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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2899_Библиотеки_им_академика_М_И_Перельмана
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COX cyclooxygenase
CPAP continuouspositiveairwaypressure
CPR cardiopulmonaryresuscitation
CRP C-reactiveprotein
CRT cardiacresynchronizationtherapy
CSF cerebrospinalfluid
CT computedtomography
CTG cardiotocograph
CTPA computedtomographypulmonaryangiogram
DIC disseminatedintravascularcoagulation
DKA diabeticketoacidosis
DMARD disease-modifyingantirheumaticdrug
DNACPR donotattemptcardiopulmonaryresuscitation
DOAC directoralanticoagulant
DRE digitalrectalexamination
DSM-5 DiagnosticandStatisticalManualofMentalDisorders,fifthedition
DVLA DriverandVehicleLicensingAgency
DVT deepveinthrombosis
DXA dual-energyX-rayabsorptiometry
EACTS EuropeanAssociationforCardio-ThoracicSurgery
EASL EuropeanAssociationfortheStudyoftheLiver
ECG electrocardiogram
EEG electroencephalogram
eGFR estimatedglomerularfiltrationrate
ENT ear,nose,andthroat
EPU earlypregnancyunit
ESC EuropeanSocietyofCardiology
ESR erythrocytesedimentationrate
FFP freshfrozenplasma
FiO
2
fractionofinspiredoxygen
FMH fetomaternalhaemorrhage
FRII fixedrateinsulininfusion
FT3 freetriiodothyronine
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FT4 freethyroxine
GAD generalizedanxietydisorder
GBS groupBStreptococcus
GCA giantcellarteritis
GCS GlasgowComaScale
GDM gestationaldiabetesmellitus
GFR glomerularfiltrationrate
GI gastrointestinal
GMC GeneralMedicalCouncil
GORD gastro-oesophagealrefluxdisease
GP generalpractitioner
GTN glyceryltrinitrate
Hb haemoglobin
HbA1c glycatedhaemoglobin
HBc hepatitisBcoreantigen
HBPM homebloodpressuremonitoring
HBsAg hepatitisBsurfaceantigen
HCC hepatocellularcarcinoma
HE hepaticencephalopathy
HFpEF heartfailurewithpreservedejectionfraction
HFrEF heartfailurewithreducedejectionfraction
HHS hyperglycaemichyperosmolarsyndrome
HIV humanimmunodeficiencyvirus
HLA humanleucocyteantigen
HRT hormonereplacementtherapy
HSV herpessimplexvirus
IBD inflammatoryboweldisease
IBS irritablebowelsyndrome
ICD implantablecardioverterdefibrillator
ICS inhaledcorticosteroid
IL interleukin
IM intramuscular
INR internationalnormalizedratio
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IPSS InternationalProstateScoringSystem
ITU intensivetherapyunit
IV intravenous
JBDS JointBritishDiabetesSocieties
JVP jugularvenouspressure
KDIGO KidneyDisease:ImprovingGlobalOutcomes
LABA long-actingbeta-2agonist
LBBB leftbundlebranchblock
LDH lactatedehydrogenase
LFT liverfunctiontests
LKMA liverkidneymicrosomalantibody
LMWH low-molecular-weightheparin
LP lumbarpuncture
MC&S microscopy,culture,andsensitivity
MDT multidisciplinaryteam
MELD ModelforEnd-StageLiverdisease
MI myocardialinfarction
MPS myocardialperfusionscintigraphy
MR mitralregurgitation
MRI magneticresonanceimaging
MSCC metastaticspinalcordcompression
NICE NationalInstituteforHealthandCareExcellence
NSAID non-steroidalanti-inflammatorydrug
NSTEMI non-ST-segmentelevationmyocardialinfarction
NT-proBNP N-terminalpro-B-typenatriureticpeptide
NVP nauseaandvomitinginpregnancy
NYHA NewYorkHeartAssociation
OD oncedaily(omniedie)
OGD oesophagogastroduodenoscopy
PaCO
2
partialpressureofcarbondioxideinarterialblood
PaO
2
partialpressureofoxygeninarterialblood
PCI percutaneouscoronaryintervention
PCR polymerasechainreaction
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PD Parkinson’sdisease
PE pulmonaryembolism
PEF peakexpiratoryflow
PET positronemissiontomography
PMR polymyalgiarheumatica
PO orally(peros)
PPH postpartumhaemorrhage
PPI protonpumpinhibitor
PRN asrequired(prorenata)
PSA prostate-specificantigen
PSC primarysclerosingcholangitis
PT prothrombintime
PTH parathyroidhormone
PTSD post-traumaticstressdisorder
QDS fourtimesdaily(quaterdiesumendus)
RAS renin–angiotensinsystem
RBBB rightbundlebranchblock
RCOG RoyalCollegeofObstetriciansandGynaecologists
RF rheumatoidfactor
S2 secondheartsound
S3 thirdheartsound
S4 fourthheartsound
SABA short-actingbeta-2agonist
SAVR surgicalaorticvalvereplacement
SC subcutaneous
SGLT2 sodium–glucosecotransporter-2
SIGN ScottishIntercollegiateGuidelinesNetwork
SMA smoothmuscleantibody
SNRI serotonin–noradrenalinereuptakeinhibitor
SPECT single-photonemissioncomputedtomography
SpO
2
oxygensaturation
SSRI selectiveserotoninreuptakeinhibitor
STEMI ST-segmentelevationmyocardialinfarction
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T1DM type1diabetesmellitus
T2DM type2diabetesmellitus
T3 triiodothyronine
T4 thyroxine
TAVI transcatheteraorticvalveimplantation
TB tuberculosis
TCA Tricyclicantidepressants
TDS threetimesdaily(terdiesumendus)
TED thyroideyedisease
TENS transcutaneouselectricalnervestimulation
TFT thyroidfunctiontests
TIA transientischaemicattack
TIPSS transjugularintrahepaticportosystemicshunt
TLoC transientlossofconsciousness
TNF tumournecrosisfactor
TSH thyroid-stimulatinghormone
TTE transthoracicechocardiography
U&E ureaandelectrolytes
UA unstableangina
UC ulcerativecolitis
UGIB uppergastrointestinalbleed
UKELD UnitedKingdomModelofEnd-StageLiverDisease
UPT urinepregnancytest
USS ultrasoundscan
VBG venousbloodgas
VRII variablerateinsulininfusion
VT ventriculartachycardia
VTE venousthromboembolism
VZV varicellazostervirus
WHO WorldHealthOrganization
Anoteonterminology
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It should be noted that where the term ‘child’ has been used, this refers to a ‘child or
young person’. The term ‘parent’ refers to ‘parent, carer, or legal guardian’. Where
guidelinesapplytopregnancy,childbirthandotheraspectsofreproductivehealthcare,the
terms ‘woman’ or ‘women’ should be assumed to cover all people who can become
pregnant and would need access to healthcare services in this capacity. Their gender
identityshouldberespectedatthepointofcare.
