a COX inhibitor are not enough: fracture, renal colic…

…vasodilation in coronary, renal, cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia…

…glycoside first described by William Withering in 1775, is the oldest pharmacologic agent in the heart failure armamentarium. Its use has declined over time due…

…marked anaemia, hypertensive emergency, heart failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute…

…may provide information comparable to BNP and NT proBNP in heart failure (HF). The biologically active natriuretic peptides promote vasodilation, renal sodium and water excretion…

…required in severe hepatic or renal impairment, and clinically relevant interactions occur with CYP3A4 inhibitors and inducers. Clinical indications Heart failure with reduced ejection fraction…

…impaired coronary circulation, vascular calcification and myocardial fibrosis further accelerate cardiovascular and renal injury. Adipokine imbalance contributes to insulin resistance, β cell failure, endothelial dysfunction…

…vasodilation in coronary, renal, cerebral and mesenteric vessels. Few Dopamine medium dose Cardiogenic shock Vasodilatory shock Heart failure (HF), acute Heart failure (HF), chronic Bradycardia…

…ionised calcium further; risk of tetany and seizures. Anuria or established renal failure. Without urine production there is no urine to alkalinise, and the sodium…

…adverse events is increased by: advanced age; diabetes mellitus; chronic kidney disease or renal failure; congestive heart failure; prior stroke; emergency coronary angiography or PCI…

…diabetes, hypertension, renal failure, ischemic heart disease (coronary heart disease) are among the common causes. The mechanisms leading to deterioration in ejection fraction vary for…

…L (< 300 in acute dyspnoea) A normal value effectively excludes heart failure D dimer < 0.5 mg/L FEU Age adjusted threshold: age…

…receptors and induces vasodilatation in the coronary, renal, cerebral and mesenteric vessels. Few Dopamine — intermediate dose Cardiogenic shock. Vasodilatory shock. Heart failure, acute or chronic…

…a threatened airway, a marked risk of aspiration, or failure that is not rapidly reversed by an antidote B Respiratory rate, saturation, chest movement and…

…the last dose, the renal function and the severity of the bleeding 7 Manage antiplatelet drugs according to their indication. Do not routinely stop aspirin…

…syncope, renal deterioration, functional decline, and cognitive impairment. Heart failure Heart failure represents a major intersection between cardiovascular disease and geriatric medicine. Its incidence and…

…includes: Symptom burden and functional limitation Evidence of heart failure Haemodynamic stability Diabetes status Renal dysfunction and other important comorbidities Frailty Liver cirrhosis Cognitive function…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Spontaneous coronary artery dissection (SCAD) is an acute coronary disorder caused by separation within the coronary arterial…

…multiple QT prolonging medications, and drug accumulation secondary to renal or hepatic impairment or the inhibition of cytochrome P450 metabolism [1]. Nonmodifiable risk factors encompass…

…Concurrently, the atrial myocardium undergoes structural remodeling driven by aging, hypertension, heart failure, and the arrhythmia itself. This remodeling manifests as interstitial fibrosis, atrial dilation…

…since it may affect the choice of device therapy and also suggest whether other interventions (e.g. heart failure management, evaluation for coronary artery disease…

…brachial index (TBI). The digital arteries rarely calcify, which makes toe pressure the method of choice in diabetes and renal failure. A normal TBI is ≥

…pulmonary oedema, aortic dissection, acute renal failure, pre eclampsia) — intravenous treatment with a controlled reduction, as a rule no more than 25% during the first…