bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic factors of chronic myeloid leukaemia
Authors: Baccarani Michele , Castagnetti Fausto , Gugliotta Gabriele , Palandri Francesca , Soverini Simona , Rosti Gianantonio
Published: August 2020

Two decades following the successful introduction of the ABL tyrosine kinase inhibitors in clinics for the treatment of patients with chronic myeloid leukaemia (CML), the principal objective of treatment in chronic phase (CP) is survival, preferably without life-long therapy. In tandem, the methodology and tools for assessing the prognosis of the newly diagnosed patient with CML in CP has evolved substantially. Prior to the era of tyrosine kinase inhibitors (TKIs), risk assessment depended more on the response to treatment than on baseline characteristics. The Sokal score, introduced in 1984, was the first one dividing patients into three risk categories based on a mathematical formula taking into account the patient’s age, and baseline characteristics like blast cell count, spleen size, and platelet count. This, and the several other subsequent risk stratification methods developed during the chemotherapy and interferon-alpha era, have remained useful in the first-line TKI treatment, and identifies a variable proportion of high-risk patients with lower response rates and worse outcomes. In second line, the most important risk factors are the absence of haematologic or cytogenetic response on first line, the presence of hematologic toxicity the development of additional cytogenetic abnormities (ACA), and the development of BCR-ABL1 kinase domain mutations. In this chapter, we address the prognosis of CML and the various methods for risk stratification.
Chronic myeloid leukaemia
Authors: Mughal Tariq I.
Published: August 2020

Chronic myeloid leukaemia (CML) was recognized in the 1970s by Janet Rowley to be a genetically simple malignancy; resulting as a consequence of a balanced translocation between chromosome 9 and 22. This provided vital insights into the molecular aberration, in the 1990s, which ushered in the current ‘precision medicine’ era, not only for patients of CML, but for cancers in general. As a result, today, a personalized treatment algorithm is available for all newly diagnosed patients with CML. Treatment involves a choice of three first-line orally administered tyrosine kinase inhibitors (TKIs) and two effective next-line TKIs that should be used based on risk stratification, comorbidities, the side effects profile, and the BCR-ABL1 genotype. Regardless of the initial choice of TKI, the vast majority of patients achieve a durable complete cytogenetic remission, with a lifespan approaching that of the general population. In most instances the medication must be continued indefinitely, and a principal challenge now, is to develop strategies to stop TKIs safely and effectively. Challenges remain in how to achieve optimal monitoring of patients with CML on treatment and in achieving a better understanding of the mechanisms and treatment of patients with advanced phase disease. This chapter addresses these questions as well as the concomitant topical issues in CML.
Polycythaemia vera
Authors: Barbui Tiziano , Mughal Tariq I. , Finazzi Guido
Published: August 2020

Polycythaemia vera (PV) is a clonal stem cell disorder characterized by erythrocytosis and associated with burdensome symptoms, risk of thrombohaemorrhagic complications, and transformation to myelofibrosis and acute myeloid leukaemia. Diagnostic criteria are very recently revised by the World Health Organization (WHO) based on haemoglobin and haematocrit levels, bone marrow morphology consistent with trilineage proliferation and presence of the JAK2 V617 mutation. Cytoreductive therapy is indicated in patients at increased risk of thrombosis. Hydroxyurea (HU) remains the most commonly used first-line cytoreductive therapy and interferon (IFN) is used either at failure of HU or in selected patients as first-line therapy. A recent phase 3 trial has shown the superiority of the JAK1/2 inhibitor ruxolitinib in comparison to best available treatment in HU-intolerant or resistant patients.
Myelofibrosis
Authors: Harrison Claire , Beauverd Yan , McLorran Donal
Published: August 2020

The World Health Organization (WHO) classification defines myelofibrosis (MF) to comprise of the three principal subtypes, primary myelofibrosis, post-polycythaemia vera myelofibrosis, and post-essential thrombocythaemia. Each subtype appears to exhibit a similar pathogenesis, clinical presentation, evolution, and treatment. The critical driver mutations involved in the pathogenesis are be JAK2, MPL, or CALR; mutations in the splicing machinery genes, the epigenome, transcription factors, and dysregulation in the haematopoietic stem cell niche also play pathogenetic roles. Myelofibrosis is a progressive disease, often evolves from a precursor disease state without any clinical symptoms and few laboratory anomalies, to more advanced stages with substantial symptom-burden. Janus kinase (JAK) inhibitors, such as ruxolitinib, afford significant symptomatic benefit, but no major impact on the JAK2 allelic burden, and many patients are offered a risk-adapted approach.
Eosinophilia-associated myeloproliferative neoplasms
Authors: Reiter Andreas , Cross Nicholas C.P.
Published: August 2020