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Part1
Cardiology
Acutecoronarysyndromes
Acuteheartfailure
Aorticstenosisandmitralregurgitation
Atrialfibrillation
Chronicheartfailure
Hypertension
Pericardialdisease
Stableangina
Transientlossofconsciousness
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Chapter1
Acutecoronarysyndromes
Guidelines:NationalInstituteforHealthandCareExcellence(NICE)CG95(Recent-
onset chest pain of suspected cardiac origin: assessment and diagnosis):
https://www.nice.org.uk/guidance/cg95
NICENG185(Acutecoronarysyndromes):https://www.nice.org.uk/guidance/ng185
OUP disclaimer: Oxford University Press makes no representation, express or
implied, that the drug dosages are correct and that the recommendations are an
exclusiveormandatorycourseofcare.Allhealthprofessionalsreadingthistexthave
aresponsibilityto evaluateitsappropriatenessand take the individualneeds ofthe
patientintoaccount.
Localtrustguidelines:pleaserefertoyourlocalguidelinesasnecessary.
Overview
Acutecoronarysyndrome(ACS)coversaspectrumofmyocardialischaemia(fromleast
tomostsevere):
Unstable angina (UA)—chest pain due to myocardial ischaemia at rest or minimal exertion,
withoutmyocardialnecrosis
Myocardial infarction (MI)—myocardial ischaemia resulting in myocardial necrosis. There are
twotypesofMI:
Non-ST-segmentelevationmyocardialinfarction(NSTEMI)
ST-segmentelevationmyocardialinfarction(STEMI).
Diagnosis
The diagnosis of MI requires a riseand/or fallof cardiac biomarker values (preferably
troponin), with atleastone valueabove the 99thpercentileof the upperreference limit
andatleastoneofthefollowing:
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2.
3.
4.
5.
Symptomsofmyocardialischaemia(see‘History’)
New(orpresumednew)significantST-segment/Twavechangesornewleftbundlebranchblock
(LBBB)(Fig.1.1)
DevelopmentofpathologicalQwaves(Fig.1.2)
Imagingevidenceofnewmyocardiallossorregionalwallmotionabnormality
Identificationofanintracoronarythrombusbyangiography.
Fig.1.1Leftbundlebranchblock.
ReproducedfromWilkinsonIBetal(2017)‘OxfordHandbookofClinicalMedicine10e’Oxford
UniversityPress:Oxford,withpermissionfromOxfordUniversityPress.
Fig.1.2Sequentialelectrocardiogram(ECG)changesfollowingacuteMI.
ReproducedfromWilkinsonIBetal(2017)‘OxfordHandbookofClinicalMedicine10e’Oxford
UniversityPress:Oxford,withpermissionfromOxfordUniversityPress.
History
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Characteristics of pain (site, whether pain is ongoing, time of onset, duration (>15 minutes),
character,provokingandrelievingfactors,radiation)
Associatedsymptoms,suchassweating,breathlessness,palpitations,andnauseaorvomiting
Presence of cardiovascular risk factors, e.g. type 2 diabetes mellitus, obesity, or
hypercholesterolaemia
Pre-existingdiagnosisofischaemicheartdisease
Previousinvestigationsandinterventionsforischaemicheartdisease,e.g.percutaneouscoronary
intervention(PCI)orcoronaryarterybypassgrafting(CABG)
Bleedingriskfactorswhichmaybeacontraindicationforantithrombintherapy.
Examination
Assesshaemodynamicstatus,thepresenceofACScomplications,andsignspointingtoa
non-ACScauseofchestpain.
Some examination findings may indicate heart failure (Table 1.1). This may be pre-
existing, due to an unrelated cause such as decompensated aortic stenosis, or have
developedasaresultofapreviousinfarction.
Table1.1PossibleACSexaminationfindings
B Hypoxia
Orthopnoea
Bilateralcrepitations
C Bloodpressureandheartratechanges(hypotension/hypertension±bradycardia/tachycardia)
Coolandclammyperipheries
Arrhythmias
Murmurs
Raisedjugularvenouspressure(JVP)
E Peripheraloedema
Midlinesternotomyscar
Investigations
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