Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Refractory angina is a chronic syndrome of persistent ischaemic symptoms despite the exhaustion of conventional therapeutic options…

…signs of raised intracranial pressure or impending herniation Moderately severe symptoms New confusion Severe headache Persistent nausea Moderately reduced consciousness Marked gait instability The specificity…

…electrocardiographic abnormalities and with or without an acute rise in cardiac troponin. The spectrum ranges from symptom free presentation to persistent chest discomfort, cardiac arrest…

…limiting epicardial coronary stenosis. It is therefore a disorder of coronary microvascular perfusion rather than persistent obstruction of the treated epicardial segment. The phenomenon occurs…

…elevation myocardial infarction (STEMI) is an acute coronary syndrome characterized clinically by acute myocardial ischaemic symptoms or equivalent presentations together with persistent ST segment elevation…

…undergoes extensive first pass hepatic metabolism through CYP3A4. Dose adjustment is required in severe hepatic or renal impairment, and clinically relevant interactions occur with CYP3A4…

…STEMI) is an acute myocardial infarction associated with a working diagnosis of persistent ST segment elevation or an accepted equivalent in the setting of ischaemic…

…weakness to paralysis and is a particularly important marker of threatened limb viability. Paralysis generally indicates severe and persistent ischaemia. The limb may be cold…

…Severe features include: Severe hypertension, defined as blood pressure ≥160/110 mmHg Headache that does not respond to medication Visual disturbance Persistent severe epigastric pain…

…low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to guide therapy. Diagnostics Electrocardiography…

…drainage is the treatment; antibiotics are normally neither necessary nor sufficient in an uncomplicated cutaneous abscess in an otherwise healthy person. There are two ways…

…and the severity of the illness. 7. Start NIV without undue delay in persistent hypercapnic respiratory acidosis, if invasive ventilation is not immediately required. 8…

…arrhythmia, among others. Acute severe balance disturbance without nystagmus: HINTS does not apply. Assess gait and truncal stability and investigate for a central cause. Acute…

…of ischaemia represents acute myocardial injury rather than MI. Persistent elevation without a significant dynamic change is consistent with chronic myocardial injury. Non ischaemic conditions…

…50%. Severe proximal disease of both the proximal left anterior descending and proximal left circumflex arteries may constitute a functional equivalent of left main disease…

…patients whose initial findings are less definitive. The defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk…

…patterns: Angina at rest, usually prolonged for more than 20 minutes. New onset severe angina. Previously established angina that has become more frequent, more prolonged…

…a genetic mutation in the RYR1 receptor, resulting in persistent muscle contraction upon administration of halogenated anesthetic agents. As an idiosyncratic response to substances such…

…wall disruption, rupture and compromise of branch vessels. Type A disease may cause cardiac tamponade, severe acute aortic regurgitation, coronary malperfusion, myocardial ischaemia, heart failure…

…Severe coronary artery or structural heart disease High risk features on examination include: Unexplained systolic blood pressure < 90 mmHg Suggestion of gastrointestinal hemorrhage Persistent…

…with severe symptoms, provided that first line therapies have failed and the patient does not have structural heart disease or reduced left ventricular function. Persistent…

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…

…Definition and pathophysiology A chronic total occlusion (CTO) is a complete or nearly complete coronary arterial obstruction that has persisted for at least 30 days…

…Definition and pathophysiology Familial hypercholesterolaemia (FH) is an inherited disorder characterized by persistently elevated plasma low density lipoprotein cholesterol (LDL C) from early life and…

…autonomic hyperactivity Up to 5 to 7 days, sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness or after prolonged very…

…Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce myocardial ischaemia and, when prolonged or severe, myocardial necrosis…

…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…

…years, those with symptomatic orthostatic hypotension, moderate to severe frailty, or very old or frail patients who may not tolerate rapid blood pressure reduction. Initial…

…of breathing, level of consciousness and PEF improve at the same time. Acute severe asthma is characterised by bronchospasm, mucosal oedema and mucus plugging. Expiratory…

…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…

Cardiology Emergency medicine Definition and Pathophysiology A hypertensive emergency is severe blood pressure elevation accompanied by acute hypertension mediated target organ damage (HMOD). The European…

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…

…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…

…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…

… approximately 90% deteriorate during hospitalization. Patients who develop shock often have severe multivessel coronary disease and progressive, “piece meal” necrosis extending beyond the original infarct…

…and valvular function. Levosimendan drug is generally well tolerated. Severe adverse effects are less common. Levosimendan may be administered simultaneously with milrinone. The drugs can…

…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…

…Diagnosis (ECG), Criteria & Management Acute ST Elevation Myocardial Infarction (STEMI) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology…

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

…contraindicated, for example in asthma Contraindicated in impaired left ventricular function and together with an intravenous beta blocker Digoxin In heart failure or hypotension, or…

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

…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…

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

…a longer symptomatic course Consciousness Usually preserved, but may be impaired in severe DKA Cognitive impairment is more common, particularly at very high osmolality Blood…

…injury, recent cervical spine surgery, atlantoaxial instability, severe rheumatoid arthritis of the neck. Symptomatic carotid stenosis, recent stroke or TIA in the vertebrobasilar territory. Retinal…

…a fuller account of two of the commonest acute drug problems, see Warfarin therapy and Opioid therapy in severe pain. Cardiac arrest Drug Adult Child : : …

…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…

…48 hours, or ongoing unstable angina. Uncontrolled symptomatic arrhythmia. Symptomatic severe aortic stenosis. Decompensated heart failure. Acute pulmonary embolism or deep vein thrombosis. Acute myocarditis…

…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…

…acute kidney injury, microangiopathic haemolysis, and severe pre eclampsia or eclampsia. The blood pressure is often at least 180/120 mmHg, but no absolute threshold…

…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…

…Dry, necrotic, pale Variable, often deep Pain Moderate, relieved by elevation Severe, worse on elevation, better when dependent Often painless (neuropathy) Surrounding skin Hyperpigmentation, oedema…

…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…

…retention — the commonest indication on a surgical ward. Decompression in severe vomiting where the stomach does not empty. Intraoperatively and postoperatively after major abdominal surgery…

…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…

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

…care). Rheumatic mitral stenosis with atrial fibrillation. In uncomplicated atrial fibrillation and in ordinary venous thromboembolism, a DOAC is the first choice in Sweden. Warfarin…