Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewHuman Immunodeficiency Virus Infection-Related Heart Disease.
Human immunodeficiency virus (HIV) infection and antiretroviral medications are independent risk factors for cardiovascular disease. In the pre-antiretroviral therapy (ART) era, HIV-infected patients had increased morbidity and mortality from opportunistic infections; in the post-ART era, these patients are at increased risk of chronic diseases such as acute coronary syndrome, coronary artery disease, cardiac arrhythmias, and cardiomyopathy. They may present with vague symptoms such as weakness, dyspnea, or fatigue as the initial presentation of their cardiovascular disease. An overview of the clinical presentation, workup, management, and treatment of different cardiovascular disease is provided in this article.
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewChameleons: Electrocardiogram Imitators of ST-Segment Elevation Myocardial Infarction.
The imperative for timely reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) underscores the need for clinicians to have an understanding of how to distinguish patterns of STEMI from its imitators. These imitating diagnoses may confound an evaluation, potentially delaying necessary therapy. Although numerous diagnoses may mimic STEMI, several morphologic clues may allow the physician to determine if the pattern is concerning for either STEMI or a mimicking diagnosis. Furthermore, obtaining a satisfactory history, comparing previous electrocardiograms, and assessing serial tests may provide valuable clues.
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Blunt cardiac injury encompasses multiple different injuries, including contusion, chamber rupture, and acute valvular disorders. Blunt cardiac injury is common and may cause significant morbidity and mortality; a high index of suspicion is needed for accurate diagnosis. ⋯ Patients with myocardial contusion should be observed for 24 to 48 hours for arrhythmias. Many other significant forms of blunt cardiac injury require surgical intervention.
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Cardiogenic shock is the leading cause of morbidity and mortality in patients presenting with acute coronary syndrome. Although early reperfusion strategies are essential to the management of these critically ill patients, additional treatment plans are often needed to stabilize and treat the patient before reperfusion may be possible. This article discusses pharmacologic and surgical interventions, their indications and contraindications, management strategies, and treatment algorithms.