…a massive necrotic lipid core and a highly inflamed fibrous cap measuring less than 65 micrometers in thickness. Macrophage derived matrix metalloproteinases (MMPs) degrade the…

…are performed in primary care but interpreted as specialist investigations. Both fail more often for practical than for medical reasons: the cuff is in the…

…possible, the right leg must be intact. In the case ofblockade of the right bundle of His (RBBB) , the ventricle can not depolarize normally, which…

…myxomas. Papillary fibroelastoma Papillary fibroelastoma is benign primary tumors affecting adults. These tumors most often occur in the aortic valve and the mitral valve. generally…

…expected pCO₂ or HCO₃. A value outside the expected range means there is a further primary disorder 4 Is there a metabolic acidosis? Calculate the…

…In a suspected Addisonian crisis, hydrocortisone must be given immediately — the test must never delay treatment. Indications Suspected primary adrenal insufficiency (Addison's disease): fatigue…

…those who did, only a minority had a reduced value — the majority of sudden cardiac deaths occur in patients with preserved LVEF, for whom no…

…a documented rise and/or fall of cTn values. However, myocardial injury alone is an entity in itself and may arise from non ischaemic cardiac…

…30 mm ​Indexing means that the value is adjusted for body surface area (BSA), given in square metres. Aorta, standardised values Standardised values (mean ± SD…

…stricture, tumour, primary biliary cholangitis, drugs Mixed Both raised Drug induced liver injury is the commonest cause Isolated bilirubin Unconjugated, the others normal Gilbert's…

…with a 0 degree value assigned along the lead axis of V6 [3]. Clinical Implications of Axis Deviation Deviations in the electrical axis serve as…

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…

…% 32–60 25–31 18–24 <17 Tricuspid valve Tricuspid valve regurgitation Primary parameters Mild regurgiation Moderate regurgitation Severe regurgitation PISA radius < 0,6…

…the true lumen, whereas disruption of the adventitia can result in rupture. An alternative proposed mechanism is primary rupture of the vasa vasorum, followed by…

…ECG is the primary diagnostic tool for evaluating acquired QT prolongation. The upper 99% limits of normal for corrected QT (QTc) values in the general…

…Standardized values for aorta (mean ± SD) Aortic annulus Sinus valsalva Age Women Men Women Men <30 11.4 ± 1.1 11.4 ± 1.2 15…

…to ECG interpretation 1. Which of the following ECG findings is typically considered a normal variant in asymptomatic athletes with no significant family history? A:…

…symptom. It includes pain, pressure, tightness, heaviness, burning, or discomfort in the chest and may extend to the arms, shoulders, neck, jaw, upper back, abdomen…

…be observed in a chest pain unit or another non intensive care setting while serial testing is completed. Diagnostic Framework The diagnostic pathway combines three…

…particles. For most individuals in whom these measurements are concordant, their clinical utility is similar. Their greatest incremental value occurs when triglycerides are elevated, LDL…

…or notch in the descending limb of the R wave and/or notch in the descending limb of the S wave In case of complete…

…in some cases, fatty liver disease. Interpretation of the Agatston Score The score should be interpreted both by its absolute value and in relation to…

…hours after the onset of acute myocardial infarction. The maximum troponin value is observed in 12–48 hours. Troponin may be elevated for up to…

…because the clinical value of any diagnostic test depends not only on its sensitivity and specificity but also on disease prevalence in the population being…

Procedurer The value of the exercise test lies not in ST depression alone but in the overall picture : exercise capacity, symptoms, blood pressure response, heart…

…raise the potassium. Assess the urine output and ask when the patient last passed urine. Contact intensive care in circulatory compromise, serious arrhythmia, marked QRS…

…in the first second FVC Forced vital capacity FEV₁/FVC The ratio that defines obstruction PEF Peak expiratory flow — variability rather than the absolute value…

…even when it lies buried in the QRS complex or the T wave. The whole value of the investigation lies in the ratio between the…

