…pathophysiology Chronic kidney disease (CKD) is defined by abnormalities of renal structure or function that persist for more than 3 months and have health implications…

…is substantial in very small and very large people. Acute kidney injury (KDIGO) Stage Creatinine Urine output : : : 1 A rise ≥ 26 µmol/L in 48…

…hours Use whichever criterion gives the higher stage. A patient can thus be stage 3 by urine output despite a less marked rise in creatinine…

…airway algorithm is activated in unexpectedly difficult laryngoscopy, difficult bag mask ventilation or failed intubation — and already at the planning stage when the MACOCHA score…

…Type 3 Focal or tubular stenosis resembling atherosclerosis Often requires intravascular imaging to demonstrate an intramural haematoma or double lumen Type 1 is reported in…

…mediated fibroproliferative response to endothelial injury [2] . The process initiates with endothelial dysfunction, a state provoked by systemic risk factors such as hypertension, hyperglycemia, smoking…

…Do not crush or split the tablet . Warnings and Precautions Bleeding Risk In the phase 3 study (TRITON), key exclusion criteria included increased bleeding risk…

…these stages is supported by a wide range of experimental and clinical studies. The electrical phase and circulatory phase are explained by cellular changes in…

…does not produce the same sustained shift of water [3]. Severity of DKA The classification helps in choosing the level of care. The clinical state…

…area is normally 3.0 to 4.0 cm 2 . Aortic stenosis is a progressive disease that leads to a gradual reduction in the orifice…

…The elimination half life is multiphasic. An initial 50% reduction in plasma concentration occurs 3 to 10 days after discontinuation, representing elimination from well perfused…

…a state of myocardial remission rather than true recovery. Data from the TRED HF trial demonstrated that withdrawal of guideline directed medical therapy (GDMT) in…

…poisoning, stroke, meningitis and a postictal state. 3. Check a repeat plasma sodium if the result is unexpected or does not fit the clinical picture…

…See the renal parameters for the eGFR stages and albuminuria. Inflammation and infection Test Reference Comment : : : CRP < 3 mg/L Rises within 6–8…

…3. Secure large bore access, or rapid central access, but do not delay transfusion or control of the bleeding in order to obtain a central…

…cardiac massage in trauma shock. J Trauma 1989;29:1430 3. Jeffcoach DR, Gallegos JJ, Jesty SA, et al. Use of CPR in hemorrhagic shock…

…microvascular inflammation paradigm" [9] . In this model, systemic comorbidities (obesity, hypertension, diabetes) induce a chronic, systemic proinflammatory state. This circulating inflammation leads to coronary microvascular…

…1] [2] . This exhaustive review provides a comprehensive synthesis of the current state of VT management for the practicing cardiologist. It meticulously details the classification…

…mental state, capillary refill, skin temperature, urine output, respiration, chest findings, MAP and the response to every intervention Within 60 min Contact intensive care in…

…redistributed or been given. In massive bleeding, the decision to transfuse must therefore not be based on the haemoglobin alone [3]. The airway Do not…

…thrombus, and implanted stents. The principal modalities used in the catheterization laboratory are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Unlike coronary angiography, which…

…mmHg ≤15 mmHg ≤2 Wood units The source material also presents a CpcPH threshold of PVR ≥3 Wood units in an overlapping clinical classification table…

…systole. Transesophageal echocardiography and surgical pathology demonstrate that over 90% of thrombi in non valvular AF originate within this specific anatomical cul de sac [19] …

…approximately 0.20 seconds in atrial myocardium and 0.3 seconds in the ventricular myocardium ( Figure 1 ). The phases are also illustrated in Figure 1 …

ECG Exercise stress test Exercise stress testing in patients with previous acute coronary syndromes (myocardial infarction), women, elderly and revascularized individuals Clinicians should be familiar…

…early repolarization in ECG (A) is characterized by upward concavity of the ST segment and positive T waves. In ECG (B) they state something similar…

…with each dose adjustment, typically waiting 2 to 3 days to attain a steady state concentration before further adjusting the dose. Electrophysiology Sotalol prolongs the…

