…levels of cardiac troponins. In addition to elevated troponins, the patient must display either symptoms or ECG changes consistent with myocardial infarction/ischemia. Most patients…

…V9). Criteria for ischemia/infarction have been established for these leads (please refer to ECG leads or Additional leads in acute myocardial infarction). Importance of…

…and atypical disease Fewer than half of patients with PAD have typical symptoms. Many have impaired walking or a slow gait without describing classic claudication…

…Weight loss was considered extremely difficult across patient categories. However, the emergence of incretin based therapies, starting with glucagon like peptide 1 receptor agonists (GLP…

…muscle damage or inflammation may result in elevated cTnT levels. Although both troponin T and I may be chronically elevated in patients with renal failure…

…2]. Upper gastrointestinal bleeding can present as haematemesis, coffee ground vomiting or melaena. Haematochezia can occur in massive upper bleeding with rapid intestinal transit. Coffee…

…the Framingham Heart Study, this linear correction formula adjusts the QT interval based on heart rate without involving square or cube roots. It has been…

…ischaemia (ALI) is an abrupt reduction in arterial perfusion of an upper or lower limb that causes tissue metabolic requirements to exceed available blood flow…

…presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit). Age <1 day 1–3…

…upper back, abdomen, or epigastrium. Dyspnoea, nausea, vomiting, diaphoresis, fatigue, faintness, and other symptoms may occur without chest pain and should be considered anginal equivalents…

…associated with ischemic heart disease is broader than chest pain itself, encompassing symptoms like tightness, pressure, and discomfort in the chest, arms, neck, jaw, upper…

…myocardial injury, demonstrated by a rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference limit; and…

…presented in the parenthesis). Values without confidence interval are simply the 98 th percentile (i.e the upper reference limit). Age <1 day 1–3…

…there are visible QRS complexes. The signal in the lower lead shows that the rhythm is a polymorphic ventricular tachycardia (or even flutter). ECG 3 …

…care or in the emergency department without contacting the appropriate specialty: Location Risk Management : : : Medial triangle of the face (nasal root, alae nasi, upper lip…

…at the end of expiration, with the tape horizontal and without compressing the skin. Ratios and other measurements Measurement Calculation Threshold : : : Waist–hip ratio Waist…

…normal readings at home or on 24 hour recording. Masked hypertension: normal in the office but raised outside it — associated with the same risk as…

…that can be corrected with iron, B12 or folate in a stable patient. Transfusion given solely to reach a laboratory value without a clinical question…

…g × 4 IV Exacerbation of COPD with an indication for antibiotics amoxicillin 750 mg × 3 PO 5–7 days or doxycycline 200 mg × 1 on…

…when time allows. There is complete upper airway obstruction where laryngoscopy will not succeed; plan for a surgical airway or awake fibreoptic intubation. A difficult…

…Orders of magnitude that direct the work up ALT 50 × the upper limit of normal: paracetamol poisoning, ischaemic hepatitis ("shock liver") or acute viral hepatitis…

…upper border of the rib, never at the lower border where the neurovascular bundle lies, and the drainage is stopped for coughing, chest pain, or…

…groups: current or former smokers over 40 with respiratory symptoms, and occupational exposure to dust, gas or fumes. Preoperative assessment before thoracic or upper abdominal…

…setting, manually or with an automated device. Home blood pressure monitoring (HBPM): self measurement at home, generally with a validated upper arm oscillometric device. Ambulatory…

…or under the influence of antiarrhythmic drugs—can produce atypical ECG patterns. Conversely, upper loop reentry can mimic a typical flutter ECG pattern without being…

…above the 99th percentile upper reference limit (URL). The injury is considered acute if there is a documented rise and/or fall of cTn values…

…Those with possible ACS, a non diagnostic ECG, and normal initial troponin may be observed in a chest pain unit or another non intensive care…

…in the absence of CTEPH, lung disease, or another explanatory cause. PAH reflects marked pulmonary arterial remodelling, with fibroproliferative, plexogenic, and sometimes thrombotic changes that…

…Acute myocardial injury , demonstrated by a rise and/or fall in cTn with at least one value above the 99th percentile URL; and Clinical evidence…