Accurate diagnosis of eosinophilia-associated disorders remains problematic. The World Health Organization (WHO) 2008 classification defines a rare subgroup: myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB, or FGFR1 (MLN-eo), of which by far the most common is FIP1L1-PDGFRA. It is likely that other tyrosine kinase (TK) fusions will be incorporated into this category in due course. For other cases, the finding of increased numbers of blasts and/or proof of clonality is the basis for chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS); however, in practice this diagnosis is only possible for a small minority of cases. It is also important to recognize cases that do not fulfil the diagnostic criteria for MLN-eo or CEL-NOS but who harbour KIT D816V or JAK2 V617F. As for treatment, disease stage (chronic/blast phase), potential clinical course (indolent/aggressive), potential sensitivity to imatinib, or alternative TK inhibitors and allogeneic stem cell transplantation need to be considered on an individual basis.
Transformation of myeloproliferative neoplasms to acute leukaemia
Authors: Abdelwahab Omar , Rampal Raajit , Jamieson Catriona , Mughal Tariq I.
Published: August 2020

Clinically chronic myeloproliferative neoplasms are biphasic or triphasic diseases that are usually diagnosed in the initial ‘chronic’, ‘indolent’, or ‘stable’ phase and then spontaneously evolve after some years into an advanced phase. In patients with chronic myeloid leukaemia, the advanced phase can sometimes be subdivided into an earlier accelerated phase and a later blast phase resembling acute leukaemia. Patients with essential thrombocythaemia and polycythaemia vera transform initially to myelofibrosis and then to acute myeloid leukaemia (AML). Rarely they transform directly from the initial indolent phase to AML; patients with primary myelofibrosis also transform directly to AML. Although much is known about the molecular biology and genomic landscape of the initial phases, the molecular basis of disease progression and transformation remains obscure. The clinical management of transformed disease is generally difficult, and most patients tend to have a poor prognosis. This chapter reviews what is known of the mechanisms underlying the transformation of these myeloproliferative neoplasms from a chronic phase to frank leukaemia and also discusses the current and future treatment strategies.
Monitoring efforts in myeloproliferative neoplasms
Authors: Egan Daniel , Radich Jerald P.
Published: August 2020

Targeted therapy with tyrosine kinase inhibitors (TKI) has transformed the therapy of chronic myeloid leukaemia (CML), and is increasingly playing a role in the management of the myeloproliferative neoplasms (MPN), as a whole. In CML, the Philadelphia chromosome drives disease pathogenesis, and is the basis of both therapy (aimed at the BCR-ABL protein) and monitoring (the BCR-ABL chimeric mRNA). The efficacy of tyrosine kinase inhibitor therapy in CML is now accessed by reaching treatment milestones based on the BCR-ABL mRNA levels. In MPN, the landscape of genetic mutations associated with essential thrombocytosis (ET), polycythaemia vera (PV), and primary myelofibrosis (PMF) is ongoing. However, the recent discoveries of the JAK2 V617F and calreticulin mutations (for example) have a similar potential for disease targeting and monitoring as in CML.
Stem cell transplantation for BCR-ABL1-positive and negative myeloproliferative neoplasms
Authors: Rambaldi Alessandro , Kröger Nicholas
Published: August 2020

The indication to allogeneic stem cell transplantation has changed in the treatment strategy of chronic myeloid leukaemia (CML) and myelofibrosis (MF). The introduction of tyrosine kinase inhibitors has confined the indication to transplant only to the very few CML patients who fail the medical treatment or progress to a blastic phase of the disease. Nonetheless, a distinct group of CML patients still require allogeneic transplant that remains a curable treatment options even for these otherwise incurable patients. On the other hand, the allogeneic transplant activity for myelofibrosis is growing despite the persistent concern about the non-relapse mortality that remains significantly high in most studies and never below 20%. The availability of the new treatment option represented by JAK2 inhibitors hold promise not only for improving the quality of life but also the transplant outcomes of MF patients. However, their use poses new challenges for the most wise and appropriate selection of patients to transplant.
Cardiovascular
Authors: Nolan Jerry , Dunlop Craig
Published: August 2020

In this chapter, the latest basic and advanced life support guidelines are presented. Treatment guidelines are included for asystole, pulseless electrical activity, ventricular fibrillation, bradycardia, atrial fibrillation, narrow-complex tachycardia, broad-complex tachycardia, intraoperative hypotension/hypertension, and myocardial ischaemia. Anaesthesia and emergency management guidelines are presented for patients with cardiac tamponade, pulmonary embolus, cardiac trauma, thoracic aortic dissection, aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each cardiovascular situation are all covered here. Detailed checklists and clear flowcharts are also provided to guide the user when time is of the essence, along with a list of up-to-date online resources and further reading.
Respiratory
Authors: Cook Tim , Walton Benjamin
Published: August 2020

This chapter, describes the management of respiratory emergencies. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations (e.g. paediatric implications) for each respiratory-related situation are covered. Topics covered include hypercapnia, hypocapnia, hypoxaemia, simple and tension pneumothorax, pulmonary oedema, severe bronchospasm, massive haemoptysis, air/gas embolism, ,difficult controlled ventilation and management of inhaled foreign body and airway bleeding.. Detailed checklists and clear flowcharts are also provided to guide the user when time is of the essence, along with a list of up-to-date online resources and further reading.
Airway
Authors: Cranshaw Jules , Cook Tim
Published: August 2020

