…of care. The clinical state, the circulation, comorbidity and the precipitating cause carry at least as much weight as the laboratory values [1]. Grade Blood…

Cardiology Clinical chemistry & laboratory medicine Definition and structure Lipoprotein(a), abbreviated Lp(a), is an LDL like circulating lipoprotein particle. It contains one molecule of…

…Natriuretic peptides supplement, rather than replace, clinical assessment. The result should be integrated with the history, examination, ECG, echocardiography, and other relevant investigations. Clinical Presentation…

…not exclude dangerous hyperkalaemia. Record a 12 lead ECG and start cardiac monitoring at a plasma potassium above 6.0 mmol/L, and at lower…

…10 minutes) at first medical contact. I B ECG monitoring should start immediately and a defibrillator must be ready. I B Consider connecting leads V7…

…coronary care unit (CCU), or catheterization laboratory. A 12 lead ECG must be obtained immediately after ROSC in order to identify cases with ST segment…

…A capillary glucose is sufficient to start emergency treatment, but abnormal or unexpected values should be confirmed with a laboratory analysed plasma glucose when the…

…t2, the risk of permanent neuronal injury increases. Treatment must therefore start at 5 minutes and be escalated without unnecessary pauses [1]. The aims are…

…table below shows a systematic history taking in patients presenting with chest pain (chest discomfort) or other symptoms suggestive of the five conditions listed above…

…rather than prominent breathlessness. Hemodynamic phenotypes Initial assessment should distinguish congestion from hypoperfusion. This distinction provides a practical framework for selecting treatment: Clinical state Principal…

…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…

…the case of left bundle branch block should lead the clinician to activate the catheterization laboratory (discussed in Left bundle branch block and ischemia/infarction)…

Procedurer Transcutaneous pacing takes seconds to start and can keep a patient alive until a transvenous lead is in place — but only if it is…

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…

…aims in themselves. Almost all of them have proved to work better as ranges to stay within than as figures to strive for. Ventilation In…

…body's capacity for heat elimination. Hyperthermia can induce an inflammatory state similar to the Systemic Inflammatory Response Syndrome (SIRS). Body temperatures surpassing 40°C (104°F…

…than 120 msec or longer than 220 msec. The PR segment is the flat line between the end of the P wave and the start…

…if the exacerbation is more than mild. 6. Assess the indication for antibiotics on the basis of sputum purulence, the other cardinal symptoms and the…

…3. Give oxygen in hypoxaemia. 4. Start an inhaled short acting β2 agonist immediately. 5. Add ipratropium in a severe or life threatening attack. 6…

…associated with falls, aspiration, pressure sores, loss of function, longer length of stay, institutional care, readmission, cognitive decline and increased mortality [3,4]. Do this…

…2. Assess the neurological symptoms and at the same time exclude other acute causes, for example hypoglycaemia, poisoning, stroke, meningitis and a postictal state. 3…

…immediately: 1. Call for help using the words massive haemorrhage , and state the patient's location and identity, the presumed cause of bleeding, and how…

…the first dose of antibiotic, the cultures, the fluid bolus and the start of the vasopressor. Time Action : : 0 to 5 min ABCDE, continuous monitoring…

…continue to next criteria. Assess the RS interval (interval from start of the R wave to the nadir of the S wave). If any RS…

…dose: 500 μg/kg bolus over 1 minute. Infusion start dose: 25–50 μg/kg/min. Maximum infusion dose: 300 μg/kg…

…IM: 10–20 mg every 4–6 hours. Infusion • Afterload reduction : Start infusion at 1 mg/hour. Increase by 0.5 mg/hour every 20…

…Treatment • No prior treatment, low dose, or low intensity lipid lowering therapy: • Start high potency, high dose statin therapy (Class I recommendation). • Immediate combination with…

…to 15 minutes as necessary. Continuous infusion: Start infusion at 0.1 mg/min and increase in increments of 0.1 mg. Adverse effects Tachycardia…

