…more patients survive with severe, diffuse CAD that is no longer amenable to additional mechanical revascularization. Despite treatment with antianginal drugs and PCI or CABG…

…severe symptoms New confusion Severe headache Persistent nausea Moderately reduced consciousness Marked gait instability The specificity of the symptoms is limited. In a patient with…

…shoulders, back, or one or both arms. Indigestion or heartburn, particularly when associated with nausea or vomiting. Persistent shortness of breath. Weakness, dizziness, light headedness…

…than persistent obstruction of the treated epicardial segment. The phenomenon occurs in approximately 2%–3% of PCI procedures overall. It is particularly associated with intervention…

…or equivalent presentations together with persistent ST segment elevation, or an equivalent electrocardiographic pattern, suggesting acute coronary occlusion. Most patients with this working diagnosis subsequently…

…with symptomatic HFrEF. The guideline defined population includes: LVEF ≤35%; sinus rhythm; resting heart rate ≥70 beats/min; persistent symptoms despite evidence based therapy with…

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

…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…

…respond to medication Visual disturbance Persistent severe epigastric pain Pulmonary oedema Thrombocytopenia, with platelets <100 × 10⁹/L Renal insufficiency, with creatinine 1.1 mg/dL…

…Patients with hypotension, marked low output, or persistent severe symptoms require close monitoring and consideration of invasive haemodynamic assessment when precise measurements are needed to…

…abscess, hidradenitis abscess and paronychia with a collection of pus. Persistent painful induration after a few days of antibiotics — suggests that an abscess has formed…

…an alternative diagnosis Silent or nearly silent chest Very severe airflow obstruction pH below 7.35 with raised pCO₂ Acute or acute on chronic hypercapnic…

…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…

…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…

…artery was associated with lower five year survival than a more distal lesion. Revascularisation improves myocardial blood flow and angina related health status but does…

…defining electrocardiographic feature is the absence of persistent ST segment elevation. This does not imply low risk: patients with NSTE ACS may have substantial myocardial…

…ACS is broad. Patients may be asymptomatic at presentation, have persistent chest discomfort, or present with cardiac arrest, electrical or haemodynamic instability, or cardiogenic shock…

…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…

…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…

…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…

…myocardium: a persistently dysfunctional but potentially recoverable state. The chronically dysfunctional myocardium in ischemic cardiomyopathy is therefore heterogeneous. Irreversibly scarred regions may alternate with viable…

…coronary arterial obstruction that has persisted for at least 30 days. CTOs are common among patients undergoing coronary angiography, with reported prevalence ranging from 18…

…more severe clinical disease. HeFH affects approximately 1 in 250–300 people and is the most common inherited metabolic disorder associated with premature cardiovascular disease…

…sometimes longer Persisting withdrawal, particularly after previous severe episodes, with concurrent physical illness or after prolonged very high intake More than 90 percent of withdrawal…

…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…

…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…

…severe frailty, or very old or frail patients who may not tolerate rapid blood pressure reduction. Initial Combination Therapy General Strategy For most adults with…

…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…

…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…

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…

…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…

…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…

…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…

…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…

…Before puncture: check the coagulation status, give information and obtain consent if the patient is awake, and scan the vessel with ultrasound before you drape …

…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…

…in: Diabetes with neuropathy or peripheral arterial disease — a risk of osteomyelitis and poor healing. Check the ankle brachial index and the foot status before…

…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…

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

…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…

…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…