This chapter covers the guidelines for airway emergencies in anaesthesia. Strategies, checklists, and flowcharts are presented for the management of unexpected difficult mask ventilation and difficult intubation, e.g. ‘Cannot intubate, cannot oxygenate’ (CICO) and front of neck airway (FONA), partial airway obstruction, rapid sequence induction, laryngospasm, endobronchial intubation, oesophageal intubation, aspiration, airway fire, and difficult tracheal extubation. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations (e.g. paediatric implications) for each airway-related situation are covered. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.
Thoracics
Authors: Bennett James , Gould Gerard
Published: August 2020

In this chapter on life-threatening thoracic problems in anaesthesia, the authors offer their guidance and expertise on the best-practice methods of dealing with each of these. These problems include tracheal/bronchial obstruction, inhaled foreign body, tracheal injury or laceration, bronchopleural fistula, hypoxia/pneumothorax/high airway pressure during one-lung ventilation, dynamic hyperinflation, cardiac herniation postpneumonectomy, major airway bleeding, and bleeding during mediastinoscopy. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential thoracically related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.
Equipment problems
Authors: Gupta Kim J.
Published: August 2020

This chapter provides the reader with logical guidelines and checklists to investigate and quickly correct problems with anaesthetic equipment. The anaesthetist is dependent on the smooth and correct functioning of the necessary equipment, and this chapter explains some of the issues that may be encountered. The areas covered are: leaks in the anaesthetic breathing circuit, ventilator failure, oxygen supply failure, theatre power failure, and causes of high airway pressure. Each problem is addressed by firstly its definitions, presentation, investigations, risk factors, and exclusions; then how it can be managed in the immediate, medium-, and long-term situations. Finally, any special considerations are outlaid, followed by a list of further reading.
Miscellaneous problems
Authors: Isaac John , Stoneham Mark , Williams Nerida , McCormick Bruce
Published: August 2020

The penultimate chapter covers miscellaneous topics not described elsewhere. Major haemorrhage is addressed with sections on controlling haemorrhage, using blood products, and diagnosing/treating acute transfusion reactions. Guidance is given for treating patients with burns, extravasation of anaesthetic agents, intra-arterial injection, inoculation injury, and bone cement implantation syndrome. Advice is presented for managing fire in theatre. Clinical guidance/recipes are given for anaesthetising patients who have bled after tonsillectomy, thyroid surgery, or carotid endarterectomy. The final two sections concern patients undergoing emergency laparotomy or emergency aortic aneurysm repair. Each problem is addressed by firstly its definitions, presentation, investigations, risk factors, and exclusions; then how it can be managed in the immediate, medium-, and long-term situations. Finally, any special considerations are outlined, followed by a list of further reading.
Back from the brink: a reversible cardiac cause of fetal hydrops
Authors: Lloyd David , Simpson John , Zedere Vita
Published: August 2020

Fetal hydrops is a form of cardiovascular decompensation unique to fetal physiology, with a wide range of potential causes. In many conditions, it is associated with poor fetal outcome. This chapter explores a challenging case of fetal hydrops, discussing differential diagnoses, methods of echocardiographic assessment, and potential management options. Successful identification and treatment of the underlying cardiac disorder in this case led to complete resolution of hydrops, allowing for full-term delivery, with a good long-term prognosis.
Right ventricular outflow tract stenting in the management of tetralogy of Fallot with pulmonary artery hypoplasia and major aortopulmonary collaterals
Authors: Penford Gemma , Stumper Oliver
Published: August 2020

Fallot’s tetralogy is the most common cyanotic congenital heart lesion. It is a term that encompasses a spectrum of morphologies, all emerging from the fundamental feature of anterior deviation of the outlet septum and associated abnormalities of pulmonary blood flow. This case follows the journey of a patient with severe Fallot’s tetralogy and multifocal pulmonary blood flow from the neonatal period through to his post-operative period. The case explores key points in the assessment of these patients, addressing the medical, interventional, and surgical options for neonatal cyanosis, and then goes on to discuss common issues and pitfalls surrounding peri-operative care.
Neonatal enteroviral myocarditis: a potentially devastating disease
Authors: Donne Grazia Delle , Daubeney Piers
Published: August 2020

Myocarditis is the most common cause of dilated cardiomyopathy. Diagnosis can be challenging—the presentation can vary from mild heart failure to cardiogenic shock and is often preceded by respiratory or gastrointestinal symptoms. The aetiology is predominantly viral in childhood. The electrocardiogram, echocardiogram, and cardiac biomarkers all assist in making the diagnosis. There is an emerging role for cardiac magnetic resonance imaging as a diagnostic tool. Endocardial biopsy is the gold standard for the diagnosis, but the risk of the procedure often precludes its use in childhood. Treatment of myocarditis comprises standard heart failure management and, in the most severe cases, mechanical support and transplant. Overall, myocarditis has a better outcome than other causes of dilated cardiomyopathy. Surviving the initial episode is not assured but does lead to excellent long-term outcomes, both in terms of survival and recovery of left ventricular function.
Fetal management of hypoplastic left heart syndrome
Authors: Harris Michael , Sharland Gurleen
Published: August 2020