…administration, warnings, precautions, and other relevant information for the drug Ticagrelor . Table 1 Summary Indications Ticagrelor, in combination with acetylsalicylic acid (ASA), is indicated for…

…Because of this prolonged terminal half life, achieving steady state concentration without a loading dose takes approximately 265 days. Interpatient variability mandates close clinical monitoring…

…not exclude a coronary cause of symptoms. CCS is a clinical syndrome rather than a permanently stable state. Patients may remain stable for prolonged periods…

…acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence of ongoing acute organ injury is decisive. The pathophysiology…

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

…Taught by professor Smith, any reader is guaranteed to quickly acquire state of the art knowledge and practical training. Professor Smith published a book as…

…normal. The isoelectric (flat) line between the end of the P wave and the start of the QRS complex is called the PR segment. The…

…and create a highly prothrombotic endothelial surface. Furthermore, AF induces a systemic hypercoagulable state, characterized by elevated biomarkers such as D dimer, von Willebrand factor…

…explained by the fact that these cells start leaking sodium (Na + ) into the cell as soon as they return to their resting state (Figure 1)…

…normal cardiac function, but rather to a state where stroke volume is maintained only at the expense of pathologically elevated filling pressures. Epidemiology and risk…

…40% [14] . This distinction is paramount for practicing cardiologists: HFimpEF represents a state of myocardial remission rather than true recovery. Data from the TRED HF…

…the following situations: If the normal sinus impulse disappears (e.g sinus arrest) cells around the atrioventricular node may discharge impulses. Less than three consecutive…

…Society for Cardiology (ESC). The chapter will start with basic concepts of NSTEMI and unstable angina and then elaborate the discussion gradually. As in STEMI…

…for pathological R wave progression is considerably lower than pathological Q waves and guidelines do not state any ECG criteria specific to R wave progression…

…will be reflected while others will transfer the mechanical (pressure) energy to the new medium, which may also start to vibrate (Figure 1). Figure 1…

…ventricles without any delay. Hence, the ventricle will be excited (depolarized) earlier than expected, which is referred to as pre excitation . This manifests with three…

…driven by platelet derived growth factor (PDGF) and other cytokines. Within the intima, SMCs undergo a phenotypic switch from a contractile to a synthetic state…

…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…

…shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded…

…dissection or other vascular pathology CT perfusion Used with an unclear time of onset, a late time window, or when thrombectomy can start at the…

…cause [1]. Delirium tremens most often begins after one to three days but can start earlier in patients with previous complicated withdrawal [4]. Untreated delirium…

…margin must be included in the freeze. Contraindications Absolute: Suspected melanoma or any other pigmented lesion of uncertain diagnosis. A lesion in which histology is…

…rolling it, for 4–5 seconds until a grey eschar forms. Start peripheral to the bleeding point and work inwards towards the centre. 4. Wipe…

…often than anything else. Record a resting ECG both supine and sitting, and resting blood pressure in both arms. Procedure 1. Exercise protocol: start at…

…corticosteroid drawn up in its own syringe, so that the same needle can stay in place when the syringe is changed after aspiration. Procedure 1…

…you start. Apply the tourniquet only after the block has taken effect, and note the time. It must not stay on for longer than 20…

…stridor, cyanosis or marked breathlessness — withdraw the tube to the pharynx and start again . If the tube emerges through the mouth it has coiled up…

…then guide the tip into the oesophagus rather than into the trachea. Coughing, stridor or an inability to speak means malposition; withdraw and start again…

…as required every 4 hours. Recalculate the daily dose when more than three breakthrough doses per day are needed. Dose adjustment Situation Adjustment : : eGFR <…

…or the start of dialysis < 0.3 mL/kg/h for ≥ 24 h, or anuria ≥ 12 h Other kidney related values The fractional excretion…

…explosive start and then continued blowing with loud coaching until a plateau is reached. The manoeuvre ends when the volume increases by less than 0…

…and control of shivering. Procedure 1. Start temperature management early — within the first hour after ROSC, in parallel with coronary angiography, the search for the…