Cardiology clinics
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The 12-lead electrocardiogram (ECG) remains the cornerstone of prompt diagnosis of STEMI; Furthermore, the 12-lead ECG provides the primary indication for emergent reperfuison therapy in the STEMI patient. In certain cases, a patient's ECG can resemble STEMI yet manifest ST-segment elevation from a non-coronary-based syndrome; these entities are termed the STEMI mimics and include benign early repolarization, acute pericarditis, and left ventricular aneurysm, to name only a few. In other situations, the patient's ECG makes it difficult or impossible to determine whether STEMI is present, the so-called STEMI confounders and include left bundle branch block pattern, left ventricular hypertrophypattern, and the ventricular paced pattern. The goal with STEMI mimics and confounders is to maximize rapid, accurate diagnosis while avoiding delays in treatment of alternative causes of ST-segment elevation.
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Approximately 330,000 ST-elevation myocardial infarctions (STEMI) occur yearly in the United States. Emergent reperfusion is the cornerstone of STEMI therapy and the key to restoration of coronary blood flow in an infarct-related vessel. ⋯ Timely reperfusion is highly dependent on a well-structured care system designed to meet the needs of each individual community. This article reviews the data behind different reperfusion strategies and introduces successful systems-of-care models.
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Care of the patient with return of spontaneous circulation following sudden cardiac death is complex and challenging. A systematic and comprehensive approach can increase the chances of meaningful recovery of the postarrest patient. This article focuses on a systematic approach to the postarrest patient, which includes optimizing oxygenation and ventilation, maintaining adequate perfusion pressure, monitoring oxygen delivery, initiating and maintaining therapeutic hypothermia, and identifying patients appropriate for emergent cardiac catheterization. Using this approach, providers treating the postarrest patient can maximize the chance that a patient walks out of the hospital neurologically intact.
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Atrial fibrillation (AF) is the most common tachyarrhythmia encountered in clinical practice. One-third of hospitalizations in the United States are attributed to AF, with increasing rates in the past decade. ⋯ Hallmarks of acute AF management are accurate diagnosis, clinical stabilization, symptom relief through rate or rhythm control, thromboembolic stroke risk modification, and treatment of underlying causes. Meticulous and individualized acute evaluation based on these goals facilitates successful transition to long-term collaborative optimization of outcomes.