Hypoplastic left heart syndrome (HLHS) is a major form of congenital heart disease, with universal mortality if left untreated. Even with treatment, survival to eventual palliative univentricular Fontan circulation is in the order of 65% at the age of 5 years. The condition also carries with it a significant load in terms of comorbidities, recurrent interventions, and reduced quality of life. Fetal diagnosis of HLHS is important for accurately counselling the prospective parents on the available options during and after the pregnancy. It is crucial for the adequate planning of, and preparation for, delivery, with evidence emerging that babies delivered with such preparation are in better preoperative condition. Risk stratification is possible with the assessment of restrictive flow at the interatrial septum and the use of magnetic resonance imaging to assess the status of the fetal lungs in this situation. Fetal intervention in cases of a restrictive atrial septum is an emerging and challenging area, with limited evidence for efficacy currently. Due to the high-risk nature of this condition, it is difficult to prove that fetal diagnosis makes any significant impact on mortality.
The preterm patent ductus arteriosus: the controversy of closure
Authors: Abumehdi Mohammad Ryan , Hunter Lindsey
Published: August 2020

Management of preterm patent ductus arteriosus (PDA) has, and currently is, an issue of much contention. Management strategies have varied between conservative medical management to pragmatic PDA surgical ligation. However, despite the association between the haemodynamically significant ductus arteriosus and many of the morbidities of the preterm neonate, there remains no clear benefit in morbidity and mortality to closure. This case demonstrates the challenges faced by both the neonatal and the cardiology teams and the common trajectory for the preterm infant with the haemodynamically significant patent ductus arteriosus. The case highlights up-to-date developing techniques, clinical tips, and important learning points to aid the management of this common, but controversial, pathology.
Arrhythmias in congenital heart disease
Authors: Bruaene Alexander Van De , Haldar Shouvik , Nair Krishnakumar
Published: August 2020

Patients with congenital heart disease are prone to the entire spectrum of atrial and ventricular arrhythmias. The arrhythmia can be related to the malformation itself (e.g. Wolff–Parkinson–White in Ebstein anomaly), structural remodelling due to ageing/longer life expectancy (e.g. atrial fibrillation), mode of repair (e.g. intra-atrial re-entry tachycardia after right atrial incision or monomorphic ventricular tachycardia after tetralogy of Fallot repair), and severe ventricular dysfunction in those with end-stage heart failure. Therefore, adequate knowledge of the congenital heart defect, its current haemodynamics and arrhythmogenic substrate, precise assessment, and risk stratification will lead to appropriate arrhythmia management. This chapter discusses the diagnosis, assessment, and management of arrhythmia in two adult patients with congenital heart disease. The aim is to offer practical advice for managing these patients, supported by scientific data.
Common arterial trunk
Authors: Tretter Justin T , Alsaied Tarek , Redington Andrew N
Published: August 2020

Common arterial trunk, or truncus arteriosus, is a rare form of congenital heart disease defined by the presence of an arterial trunk which arises from the ventricular mass through a common ventriculo-arterial junction and gives rise to the systemic, pulmonary, and coronary circulations. The anatomical variation and associated cardiac anomalies dictate the clinical presentation and specific surgical repair strategy. This chapter reviews a common presentation of a newborn with common arterial trunk, serving as the basis for discussion of the anatomical variation, physiology, resulting clinical presentation and preoperative management, surgical repair strategy, and outcomes.
Dyslipidaemia
Authors: Drexel Heinz
Published: August 2020

Lipid metabolism has gained cardiological interest only after statins were demonstrated to reduce cardiovascular disease in secondary and primary prevention. Therefore, this chapter first introduces the physiological and atherogenic properties of lipoproteins, before focusing on interventions. Both the efficacy and safety of statins have been proven in numerous randomized clinical trials. Because there is a considerable residual risk in statin-treated patients, additional approaches have been investigated. The focus is now on further reductions in low-density lipoprotein (LDL) cholesterol levels. First, high-intensity statin regimens were shown to reduce residual risk. Subsequently, ezetimibe was demonstrated, for the first time, to have a beneficial effect as a non-statin lipid intervention. More recently, inhibitors of the enzyme PCSK9 have demonstrated a very high efficacy in reducing LDL cholesterol levels. Although the causality of LDL for atherosclerotic cardiovascular disease has been proven in epidemiological studies, including Mendelian randomization studies, as well as interventional trials, adherence to statins and other therapies is far from optimal. In contrast, interventions to increase high-density lipoprotein (HDL) cholesterol levels could not proven to have further benefits when combined with statins.
Thrombosis
Authors: Verheugt Freek
Published: August 2020

