Cardiology clinics
-
Blunt chest trauma represents a spectrum of injuries to the heart and aorta that vary markedly in character and severity. The setting, signs, and symptoms of chest trauma are often nonspecific, which represents a challenge to emergency providers. Individuals with suspected blunt chest trauma who have only mild or no symptoms, a normal electrocardiogram (ECG), and are hemodynamically stable typically have a benign course and rarely require further diagnostic testing or long periods of close observation. Individuals with pain, ECG abnormalities, or hemodynamic instability may require rapid evaluation of the heart by echocardiography and the great vessels by advanced imaging.
-
Diagnosis of ST-segment elevation myocardial infarction has long been considered time sensitive. Several other electrocardiogram abnormalities, sometimes referred to as "STEMI-equivalents", should also alert the clinician to conditions similarly requiring aggressive intervention. The de Winter/ST/T complex, ST-segment elevation in lead aVR, Wellens' phenomenon, posterior wall myocardial infarction, and pathologic ST changes in the presence of left bundle branch block and pacemakers are all discussed in this article.
-
As the prevalence of systolic heart failure increases, the population of patients in need of advanced therapies becomes larger. As the number of transplants performed each year plateaus, the prevalence of community-dwelling patients with ventricular assist devices (VADs) increases. A broad range of physicians, including emergency physicians, general cardiologists, and generalists, will be exposed to these patients, and must be informed on the disease processes and complications specific to these devices. With an understanding of up-front evaluation and management, these patients may be triaged and stabilized, and will benefit before referral for definitive care by a VAD specialist.
-
Hypertensive crises, which include hypertensive emergencies and urgencies, are frequently encountered in the emergency department, and require immediate attention as they can lead to irreversible end-organ damage. Normal blood pressure (BP) regulation is altered during acute rises in BP, leading to end-organ damage. ⋯ Special considerations should be given to hypertensive pregnant patients and patients with postoperative hypertension. Treatment should be individualized to each patient based on the type and extent of end-organ damage, degree of BP elevation, and the specific side effects that each medication could have on a patient's preexisting comorbidities.
-
Acute coronary syndromes result in a significant burden of morbidity and mortality in the United States. This spectrum of acute coronary thrombosis (including unstable angina, non-ST-segment elevation myocardial infarction, and ST-elevation myocardial infarction) has been well studied in large clinical trials. This review details the initial management of patients presenting with possible acute coronary syndromes in the context of care from the emergency department to the cardiac care unit. The importance of a rapid and focused evaluation, risk stratification, and appropriate therapies are discussed.