Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2022
ReviewPacemaker Malfunction-Review of Permanent Pacemakers and Malfunctions Encountered in the Emergency Department.
Pacemaker malfunction refers to a failure of the pacemaker to perform the desired cardiac pacemaking function. These malfunctions can occur anywhere within the system from the pulse generator and leads to the electrode-myocardium interface. These failures of sensing, capture, and inadequate pacing can have severe hemodynamic consequences, so rapid identification of specific dysfunction is critical to intervention and stabilization. Emergency providers should be aware of pacemaker components, function, basic programming, and types of malfunctions to adequately assess, stabilize, and disposition patients.
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Narrow-complex tachycardias are commonly seen on shift in the emergency department. Although a portion of patients present with hemodynamic instability because of arrhythmia, it is important to know that the tachycardia can be a result of an underlying condition. Rapid identification of the type and etiology of the arrhythmia is vital to directing appropriate management strategies and disposition decisions.
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Acute coronary syndrome is pathologically distinct in women and requires an appreciation of the specific risk factors, presenting symptoms, laboratory findings, and imaging results to treat correctly. Persistent disparities in mortality between men and women may be the result of failure to recognize and intervene, especially in the case of women aged less than 55 years. Protocols which establish criteria for activating the cardiac catheterization laboratory and which empower emergency department physicians to do so without delay show signs of eliminating disparities, as does guideline-directed therapy at the time of discharge from the hospital.
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Sudden cardiac death (SCD) describes the unexpected natural death from a cardiac cause within a short time period, generally 1 hour or lesser from the onset of symptoms, often due to a cardiac dysrhythmia. Overall, the most common cause of SCD is coronary artery disease but for patients aged younger than 35 years, the most common cause of SCD is a dysrhythmia in the setting of a structurally normal heart. This article will review the background, diagnosis, and management of the common hereditary channelopathies and cardiomyopathies associated with an increased risk of SCD in patients without ischemic heart disease.