Blood coagulation plays a role in the pathogenesis of acute and chronic vascular disease. Acute myocardial infarction is generally associated with partial or complete thrombotic occlusion of one of the coronary arteries, whereas embolic stroke usually is associated with clot formation in the left atrium, left ventricle, or carotid arteries. Arteries in the lower extremities may get occluded by thrombosis, leading to ischaemia or amputation. Finally, venous thromboembolism is mainly caused by thrombus formation in the veins of the pelvis and/or the legs. This chapter deals with the effectiveness and safety of antiplatelet and anticoagulant drugs in primary and secondary prevention of cardiovascular disease.
Heart failure
Authors: Zannad Faiez , Ferreira João Pedro , McDonagh Theresa
Published: August 2020

Heart failure (HF) is a global pandemic affecting nearly 30 million people worldwide and is increasing in prevalence. Chronic heart failure with reduced left ventricular ejection fraction (HFrEF) results from impaired systolic dysfunction and represents about half of HF cases. The commonest aetiology is myocardial ischaemia. Chronic heart failure with preserved left ventricular ejection fraction (HFpEF) is symptoms and/or signs of heart failure, with left ventricular ejection fraction in the normal range. Acute HF is characterized by a rapid onset of signs and symptoms of HF, requiring urgent treatment. Acute HF may present as a first occurrence (de novo) or, more frequently, as a consequence of acute decompensation of chronic HF and may be caused by primary cardiac dysfunction or precipitated by extrinsic factors, often in patients with chronic HF. The diagnostic, workup, and treatment options for these conditions will be summarized in the chapter.
Atrial fibrillation
Authors: Dan Gheorghe-Andrei , Steffel Jan
Published: August 2020

Atrial fibrillation (AF) is the commonest cardiac arrhythmia in hopspitalized patients, with an increasing incidence with age and an epidemic increase projected for the next 10 years. Therapy of AF has several goals: to decrease mortality (mainly due to cardiovascular diseases), stroke rate, ventricular deterioration and heart failure, cognitive impairment, and dementia, as well as to increase quality of life. The recent European AF guidelines specify the management strategies for each of the above-mentioned goals. For stroke prevention, treatment with a non-vitamin K antagonist oral anticoagulant (NOAC) has emerged as the therapy of choice for the majority of patients with AF in the absence of rheumatic mitral disease and mechanical valve prostheses. However, in daily use of these drugs, many challenges remain that healthcare providers need to be aware of. Regarding treatment of the arrhythmia itself, it remains a therapy addressing the quality of life. Catheter ablation has emerged as a valid alternative for a variety of patients. Nevertheless, pharmacological antiarrhythmic drug therapy remains an important pillar for the majority of patients, and effective and safe use implies an important skill for every cardiologist.
Supraventricular (narrow complex) tachycardias
Authors: Martí-Almor Julio
Published: August 2020

Supraventricular tachycardia (SVT) includes all tachycardia rhythms (more than 100 bpm), of which the mechanism involves the His Bundle or tissues above it. Usually, these tachyarrhythmias present a narrow QRS complex (except in the presence of a bundle branch block or a manifest accessory pathway which conducts anterogradely to cause a ventricular pre-excitation pattern on the electrocardiogram). This chapter only focuses on narrow QRS complex SVT involving the atrial tissue, the atrioventricular node, and accessory pathways. Atrial fibrillation and atrial flutter are excluded because they are specifically covered in other chapters. The role of antiarrhythmic drugs in SVTs is mainly restricted to acute situations because ablative therapy has surrogate pharmacotherapy and ablation is considered the best long-term treatment for most cases. Nevertheless, it is very important to know how to deal with antiarrhythmic drugs in emergency situations.
Bradyarrhythmias
Authors: Burri Haran
Published: August 2020

This chapter overviews the types of bradycardia and their acute management, including the use of rate-accelerating drugs, and overviews the indications for pacemaker therapy. Focus is on pharmacotherapy with atropine, adrenaline, isoprenaline, isoproterenol, dobutamine, dopamine, theophylline, and aminophylline.
Syncope
Authors: Ruiz-Granell Ricardo
Published: August 2020

Syncope results from sudden, transient, global cerebral hypoperfusion. Neurally mediated syncope, orthostatic hypotension, arrhythmic and cardiac syncope, and steal syndromes are the main pathophysiological forms of syncope. This chapter focuses on the treatment of neurally mediated syncope and orthostatic syncope, since other forms of syncope are reviewed elsewhere. In neurally mediated and orthostatic syncope, patient education and non-pharmacological measures are the mainstay of treatment, although benefits of pharmacological treatment are not so evident.
Myocarditis and pericardial syndromes
Authors: Boffa Giovanni , Ceconi Claudio
Published: August 2020