…tongue, and uvula causing airway obstruction Cardiovascular: Hypotension Circulatory collapse culminating in cardiac arrest Anaphylaxis can develop without dermatological or upper airway manifestations. Anaphylactic cardiac…

…dilatation Atrial enlargement: left atrial enlargement (P mitrale) and right atrial enlargement (P pulmonale) The atria may become dilated and/or hypertrophic during pathological circumstances…

…arm electrodes are placed proximally on the upper arm. Placement of chest (precordial) electrodes are not changed but additional leads may be attached in children…

…seconds. Upper reference limit is 0,20 seconds in young adults. A prolonged PR interval ( 0.22 s) is consistent with first degree AV block…

…side with a dialysis fistula, lymphoedema after axillary clearance or a recently inserted venous port. Procedure 1. Arm pressure. Place the cuff on the upper…

…not eGFR relative to 1.73 m². Recalculate in patients who are markedly larger or smaller than average. Higher doses may be required in the…

…available on the unit. Preparation and equipment A device capable of both CPAP and bilevel ventilation, or alternatively flow generated CPAP with a PEEP valve…

…Active malignancy with a risk of transmission (an individual assessment; certain tumour types are not a bar). Untreated generalised infection, or certain transmissible agents according…

…body reaching the stroma or deeper. The absence of a slit lamp — the cornea should not be instrumented without magnification. With a suspected chemical injury…

…together with the distal pulse and sensation throughout the arm. External rotation (the Hennepin technique). The patient lies supine or sits. The upper arm is…

… it is part of the treatment itself. Indications Salicylate poisoning with symptoms or a rising serum concentration. Alkalinisation increases renal elimination several fold and at…

…throat clearing, sneezing, and rhinorrhea, which may indicate upper airway cough syndrome. Symptoms of retrosternal burning after meals or on recumbency, frequent eructation, hoarseness, and…

…In patients with severe mental illness (SMI) receiving antipsychotic therapy, sinus tachycardia is common, and symptoms may reflect underlying arrhythmia or sudden cardiac death (SCD…

…refers to individuals without established atherosclerotic cardiovascular disease (ASCVD), coronary artery disease, cerebrovascular disease, or peripheral artery disease. Secondary prevention concerns patients with established vascular…

…neck, or upper back. Chest discomfort triggered by emotional stress. Palpitations associated with physical activity, a large meal, emotional upset, or cold exposure. The absence…

…changes occur during the first year of life. The electrocardiogram (ECG) evolves in parallel with the changing anatomy and physiology of the heart. ECG amplitudes…

…of the P wave, PR interval and PR segment The P wave ECG interpretation usually starts with assessment of the P wave. The P wave…

…troponin rise, with thresholds differing for PCI and CABG; and At least one additional indicator of new myocardial ischemia or procedural coronary compromise. When preprocedural…

…and with several patient and treatment related factors: Age older than 80 years Female sex Low body mass index Asian ancestry Previous muscle disease or…

…when encountering a patient with chest pain the primary task is to exclude or verify the following potentially life threatening causes of chest pain: Ischemic…

…artery disease has been classified into the following three syndromes: Stable angina pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load…

…normal findings, normal variants, etc – from adult electrocardiograms. It is crucial to be familiar with normal findings, normal variants, and pathology in neonates, infants and…

…changes occur during the first year of life. The electrocardiogram (ECG) evolves in parallel with the changing anatomy and physiology of the heart. ECG amplitudes…

…depolarize and repolarize the ventricles ( Figure 1 ). The length of the QT interval correlates strongly with the risk of potentially life threatening ventricular arrhythmias. Therefore…

…Unstable Angina presents with clinical and/or electrocardiographic signs of myocardial ischemia but lacks this biomarker elevation. With the ubiquitous adoption of hs cTn assays…

…sinoatrial node are either not conducted to the atria or are so with a delay. This manifests with loss of P waves (loss of atrial…

…artery disease has been classified into the following three syndromes: Stable angina pectoris : Symptoms appear primarily during exercise or other situations with increased myocardial load…

…QRS complexes may be normal or wide. P waves have constant PP interval and ride straight through the strip, without any relation to QRS complexes…

…a certain threshold, pressure rises rapidly with further volume increases. This is explained by the existence of an upper limit for ventricular compliance. The greater…