A 40yearold man is brought to A&E with severe headache. On
examination he has papilloedema and fundal haemorrhages. His BP is
220/ 145 mmHg.
Malignant hypertension is severe hypertension associated with acute
endorgan failure, e.g. encephalopathy, renal f
Visible carotid pulsations: Corrigans sign
Capillary pulsations in the nail bed: Quincke's sign
Pistol shots over the femoral arteries: Traube's sign
Head nodding in time with the pulse: de Mussets sign
Middiastolic murmur heard at the apex: Austin Flint
A 65yearold man presenting with acute heart failure requires rate
control to treat coexisting atrial brillation.
Digoxin has a narrow therapeutic window and toxicity with normal
doses can be precipitated by hypokalaemia, hypomagnesaemia, renal
A 45yearold man with chronic glomerulonephritis presents with a
severe headache. On examination he has papilloedema and bilateral
retinal haemorrhages. His BP is 240/ 132mmHg.
This is the presentation of malignant hypertension. The therapeutic aim
10 Cardiovascular emergencies
A oral dobutamine F aspirin, heparin
B DC shock and adrenaline G DC shock and atropine
C 100 per cent 02, subcutaneous H labetalol
LMW heparin, intravenous I emergency renal dialysis
uids J aspirin, GTN
nifedipine K aspirin,
A 69yearold woman with asthma being treated with a loop diuretic,
ACE inhibitor and longacting nitrate is prescribed a drug to reduce
Spironolactone was shown to decrease long-term mortality when added
to conventional therapy in the RA
Sinus rhythm, bid p waves best seen in 11, V3 and V4.
Known as P mitrale, this bid P wave suggests left atrial hypertrophy.
A peaked F wave is called P pulmonale and suggests right atrial
Edited by Mostafa Ghanei
Edited by Mostafa Ghanei
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright 2011 InTech
All chapters are Open Access distributed under the Creative Commons Attribution 3.
A 40yearold woman collapses after a ight with breathlessness and
rightsided pleuritic chest pain.
C This is a presentation of pulmonary embolus (PE). Streptokinase has also
been used successfully following a major embolism. Open embolectomy
. 22 Cardiovas
Initial therapy in a 60yearold woman presenting severely
compromised with acute persistent AF.
In this case immediate DC shock is indicated because the patient is
severely compromised. The administration of heparin decreases but does
not abolish the risk
Principal Routes of Drug Administration (1)
Advantages and Disadvantages
convenient, non-sterile route; inactivation of some drugs
good absorption for most by acidlenzymes; variable
drugs absorption; rst pass
metabolism; G.l. irri
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Trachea deviated to right, horizontal ssure and right hilum displaced
C These chest x-ray ndings are characteristic of right upper lobe collapse.
Try to find the horizontal ssure because its position is a good clue to
the presence of volume loss.
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A 28-year-old man involved in a road traffic accident presents with
severe respiratory distress. Examination reveals decreased expansion
on the right side of the chest with mediastinal shift to the left.
Tension pneumothorax is a medical emergency and man
Treatment of mild symptoms of shortness of breath and ankle oedema
in a 65yearold man with left ventricular dysfunction caused by
ischaemic heart disease. He is already taking an ACE inhibitor.
K Patients with mild left ventricular dysfunction may be sati
A 57yearold businessman presents with a 4h history of crushing
chest pain. The ECG changes include ST elevation in II, III and aVF.
This is the presentation of an inferior myocardial infarction and where
primary percutaneous coronary intervention [PPCI] i
A 65yearold man presenting with chest pain becomes unresponsive.
His ECG shows ventricular brillation.
DC shock is indicated according to current ALS [Advanced Life Support)
guidelines, which emphasize the importance of early debrillation.
visceral afferent APs pass bilaterally to thalamus & cardiopulmonary
hypothalamus then diffuse areas of the cortex splanchnic
. :r. nerves
/ 't (sympathetic nerves
E 71. to chest organs)
ischaemia PL US