Myocarditis is defined as inflammatory disease of the myocardium, diagnosed by established histological, immunological, and immunohistochemical criteria. Aetiology-targeted therapy is indicated when supported by evidence. However, in the vast majority of patients with myocarditis, the most important targets of treatment are heart failure and arrhythmias. Management of systolic left ventricular (LV) dysfunction should follow the recommendations of current European Society of Cardiology guidelines on heart failure. Immunosuppression is indicated only in giant cell myocarditis. In patients with severe LV dysfunction, inotropic support may be necessary and ventricular assist devices may represent a bridge to recovery or to heart transplantation There are no specific treatments of arrhythmias in myocarditis. Implantation of cardioverter–defibrillators must be deferred in the acute phase. In patients with severe ventricular arrhythmia, a wearable cardioverter–defibrillator can represent a bridge to recovery, implantation of cardioverter–defibrillators, or heart transplantation. Pericardial diseases may be either an isolated disease or part of a systemic disease. The main pericardial syndromes that are encountered in clinical practice include pericarditis (acute, subacute, chronic, and recurrent), pericardial effusion, cardiac tamponade, and constrictive pericarditis, and pericardial masses. Major advances have occurred in therapy with the first multicentre randomized clinical trials. Colchicine has been demonstrated as a first-line drug to be added to conventional anti-inflammatory therapies in patients with a first episode of pericarditis or recurrences, in order to improve response to therapy, increase remission rates, and reduce recurrences.
Kidney disease
Authors: Banerjee Debasish , Ramphul Robin , Goldsmith David
Published: August 2020

The cardiovascular disease profile in patients with chronic kidney disease, and liver disease and during pregnancy is different from that in the general population. Due to altered physiology in these conditions, drug handling is different. Hence, drug therapies in these conditions are described separately in this section. Cardiovascular disease is the commonest cause of morbidity and mortality in patients with chronic kidney disease. Yet drug therapy is often withheld or used in inappropriate doses. The kidneys have a major role in the pharmacokinetics of numerous drugs, and hence the renal function determines the dose and effect of these drugs. This chapter describes common cardiovascular events in chronic kidney disease patients and appropriate drug therapy. Evidence-based guidance is provided when appropriate, and the dose adjustments are as known, when available, in accordance to the current European Society of Cardiology guidelines.
Liver disease
Authors: Hojs Nina Vodošek , Ala Aftab , Banerjee Debasish
Published: August 2020

Cardiovascular disease in patients with liver disease, previously uncommon, is rising because of an increasing incidence of non-alcoholic fatty liver disease and better survival of patients with viral hepatitis, particularly hepatitis C. Liver dysfunction alters the pharmacokinetics and pharmacodynamics of many drugs, and hence careful use and dose adjustments are necessary. This chapter describes common cardiovascular conditions and the pharmacotherapy in patients with different liver diseases.
Major drug interactions
Authors: Poulsen Maja Hellfritzsch , Krogh Marlene Lunddal
Published: August 2020

Drug interactions are commonly present in our daily clinical work and have the ability to either enhance or reduce the effects of a drug, but also, just as importantly, decrease or increase the risk of side effects, thereby increasing the risk of toxicity. This chapter will focus on the clinically important drug–drug interactions with some of the most often used cardiovascular drugs and especially where there is a risk of causing harm to patients due to serious side effects. Both pharmacokinetic and pharmacodynamic interactions will be discussed, with focus on the most vulnerable patients. In some cases, drug combinations are contraindicated, whereas in other cases, the combinations can be used with, for example, close monitoring or dose reductions, but most importantly, the risk of interactions should be considered in order to take appropriate precautions upfront.
Cardiovascular drugs—from A to Z
Authors: Tamargo Juan , Caballero Ricardo , Delpón Eva
Published: August 2020

Cardiovascular drugs from A to Z.
Non-cardiac drugs affecting the heart—from A to Z
Authors: Delpón Eva , Tamargo Juan
Published: August 2020

Non-cardiac drugs affecting the heart.
Oxford Handbook of Emergency Medicine
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J.
Published: August 2020