…value normalized to a standard body surface area of 1.73 m². Advantages of MDRD eGFR Clinical utility: The MDRD equation has been instrumental in…

…protocol NT proBNP < 125 ng/L (< 300 in acute dyspnoea) A normal value effectively excludes heart failure D dimer < 0.5 mg…

…abnormal or unexpected values should be confirmed with a laboratory analysed plasma glucose when the situation allows. Glucose meters are less reliable in the hypoglycaemic…

…trial shortens the time on the ventilator. See the article on confusion for the management of delirium in intensive care. Renal replacement therapy Absolute indications:…

…pressure. A value of around 0.9 to 1.0 or higher in an adult trauma patient suggests significant hypovolaemia and an increased transfusion requirement…

…antianginal purposes in CCS, the target resting heart rate is generally 55–60 beats per minute. Beta blockers also have prognostic value in selected populations…

…in the SYNTAX trial, patients with high scores had significantly higher mortality and MACE rates compared to those with low scores. Monitor Quality of Care…

…Conversely, a rapid rise in blood pressure from a previously low level can cause organ damage at lower values, for example in pregnancy, acute glomerular…

…used for dosing, not the value normalised to body surface area — the difference is substantial in very small and very large people. Acute kidney injury…

…in the setting of left bundle branch block (LBBB), fractional shortening is not representative of ventricular function, since the activation proceeds abnormally. Normal value for…

…between patient groups and care settings [2]. Practical first actions Do the following in parallel, not sequentially: 1. Check previous creatinine values and establish the…

…with haemodynamic compromise, whatever the current haemoglobin — haemoglobin falls late in acute haemorrhage and a normal value does not exclude significant blood loss. Massive haemorrhage…

…and the appropriate action differs fundamentally between these cases. Pressures in the heart and pulmonary circulation Flow, resistance and oxygen transport Formulas Mean arterial pressure…

…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…

…sickle cell crisis. Contraindications There are no absolute contraindications in hypoxaemia. Take particular care in: A risk of hypercapnic respiratory failure — COPD, severe obesity with…

…age, the sex and the ancestry before the measurement; the reference values are based on them. In kyphosis, or when the patient cannot stand, the…

…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…

…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…

…The value of exercise stress testing is evident from the fact that exercise capacity (cardiopulmonary capacity) is one of the strongest predictors of cardiovascular and…

…an integrated decision pathway for physiology guided revascularization. Overview: Comparison of Physiological Indices The table below summarizes the four index families discussed in this review…

…well as in older adults with markedly limited physical activity. Traditional labels such as “typical” and “atypical” angina have limited value, particularly in patients with…

…high risk of hypoglycaemia 8–12 mmol/L The critically ill patient in intensive care According to the local protocol Avoid tight targets in inpatients…

…2.0 3.0 A mechanical valve may require a higher target Doses in venous thromboembolism Treatment doses in deep vein thrombosis and pulmonary embolism…

…has therefore not been abandoned, only redefined: continuous core temperature measurement and a target value that must never be exceeded, during the first 72 hours…

…for example in newly diagnosed venous thromboembolism. 1. Check the INR before the first dose. A raised baseline value suggests liver disease or vitamin K…

…cycle, encompassing both systole and diastole. It is a critical parameter in cardiovascular physiology, providing insight into the perfusion pressure experienced by organs and tissues…

…term relationship with cardiovascular risk is therefore graded, although practical clinical care requires diagnostic and treatment thresholds. The 2024 European guideline defines hypertension as an…

…attenuation is expressed relative to water in Hounsfield units. Bone is highly attenuating, air has very low attenuation, and blood and myocardium have intermediate values…

…precisely, FFR compares the pressure driving flow distal to a stenosis with the pressure that would be available in the absence of that stenosis. The…

…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…

…abdominal aortic aneurysm, and calcific aortic valve stenosis. Lp(a) is not associated with venous thromboembolism in prospective epidemiological studies. Its biological effects appear to…