Disease and conditions 

Fecal breath odor, typically seen in conditions like intestinal obstruction or gastrojejunocolic fistula, signals a potentially life-threatening GI disorder. Immediate evaluation and emergency interventions, including possible surgery, are crucial for managing this condition.

Ammonia-scented breath, common in end-stage chronic kidney disease, is caused by metabolic disturbances and the breakdown of urea into ammonia. Regular oral care and dietary adjustments are important in managing this symptom.

A breast ulcer, often a late sign of cancer, can result from trauma, infection, or radiation. It requires careful evaluation of patient history, physical examination, and appropriate diagnostic tests to determine the underlying cause and guide treatment.

Breast pain is usually due to benign conditions like fibrocystic changes, infections, or hormonal shifts, rather than cancer. It can be cyclic or constant, affecting one or both breasts, and may radiate to the arms, back, or neck.

Hypertension can develop gradually or suddenly and may signal serious underlying conditions. It is more common in women using hormonal contraceptives, especially those over 35 who smoke.

Breast nodules are lumps in the breast that may be benign or malignant and require thorough evaluation. Most are caused by benign conditions like fibrocystic changes, but cancer must always be ruled out.

This rhythm does not require treatment, unless they are causing symptoms, i.e. syncope, dizziness, tiredness and poor effort tolerance. Sinus bradycardia < 50/minute or sinus arrest with slow escape rhythm, accompanied by hypotension, strongly suggests a treatable underlying cause:

Most cases occur in patients over 60 years and is idiopathic, with an excellent long-term prognosis, provided a permanent pacemaker is implanted.

Has a twisting pattern to the QRS complexes and a prolonged QT interval in sinus rhythm It is usually due to a QT–prolonging drug, ± hypokalaemia

Chronic pulmonary emboli are mainly a consequence of incomplete resolution of acute pulmonary thromboembolism. Clinically symptoms and signs may be preceded by Acute PE for more than two weeks

An acute pulmonary embolism, or embolus, is a blockage of a pulmonary (lung) artery. Most often, the condition results from a blood clot that forms in the legs or another part of the body (deep vein thrombosis, or DVT) and travels to the lungs.

These are chronic acquired sequelae of Acute Rheumatic Fever or Acute Sequelae of Infective Endorcaditis or Ischaemic Heart Disease, consisting of valvular damage, usually left heart valves, with varied progression of severity and complications.

It is a non–suppurative sequela of a group A ß haemolytic streptococcal (GABHS) pharyngeal infection.

The infective process of endocardial layer of the heart can involve native or prosthetic valve and congenital defects/shunts.

Pulmonary oedema or pulmonary congestion is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extravascular compartments of the lung

Patients who have had HF as defined above for some time are often said to have ‘Chronic Heart Failure’. A treated patient with symptoms and signs that have remained generally unchanged for at least 1 month is said to be ‘Stable chronic heart failure’

Heart Failure is a clinical syndrome characterized by typical symptoms that may be accompanied by signs caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.

Acute heart failure

AHF is defined as rapid or gradual onset of signs and symptoms of heart failure that results in urgent unplanned hospitalization or Emergency Medicine Department visits. The clinical signs and symptoms are significantly life threatening if the above features occur in patients with established diagnosis with structurally heart disease categorized as Acute Decompensated Heart Failure (ADHF). The cause and immediate precipitating factor(s) of the AHF must be identified and treated to prevent further damage to the heart.

Treatment Goals

To improve clinical symptoms and outcome, management strategy should be based on clinical, laboratory and haemodynamic findings. All patient with AHF should be cared and admitted to a high care dependent unit or Intensive Care Unit.

Consider oral vasodilators in case intravenous vasodilator not available or unavailability of intensive care or high dependent unit care
• Isosorbide mononitrate 10–20mg (PO) 12 hourly
OR
• Hydralazine 25 mg (PO) 6–8 hourly. Maximum dose: 200 mg/day

Inotropes (Inotropic agents)

Indicated in patients with hypotension (SBP <90 mmHg or mean arterial BP < 60mmHg) and peripheral hypoperfusion. Dosage see in image number 2 above.

Vasopressor (norepinephrine preferably) Indicated in patients with cardiogenic shock, despite treatment with another inotrope, to increase blood pressure and vital organ perfusion

Hypertension is elevation of Blood Pressure (BP) measured on at least three separate occasions. There is strong association between hypertension and CAD.

STEMI/AMI is a medical emergency caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and intensive care intervention management.

Non-ST Elevation Myocardial Infarction is medical emergency characterized with chest pain that is increasing in frequency and/or severity or occurring at rest.

Unstable angina is a medical emergency and if untreated can progress to Non-ST Elevation Myocardial Infarction (NSTEMI) 11, 12, 13.

Mostly from clinical history characterized by chest pain due to myocardial ischaemia usually inducible by exercise, emotion or other stress and reproducible, relieved by rest but may occur spontaneously and stable in nature.

Dyslipidemia is defined as having blood lipid levels that are too high or low. Lowering blood cholesterol levels using statins is recommended to reduce the impact of cardiovascular morbidity and mortality

Cardiovascular disease (CVD) prevention is a coordinated set of actions, at the population level or targeted at an individual at risk of developing cardiovascular disease, that are aimed at eliminating or minimizing the impact of CVDs and their related disabilities.

Hypertension that remains >140/90mmHg despite the use of 3 antihypertensive drugs in a rational combination at full doses and including a diuretic i.e. thiazide.

Symptomatic severe hypertension SBP 180mmHg and/or DBP >110 mmHg with evidence of Target Organ Damage or grade III/IV Retinopathy with no immediate life–threatening neurological or cardiac complication such seen in emergencies

A marked elevated systolic blood pressure SBP ≥ 180mmHg and/or a diastolic DBP ≥130mmHg associated with life threatening situations.