The Oxford Handbook of Emergency Medicine is written for all junior doctors, specialist nurses, paramedics, clinical students, general practitioners, and other allied health professionals. It is a quick-reference guide to all the common conditions that present to the emergency department. It explores all emergency presentations, practices, and procedures in the areas of life-threatening emergencies, toxicology, infectious diseases, environmental emergency, analgesia and anaesthesia, major trauma, wounds, fractures, and orthopaedics, surgery, ophthalmology, ear, nose, and throat (ENT), obstetrics and gynaecology, psychiatry, and paediatric emergency.
General approach
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine is an introduction to the emergency department (ED). It discusses the practice of emergency medicine both within the ED and beyond. It explores patient flow, patient safety, and note keeping. It discusses the art of radiological request, triage, discharge, referral, and handover, as well as liaising with general practitioners (GPs) and the ambulance crew, giving telephone advice, and coping as a junior doctor. It examines inappropriate attenders, as well as the patient with a label, the difficult patient, special patient groups, and patient transfer. It explores the patient with learning difficulties, and assessment and discharge of the elderly patient. It discusses end-of-life care, including breaking bad news and what to do after death. Medicolegal aspects are examined, on both how to avoid trouble and duty under the law. Infection control and prevention, roadside emergency, and major incidents are also discussed.
Life-threatening emergencies
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine examines all aspects of life-threatening emergencies encountered in the emergency department (ED). It examines anaphylaxis and its treatment, as well as choking. It discusses cardiac arrest and its management, as well as in-hospital resuscitation and adult Basic and Advanced Life Support algorithm use, post-resuscitation care, and central venous access. It explores recognition of the sick patient, sepsis, and shock.
Medicine
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine encompasses all medicine practised in the emergency department (ED). It explores electrocardiogram interpretation, chest pain, cardiac ischaemia, acute coronary syndrome, ST segment elevation MI (STEMI), myocardial infarction, acute pericarditis, bradyarrhythmia, tachycardia, broad complex and regular narrow complex tachyarrhythmia, atrial fibrillation, hypertensive problems, implantable cardiac devices, and aortic dissection. It examines haemoptysis and administering oxygen, the dyspnoeic patient, hyperventilation, blood gas, pulmonary oedema, pleural effusion, asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary aspiration, and spontaneous pneumothorax. It discusses deep venous thrombosis and pulmonary embolism, gastrointestinal bleeding, gastrostomy, and refeeding syndrome. Jaundice is explored, alongside ascites and liver failure. It discusses headache, subarachnoid haemorrhage, migraine, giant cell arteritis, space-occupying lesions, acute confusional state (delirium), transient global amnesia, and the unconscious patient. Falls in the elderly are examined, along with collapse and syncope, acute generalized weakness, stroke, intracerebral haemorrhage, transient ischaemic attacks, seizures, and status epilepticus. It explores hypoglycaemia, hyperglycaemic crises, sodium derangements, Addisonian crisis, and thyrotoxic crisis. It discusses acute kidney injury, chronic kidney disease, urinary tract infection, hyperkalaemia, and hypokalaemia. It ends with an exploration of porphyria, bleeding disorders, anticoagulants, blood transfusion, and sickle-cell disease.
Infectious diseases
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine discusses infectious diseases in the emergency department (ED). It starts by examining the general subjects of incubation periods, notifiable infectious diseases, and childhood diseases. It goes on to explore specific diseases, including meningitis, acute encephalitis, herpes simplex virus, herpes varicella-zoster, Zika virus, gastroenteritis/food poisoning, fish poisoning, infestations, tuberculosis, anthrax, streptococcal infections, staphylococcal infections, tetanus, gas gangrene, botulism, sexually transmitted infections, hepatitis, leptospirosis (Weil’s disease), and human immunodeficiency virus (HIV). It discusses imported infectious diseases, such as malaria, typhoid and paratyphoid (enteric fever), dengue, poliomyelitis, rabies, viral haemorrhagic fevers, and severe acute respiratory syndrome, before looking at influenza pandemics, avian flu, and swine flu.
Major trauma
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates major trauma in the emergency department (ED). It reviews general treatment principles, resuscitation, and investigations, and explores airway obstruction, tension pneumothorax, rib fractures, sternal fracture, flail segment, ruptured diaphragm, oesophageal rupture, traumatic pneumothorax, haemothorax, chest drain insertion, pulmonary contusions and aspiration, penetrating chest injury, open chest injury, traumatic cardiac arrest, thoracotomy for cardiac arrest, aortic injury, focused assessment with sonography for trauma (FAST) scan, blunt abdominal trauma, penetrating abdominal trauma, renal trauma, bladder injury, urethral trauma, scrotal and testicular trauma, minor and serious head injury, post-concussion symptoms, carotid/vertebral artery dissection, maxillofacial injuries, mandibular injuries, temporomandibular joint dislocation, penetrating neck trauma, silver trauma, spine and spinal cord injury, dermatomes, gunshot injuries, blast injuries, burns, inhalation injury, and crush syndrome.
Surgery
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates surgery in the emergency department (ED). It reviews abdominal pain, acute appendicitis, acute pancreatitis, biliary tract problems, peptic ulcer disease, intestinal obstruction, mesenteric ischaemia/infarction, large bowel emergency, anorectal problem, and ruptured abdominal aortic aneurysm. It describes acute limb ischaemia, varicose veins, ureteric colic, and retention of urine, and explores penile problems, prostatitis, and testicular problems. It discusses cellulitis and erysipelas, abscesses, and complications after surgery.
Ophthalmology
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates ophthalmology in the emergency department (ED). It examines a general approach to eye problems before dealing with specific issues such as corneal trauma, contact lens problems, blunt eye injury, penetrating eye injury, sudden visual loss, the red eye, and pupillary abnormality.
Ear, nose, and throat
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates ear, nose, and throat (ENT) emergencies seen in the emergency department (ED). It reviews treatment of foreign bodies in the ear, nose, and throat, facial nerve palsy, ear examination, cochlear implants, earache, epistaxis, nasal fracture, sore throat, vertigo, salivary gland problems, dental anatomy, and dental emergencies.
Obstetrics and gynaecology
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates obstetrics and gynaecology in the emergency department (ED). It reviews gynaecological problems, vaginal discharge, contraceptive problems, genital injury, assault and female genital mutilation, gynaecological pain, and vaginal bleeding. It discusses the pregnant patient and explores prescribing, hyperemesis gravidarum, vaginal bleeding, miscarriage, ectopic pregnancy, vaginal bleeding in later pregnancy, abdominal pain, and medical complications of pregnancy. It also reviews emergency normal delivery, obstetric emergencies, trauma and cardiac arrest in pregnancy, and post-partum problems.
Psychiatry
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates psychiatry in the emergency department (ED). It provides a glossary of psychiatric terms and reviews the psychiatric interview and mental state examination. It explores dealing with the aggressive patient and safe consultations with potentially violent patients, managing aggression, and emergency tranquillization. It discusses self-harm, assessment of suicide risk, mental health assessment issues, depression, mania, schizophrenia, and complications of psychiatric drugs, as well as Munchausen’s syndrome and medically unexplained symptoms. It investigates how to deal with alcohol abuse, acute alcohol intoxication, alcohol withdrawal, alcohol-related brain injury, and help for alcoholics, as well as drug and substance abuse, compulsory hospitalization, and the Mental Capacity Act.
Context
Authors: Bashford Tom , Gore-Booth Julian , James Jo , Pickering Stephen , Paris Becky , Ross Oliver , Shamambo Naomi
Published: August 2020

