…cardiac contractile force (contractility). Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Most agents exhibit both vasopressor…

…proarrhythmia, and severe bradycardia. Patients should be monitored for arrhythmias and QT prolongation with each dose adjustment, typically waiting 2 to 3 days to attain…

…cardiac contractile force (contractility). Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Most agents exhibit both vasopressor…

…severe kidney disease (glomerular filtration rate < 30 mL/min). Patients with mild to moderate heart failure, kidney or liver disease, especially when combined with…

…Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the test is then performed with preparedness for anaphylaxis. An untreated…

…with a peak at approximately 3–5 days and resolution within about 1 week in the usual course. Severe AKI requiring dialysis is uncommon except…

…evidence for their efficacy is limited. Ivabradine alone or combined with a beta blocker should be considered in symptomatic patients. This is a class IIa…

…usually subside with cessation of activity, distinguishing it from angina pectoris. The location of the pain beneath the xiphoid and epigastrium, combined with patient denial…

…ciclosporin, warfarin and grapefruit juice. Gemfibrozil should not be combined with statins because it alters statin absorption, hepatic uptake and disposition. Clinical presentation and symptoms…

…combined effects of hyperglycaemia, hypertension, dyslipidaemia, obesity, smoking and other conventional risk factors, together with diabetes specific vascular and metabolic abnormalities. Diabetes is associated with…

…calcium and magnesium. Note that some patients may exhibit combined electrolyte imbalance. The ECG may be used to estimate the severity of electrolyte imbalances and…

…Coronary angiography remains primarily an anatomical examination, whereas contemporary decision making increasingly combines anatomical imaging with functional assessment. A central practical principle is that the…

…prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or…

…or with minimal exertion, lasting at least 10 minutes unless promptly treated Severe chest pain, pressure, or discomfort An accelerating pattern of angina, with increasing…

…may produce severe venous congestion even when the left sided filling pressure is normal or only slightly elevated. This combination—systemic venous hypertension with relatively…

…when prolonged or severe, myocardial necrosis. It most commonly reflects atherothrombosis: disruption of an atherosclerotic plaque followed by platelet activation and coagulation, with formation of…

…Important presentations include: Hypotension or shock Acute severe aortic regurgitation with heart failure Cardiac tamponade from haemopericardium Myocardial ischaemia from coronary ostial compromise Focal neurological…

…International thresholds vary somewhat, but a PEF of 50 percent or less together with marked symptoms indicates a severe attack, while a PEF below 33…

…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…

Pulmonary valve regurgitation Mild regurgiation Moderate regurgitation Severe regurgitation Pulmonary valve morphology normal normal/abnormal abnormal Density CW Doppler weak, slow deceleration variable dense, steep…

Mitral valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation Vena contracta (cm) < 0,3 0,3 0,69 0,69 EROA (cm²…

Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6 0,6 0,9 0,9 Vena contracta (cm…

…hypertensive encephalopathy and should prompt consideration of stroke. Acute ischemic or intracerebral haemorrhage may coexist with severe hypertension. The decision to lower BP in acute…

Cardiology Myocardial ischemia and infarction Definition and pathophysiology Ischemic cardiomyopathy is severe myocardial dysfunction caused by coronary artery disease (CAD). The clinical syndrome may resemble…

…before treatment. 5. With severe symptoms: give hypertonic saline immediately. Do not wait for a complete work up of the cause or for imaging. 6…

ECG Myocardial ischemia and infarction Acute Myocardial Infarction: Definition & Criteria Acute myocardial infarction is the most severe complication of coronary artery disease. The most common…

…particularly after previous severe episodes, with concurrent physical illness or after prolonged very high intake More than 90 percent of withdrawal seizures occur within 48…

…several non pharmacological measures at the same time, and use drugs only in severe agitation or marked distress. Delirium is an acute neuropsychiatric syndrome and…