…end stage of pericardial inflammation Constrictive pericarditis is the result of chronic inflammation of the pericardium. In principle, all causes of pericarditis can result in…

…hypertensive emergency, heart failure, and end stage renal disease, may produce elevated troponin concentrations. The probability of MI increases continuously as the absolute hs cTn…

…treatment. Reported risks of myocardial infarction, stroke, end stage renal disease, and death may be two to six fold higher in affected adults. True, apparent…

…while cardiomyocyte swelling, interstitial oedema and tissue inflammation produce extravascular compression. In the most severe form, termed no reflow, structural and functional microvascular impairment persists…

…follow up and appropriate therapy. In this setting, the risk of sudden death and end stage heart failure is high, and assessment for advanced therapies…

…weight gain, peripheral edema, early satiety, abdominal distension and, in some patients, bendopnea. Congestion may also aggravate functional mitral regurgitation, ventricular dilatation, myocardial wall stress…

…coexistence of defined clinical and laboratory components; the diagnostic criteria themselves are not reproduced in the available source material. Waist circumference is particularly important because…

Critical care Myocardial ischemia and infarction Definition and Pathophysiology Cardiogenic shock is a state of inadequate tissue and end organ perfusion caused by cardiac insufficiency…

…GFR in individuals with near normal or mildly reduced kidney function (eGFR 60 mL/min/1.73 m²), potentially leading to misclassification of CKD stages…

…may produce a transient mismatch between myocardial oxygen demand and coronary blood supply, resulting in myocardial hypoperfusion or ischaemia. Ischaemia is commonly precipitated by exertion…

Myocardial ischemia and infarction Definition and pathophysiology In acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD), revascularization may be directed exclusively at the…

…vector typically shifts in the direction of the outer epicardial layers, producing ST elevations over the ischemic zone [15]. In the earliest stages of ischemia…

…encephalopathy, acute heart failure, disseminated intravascular coagulation, and abrupt deterioration in renal function. By contrast, hypertensive urgency describes severe hypertension without clinical evidence of acute…

…contrast, chronic hypoperfusion may result in hibernating myocardium: a persistently dysfunctional but potentially recoverable state. The chronically dysfunctional myocardium in ischemic cardiomyopathy is therefore heterogeneous…

…to apolipoprotein(a). The length of apolipoprotein(a) varies because of genetically determined differences in the number of kringle IV type 2 repeats. Lp(a)…

…of the most comprehensive blogs in practical ECG interpretation. Taught by professor Smith, any reader is guaranteed to quickly acquire state of the art knowledge…

…R wave progression Normal R wave progression implies that the R wave amplitude increases gradually from V1 to V5 and then diminishes again in V6…

…ischemia at later stages, when functional or electrical alterations are evident. Subjective symptoms (i.e. chest pain) appear as the last event in the cascade…

…markers of myocardial wall stress. They are released principally by ventricular cardiomyocytes in response to increased transmural stress and ventricular stretch. Atrial natriuretic peptide is…

…HF), atrial fibrillation and cardiovascular events. In clinical practice, obesity is conventionally defined by a body mass index (BMI) of ≥30 kg/m2. Severe obesity…

…of consciousness, a confusional state, profound weakness, the appearance of an arrhythmia, evidence of peripheral embolism, or an unexplained drop in arterial pressure. Silent or…

…Type 2 myocardial infarction (MI) is defined as an ischaemic myocardial injury occurring in the context of a mismatch between myocardial oxygen supply and demand…

…useful tool for detecting hypertrophy/dilatation but echocardiography and magnetic resonance imaging (cardiac MRI) are superior to the ECG in terms of sensitivity and specificity…

…vegetative state, or brain death. The cause of brain injuries is anoxic cell death, continued dysfunction in cerebral blood flow (autoregulation) after ROSC and cerebral…

…similar state with downregulated metabolism, which is presumed to explain why neuronal cell death begins within 5–6 minutes (Lipton et al). Survival in cardiac…

…Figure 1. Echocardiogram showing takotsubo cardiomyopathy in acute phase (A) and resolution phase (B). Note the apical ballooning of the apical portion fo the left…