The chapter provides the reader with information on the non-clinical background to working as an anaesthetist in a low-resource setting. It concentrates on important concepts that should inform the way you practise and teach, rather than technical aspects of anaesthesia. Although technical aspects of delivering anaesthesia are usually uppermost in the minds of anaesthetists new to working in low-resource settings, it is often the case that adapting successfully to the local context proves the more challenging aspect. Topics covered include humanitarian and developmental principles, teaching anaesthesia, looking after your own health, being a good visitor, and how to adapt your practice.
Anaesthesia Equipment and Utilities
Authors: Dobson Michael , Neighbour Robert , Wilkes Matt
Published: August 2020

The chapter covers anaesthetic equipment that may not be familiar to anaesthetists practising in high-resource settings. Primarily this means draw-over anaesthesia equipment—recognition, set-up, usage in adults and children, and practical tips. How to maintain your equipment yourself so that it continues to function safely is covered. The chapter also considers the two basic utilities of anaesthetic practice that are often taken for granted in high-resource settings—oxygen and electricity—and how to cope with an unpredictable supply of both. Hygiene and sterilization, a responsibility that often falls to the medical team in resource-poor settings, is also covered with practical advice on how to do it yourself.
Perioperative Care
Authors: Bashford Tom , Morriss Wayne , Roques Clare , Shamambo Naomi , Wilkes Matt
Published: August 2020

The chapter covers pre-op assessment in the context of limited availability to tests and investigations outlining the key considerations that should be made in assessing fitness for and appropriateness of surgery. Key aspects of consent within different cultural contexts are explored as well as important consent considerations for quality improvement and research projects. A practical approach to the assessment and management of pain in the context of limited availability of medications and trained staff is taken including the management of acute pain, non-surgical pain, pain related to cancer, chronic pain, and neuropathic pain. In the last section, key aspects of anaesthesia and resuscitation at high altitude are covered.
Obstetrics and Gynaecology
Authors: Collis Rachel , Jones Rebecca , O’Neill Sarah
Published: August 2020

In low-resource settings, obstetrics and gynaecology frequently forms a large part of the anaesthetist’s workload. The chapter serves both as an aide-memoire for those who are not regular practitioners in obstetric anaesthesia and as a guide to adapting your practice in low-resource settings. It contains practical advice on analgesia in labour and anaesthesia for Caesarean section, including spinal, general anaesthesia, and local anaesthesia techniques. It contains advice on drug alternatives in the absence of commonly used obstetric drugs, e.g. spinal bupivacaine. There are also sections on management of pre-eclampsia and obstetric haemorrhage, both of which are commonly encountered in low-resource settings. Neonatal resuscitation and non-obstetric surgery in the pregnant patient are also covered.
Trauma
Authors: Hodges Sarah , Janjanin Sanja , Kendell Judith , Lubis Nur , Nott David , Olim Nelson
Published: August 2020

In low- and middle-income countries, trauma, often from road traffic collisions, is one of the leading causes of morbidity and mortality. The approach to treating trauma in resource limited settings can be quite different to that in high-resource settings, requiring a lot of improvisation. The concepts of damage control surgery and resuscitation are covered, as are considerations for difficult patient groups such as head injuries, burns, and spinal injuries. The injury patterns seen as a result of armed conflicts (gun shots, blast injuries) will be unfamiliar to most anaesthetists and are also addressed in the chapter.