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

…10 people must be treated to save 1. Thus, the greatest opportunities exist in the first few minutes, which is within the reach of bystanders…

…accounts for a minority of cases Hypoactive Lethargy, slow responses, reduced speech, immobility, poor food intake, reduced eye contact Common and particularly easy to miss…

…Journal of the American Medical Association (JAMA) published an article titled Hearts too good to die (JAMA, 1961). A total of 500 cases of fatal…

…target of less than 10 minutes from STEMI diagnosis to the fibrinolytic bolus. In suitable systems, pre hospital fibrinolysis is reasonable when it provides a…

…have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction), a rehearsal is provided below. Management of acute STEMI is discussed in detail…

…A significant majority of these patients exhibit satisfactory neurological function upon discharge. Figure 1 . Expected cardiopulmonary function and alertness in decreasing body temperature according to…

…ventilation can extend the duration of the shockable rhythm by several minutes, allowing for EMS or bystanders to connect a defibrillator or AED and defibrillate…

…brain infarction is not expected to occur within a reasonable time, and in whom death is judged likely within 180 minutes of treatment being withdrawn …

…consider within 15 hours of the last dose. Andexanet alfa where available Low molecular weight heparin Protamine has only a partial effect Unfractionated heparin Protamine…

…10 minutes of the diagnosis, if symptom duration is under 12 hours and there is no contraindication After successful fibrinolysis Transfer directly to a PCI…

…is sufficient to alert the emergency service and commence CPR. Agonal breathing before apnea A cardiac arrest occurs within a minute after cessation of breathing…

…Notably, 31.2% of patients discharged with intact neurological function were observed to lack a pupillary reflex upon their initial presentation. An absent pupillary reflex…

…similar to those used in echocardiography. The 17 segment model of the left ventricle serves as a standardized framework for identifying and localizing areas of…

…serves as a valuable diagnostic tool and educational model, promoting earlier identification and treatment of high risk ACS patients. Future randomized trials are needed to…

…through a catheter advanced from a peripheral artery to the aortic root and coronary ostia. It remains the reference standard for defining the extent of…

…aspects of rhythm will also be covered in this discussion (refer to Normal Rhythm and Arrhythmias). Also note that this chapter is accompanied by a…

…are attributed to the pericardium: The pericardium serves as a barrier to infections. The pericardium reduces friction between the ventricles and surrounding structures of the…

Echocardiography The standard transthoracic echocardiographic examination This chapter presents a sequential series of images that comprise a complete standard echocardiographic examination. The image views are…

…milieu composed of extracellular cholesterol crystals, apoptotic and necrotic macrophage debris, and abundant tissue factor [9] . The transition from a stable plaque to a high…

…by dividing body weight in kilograms by the square of height in meters. BMI is relevant for medical prognostication as it serves as a quick…

…and clinical presentation of VT, with a deep dive into the underlying etiologies ranging from benign idiopathic variants to complex scar related and genetic substrates…

…as a reason to withhold anticoagulation therapy. Instead, it serves as a tool to identify patients who may require more careful monitoring and management of…

…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…

…the plateau phase of the action potential. This action potential prolongation exhibits reverse use dependence, meaning the repolarization time is extended to a greater degree…

…using a needle due to reduced risk of injury. Thoracostomy should be performed promptly following needle decompression. Thoracostomy with drainage typically serves as a stabilizing…

…Only a minority of patients presenting with acute chest pain ultimately have ACS; reported rates are generally 5–10%, although some series report 10–20…

…of angiographic series and up to 5–75% of CT series; other angiographic descriptions report rates of approximately 5–10%, while fewer than 5% of…

…unknown or if disease progression is suspected. Reversible causes may account for up to 50% of SCA cases, though determining the exact underlying cause and…

…measure of luminal obstruction. Calcified plaque is generally less likely to rupture than non calcified, lipid rich plaque. CAC nevertheless serves as a marker of…

…Patients with MINOCA tend to be younger and more often female than patients with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be…

…per hour for a total of 4 6 mEq/L in 24 hours may be targeted. Chronic Hyponatremia ( 48 hours duration): Due to cellular adaptations…

…presence of an accessory pathway). This is associated with a delta wave. For further details on the PR interval and the PR segment, refer to…

…some series, is reported in up to approximately one third of patients. Its absence therefore does not exclude the diagnosis. Findings suggesting pericardial effusion A…