…patients undergoing coronary angiography, with reported prevalence ranging from 18% to 52%. They frequently occur in patients with severe coronary artery disease, defined in the…

…and cardiac tamponade. Papillary muscle rupture, producing acute severe mitral regurgitation (MR). These complications result from transmural myocardial necrosis and subsequent tissue disruption. Infarct expansion…

…as severe pre existing valvular disease or excessive beta blocker or calcium channel blocker exposure. The incidence of cardiogenic shock complicating STEMI has fallen with…

…workload. Levosimendan is used in severe acute or chronic heart failure. Consider urgent angiography in patients with unknown etiology for acute severe heart failure. A…

…exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis, decompensated heart failure, or aortic aneurysm. Baseline ECG abnormalities rendering…

…STEMI) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology, definitions, criteria and management of patients with acute STEMI…

…triggers it [1,2]. The single most important practical rule is: Continuous acute dizziness with spontaneous nystagmus: consider HINTS plus, but only if the examiner…

…adrenaline never replace intramuscular adrenaline [1,2]. Delayed administration of adrenaline is associated with more severe and more protracted reactions, biphasic courses and fatal outcome…

…Repeated blood gases, for example during mechanical ventilation or severe metabolic derangement. Major surgery with expected blood loss or large volume shifts. Patients in whom…

…the following: A systolic blood pressure < 90 mmHg caused by the arrhythmia. Ongoing myocardial ischaemia with chest pain and ECG changes. Acute pulmonary oedema…

…suspected granulomatous disease with marrow involvement. Work up of unexplained iron, B12 or folate deficiency when blood tests are insufficient. Contraindications Severe coagulopathy or ongoing…

…departments — follow local protocol. Severe lung disease or a contralateral pneumothorax: avoid the subclavian and jugular routes on the healthy side, since a pneumothorax there…

…from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction is judged possible during…

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

…standing up, tilting the head backwards. A symptom free interval between attacks, with possible residual unsteadiness. No hearing loss, tinnitus or neurological deficits. In horizontal…

…below apply to adults unless otherwise stated, and paediatric doses are given per kilogram with the stated maximum. Always check against the local guideline and…

…severe piperacillin–tazobactam 4 g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline…

…on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract obstruction Caution Tachyarrhythmia…

…a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest with suspected hyperkalaemia, advanced life…

…coronary syndrome, acute left ventricular failure with pulmonary oedema, acute aortic syndrome, acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood…

…marked reflux. A need for high airway pressures, for example severe ARDS, marked obesity or a stiff chest wall. Glottic or subglottic obstruction — the mask…

…injury Peripheral neuropathy of other cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every…

…inflammation Splinting with a cotton wisp Ingrown nail with moderate inflammation Splinting with a strip of suture material or a drain Ingrown nail, severe or…

…the tube is safe. A misplaced tube in the airway produces no reliable symptoms in a patient with an impaired cough reflex, and the first…

…venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when peripheral access fails or is judged futile. Children in an emergency…

…close to delivery (embryopathy and fetal bleeding respectively). Marked liver failure with coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit…

…Turner syndrome 40 mm • Patients with mutations in TGFBR1, TGFBR2 or Loes Dietz syndrome, who have low BSA or severe extra aortic features 45 mm …

…<13 g/dL in men or <12 g/dL in women (3 points) Severe Renal Disease: Estimated glomerular filtration rate (eGFR) <30 mL/min or…

…failure. Caution • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension…

…Caution • Clonidine may induce severe hypotension. • Clonidine is not recommended in most patients with severe cardiovascular disease or in those who are otherwise haemodynamically unstable…

…less Myocardial infarction severe CAPASTAT SULFATE CAPREOMYCIN capreomycin sulfate NA no no INFED IRON DEXTRAN IRON DEXTRAN Mixed ar less patients with pre existing cardiovascular…

…depletion and high plasma renin activity increase the effect of enalaprilat, and may cause severe hypotension. Time to onset of action 15 to 30 minutes…