Medicine in a Minute

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Winner of the Young Authors Award at the BMA book awards 2019! AND Highly Commended in the Medicine category! Here's what the BMA reviewers said: Modifiable risk factors include diabetes mellitus, hypertension, hyperlipidaemia, smoking and obesity Oxygen: indicated only if SpO2 <94%; the evidence indicates that oxygen may have a vasoconstrictive effect on the coronary arteries and should be avoided if the patient is not hypoxic Definition • Epidemiology • Risk factors • Differential diagnosis • Etiology • Pathophysiology • Clinical features • Investigations • Management I’ve got finals coming up in a few months and feel with this book I will be well prepared! It’s well worth the money.

Depolarisation then continues through the bundle of His (which subdivides into left and right bundle branches) and then through Purkinje fibres to the ventricular muscle, which provokes contractionDefinition: the term acute coronary syndrome (ACS) refers to a group of conditions that result from a sudden and unpredictable disruption in coronary blood flow. ACS exists on a continuum, from myocardial ischaemia (unstable angina) to the development of myocardial infarction and necrosis (NSTEMI or STEMI; see Fig. 1.9). Clinically, these conditions are classified according to changes in the electrocardiogram and biochemical markers of myocardial necrosis. Another mechanism that modifies BP is the renin–angiotensin–aldosterone system (RAAS; see Fig. 1.6). When the arterial pressure falls, renin is released from the juxtaglomerular cells of the kidney. Renin converts angiotensinogen (released from the liver) into angiotensin I.

Blood pressure is sensed by baroreceptors (mechanoreceptor sensory neurons) at the carotid sinus and aortic arch, which detect changes (e.g. low BP) based on the degree of stretch. Afferent information is then transmitted to the brain, which leads to reflexive vasoconstriction, an increased heart rate and contractility, increasing SV, CO and BP in turn.

Stroke volume

I would unreservedly recommend this book to any medical student and indeed anyone else who wanted to learn more about internal medicine including junior doctors, nurses, physicians' assistants. I would have loved a book like this when I was a medical student." I would unreservedly recommend this book to any medical student and indeed anyone else who wanted to learn more about internal medicine including junior doctors, nurses, physicians’ assistants. I would have loved a book like this when I was a medical student.” Transoesophageal echocardiography (TOE) is an alternative, invasive method requiring sedation, which captures images via a probe placed down the oesophagus; TOE has a higher sensitivity and produces higher-quality images, while being particularly effective at imaging the posterior heart Essential hypertension is a multifactorial environmental and genetic condition. There is a greater prevalence of hypertension in first-degree relatives with hypertension, and a high concordance in identical twins. The exact pathophysiology, however, remains undefined. Guidelines: Defining hypertension (NICE 2011, CG127)

The intrinsic pacemaker of the heart is usually the sinoatrial node (SA node) because it has the fastest rate of automaticity of all cardiac fibres ( see Fig. 1.4) Bivalirudin (direct thrombin inhibitor), in combination with aspirin and clopidogrel, is recommended for patients with STEMI undergoing PPCI (although practice may vary between centres) Classically presents with gangrene of the extremities, particularly the toes, if emboli lodge in the lower limbs Holding treatments include reducing afterload (e.g. treating with sodium nitroprusside), inotropes, diuretics, ventilation, followed by urgent surgical repair/replacement Afterload represents the resistance to ventricular ejection because the afterload force opposes muscle contractionEchocardiography performed before and after exercise (or with dobutamine if exercise is not possible) to assess the myocardium Diuretics are used to treat oedema and heart failure by increasing urinary sodium excretion and urine output. Hypotension and hyponatraemia are potential side effects in all classes. Thiazide diuretics (e.g. bendroflumethiazide) and loop diuretics (e.g. furosemide) can also cause hypokalaemia, hyperuricaemia and gout. Ototoxicity is specific to loop diuretics. Potassium-sparing diuretics (e.g. spironolactone) can cause hyperkalaemia. Classically, the right radial (increasingly preferred) or right femoral arteries are used for arterial access in angiography