…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

…QRS duration largely unchanged. Continuous ECG monitoring is mandated during hospital initiation to detect excessive QT prolongation, proarrhythmia, and severe bradycardia. Patients should be monitored…

…and additionally severe hypertension (caution if patient on nonselective beta blockers). Dobutamine Cardiogenic shock Bradycardia (second line therapy) Stress testing (due to induced increase in…

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

…is performed later. Contraindications Known hypersensitivity to tetracosactide or ACTH. Marked atopic disease, particularly severe asthma and a history of anaphylaxis — a relative contraindication; the…

…necrosis arising from the combined effects of contrast exposure and other ischaemic or nephrotoxic stresses. The kidney is particularly vulnerable to toxic injury because of…

…beats/min. The reduction in the combined outcome of cardiovascular death or heart failure hospitalisation was related to the magnitude of heart rate reduction. Ivabradine…

…the pain beneath the xiphoid and epigastrium, combined with patient denial, often leads to a mistaken impression of indigestion. STEMI pain can simulate pain from…

…severe form of muscle injury. The biological basis of many reported muscle symptoms remains uncertain. Randomized trials have shown muscle adverse event rates similar to…

…condition. It is associated with a two to four fold increase in lifetime cardiovascular disease (CVD) risk and approximately doubles cardiovascular risk on average. Its…

…lithium, thiazide diuretics, D vitamin and calcium overdose. ECG changes due to hypercalcemia Common ECG changes Shortened QT interval. Lengthened QRS duration. Bradycardia may occur…

…lesion that appears moderate may be functionally important, while an anatomically severe lesion may not identify the patient most likely to benefit from intervention. Conversely…

…used primarily to identify inducible myocardial ischaemia and to estimate prognosis in patients with suspected or established coronary artery disease (CAD). It combines echocardiographic assessment…

…the likelihood of ACS include: Sudden symptoms at rest or with minimal exertion, lasting at least 10 minutes unless promptly treated Severe chest pain, pressure…

…while infarction confined predominantly to the right ventricle is rare. The clinical spectrum extends from limited right ventricular dysfunction to severe right sided failure and…

…high risk plaques may exist throughout the coronary tree, while inflammation and thrombotic susceptibility are often systemic rather than confined to a single lesion. Consequently…

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

…severe attacks, and a systemic steroid given early [2,3]. Grading Grade the severity by the most serious finding. A patient does not have to…

…on the bowel must be taken into account). Known allergy to the preparation — rare; itching and urticaria are usually due to histamine release, not allergy…

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…

…no isolated BP value is sufficient Severe elevation Acute HMOD Present Absent clinically Symptoms Often present and related to the affected organ May be absent…

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…

…Does the patient have severe neurological symptoms that may be due to the hyponatraemia? 2. Is the hyponatraemia acute or chronic? Severe symptoms require immediate…

…would previously have been classified as unstable angina are now classified as NSTEMI due to the sensitive troponin assays). Interested readers are referred to E…

…hypoactivity, hallucinations and marked autonomic hyperactivity Up to 5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness…

…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…

…producing an acute left to right shunt. Ventricular free wall rupture, producing haemopericardium and cardiac tamponade. Papillary muscle rupture, producing acute severe mitral regurgitation (MR…

…interventricular septum, or mitral valve apparatus. These lesions can cause acute severe regurgitation, a left to right shunt, tamponade, or sudden loss of effective cardiac…

…patients with unknown etiology for acute severe heart failure. A recent echocardiographic examination should be available or performed urgently to evaluate ventricular and valvular function…

…stress tests are indicated in the following scenarios: Inability to exercise due to physical limitations. Contraindications to exercise, such as unstable angina, severe aortic stenosis…

…tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Death due to ventricular dysfunction, or mechanical complications…

…but only if the examiner is trained. Brief attacks triggered by the position of the head relative to gravity: perform Dix Hallpike and, if needed…

…oedema, together with at least one of the following: airway compromise respiratory compromise circulatory compromise severe gastrointestinal symptoms, particularly after exposure to a drug, insect…

…are routinely missed. The third thing to know by heart is that an arterial line must never be confused with a venous access. Indications Continuous…

…2 An oral anticoagulant is recommended A DOAC is preferred to warfarin except in a mechanical valve prosthesis and in moderate to severe mitral stenosis…

…involvement. Work up of unexplained iron, B12 or folate deficiency when blood tests are insufficient. Contraindications Severe coagulopathy or ongoing anticoagulation — correct this first . Thrombocytopenia…

…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…

…donor care The time from withdrawal of treatment to circulatory arrest Indications An intensive care patient with severe brain injury in whom total brain infarction…

…preserved, but may be impaired in severe DKA Cognitive impairment is more common, particularly at very high osmolality Blood ketones are preferable to urine ketones…

…manoeuvre. Indications Brief attacks of vertigo, seconds to a minute or so, that are provoked by a change of position — turning over in bed, lying…

…poorly to adrenaline. If there is no response, give glucagon 1–5 mg IV followed by an infusion. Arrhythmias Drug Adult Child Comment : : : : Adenosine 6…

…Duration : : : : Pneumonia, non severe (DS CRB65 0–1) phenoxymethylpenicillin 1 g × 3 PO 5–7 days or benzylpenicillin 3 g × 3 IV Pneumonia, in chronic…

…the test only on a clear indication and with full preparedness Moderate to severe aortic stenosis without symptoms Individual assessment Hypertrophic cardiomyopathy with outflow tract…

…nephrology early in anuria, in a dialysis patient, in severe acute kidney injury, in treatment failure or in ongoing massive potassium release. In cardiac arrest…

Kardiologi Akutsjukvård Intensivvård Lathundar Clinical use This overview is a quick reference to the intravenous antihypertensive drugs used in a hypertensive emergency. It summarises the…

…kills because the tube would not pass, but because the team keeps trying to intubate instead of changing the plan. The aim is always oxygenation…

…cause As above Severe pain Titrate the pressure up gradually Rheumatoid arthritis with vasculitis Individual assessment Repeat the ABI every three to six months during…

…a strip of suture material or a drain Ingrown nail, severe or recurrent Partial nail avulsion, often with chemical matrix ablation A nail spicule that…

…surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery, according to local practice. Enteral nutrition…

…Infection or burns over the puncture site. Osteogenesis imperfecta and severe osteoporosis (relative). An inability to identify the landmarks. Choice of vein and cannula size…

…coagulopathy. Severe uncontrolled hypertension. Recent intracranial haemorrhage without a fresh assessment of benefit and risk. An inability to attend for sampling and follow up — relative…

…who have low BSA or severe extra aortic features 45 mm • Patients who are undergoing aortic valve surgery • Patients with Marfan syndrome who have additional…

…Developed from the ATRIA study cohort, this score aids clinicians in estimating the risk of bleeding complications due to anticoagulants. Components of the ATRIA Score…

…with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. Clevidipine doses and administration in hypertension.

…administration in these patients should be carefully balanced against the potential risks resulting from hypotension. • Withdrawal of clonidine may lead to rebound hypertension. Withdraw slowly…

…A PENICILLIN G BENZATHINE PENICILLIN G BENZATHINE Arrhythmia ar less Cardiac arrest severe INVEGA HAFYERA PALIPERIDONE PALMITATE paliperidone palmitate Arrhythmia wp most QT Prolongation moderate…

Enalaprilat Enalaprilat is rarely used in hypertensive crisis due to its slow onset, prolonged duration of effect, and significant individual variations in its effect. Drug…