BOOK
Emergency Cardiology: From ED to CCU, An Issue of Cardiology Clinics, E-Book
(2017)
Additional Information
Book Details
Abstract
This issue of Cardiology Clinics, edited by Dr. Amal Mattu and Dr. John Field, focuses Emergency Cardiology. Topics include, but are not limited to: Evaluation of Chest Pain and Acute Coronary Syndromes; Evolving Electrocardiographic Indications for Emergent Reperfusion; Cardiac biomarkers in emergency care; Non-ST-Segment Elevation Myocardial Infarction; Cardiogenic Shock, Acute Dyspnea and Decompensated Heart Failure; Evolving Strategies for Management of Cardiac Arrest; Multidisciplinary management post-cardiac arrest; Acute Myopericardial Syndromes; Acute Valvular Heart Disease; Ventricular Arrhythmias; Atrial Fibrillation, A New Face of Cardiac Emergencies: HIV-Related Cardiac Disease; Cardiovascular Emergencies in Pregnancy, and Blunt Cardiac Trauma.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Emergency Cardiology:From ED to CCU\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| EDITORIAL BOARD | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Emergency Cardiac Care: Rowing Together | vii | ||
| Evaluation of Chest Pain and Acute Coronary Syndromes | vii | ||
| Evolving Electrocardiographic Indications for Emergent Reperfusion | vii | ||
| Cardiac Biomarkers in Emergency Care | vii | ||
| Non–ST-Segment Acute Coronary Syndromes | vii | ||
| Cardiogenic Shock | viii | ||
| Acute Dyspnea and Decompensated Heart Failure | viii | ||
| Evolving Strategies in Cardiac Arrest Management | viii | ||
| Multidisciplinary Management of the Post–Cardiac Arrest Patient | viii | ||
| Acute Myopericardial Syndromes | ix | ||
| Acute Valvular Heart Disease | ix | ||
| Ventricular Arrhythmias | ix | ||
| Acute Management of Atrial Fibrillation: From Emergency Department to Cardiac Care Unit | ix | ||
| A New Face of Cardiac Emergencies: Human Immunodeficiency Virus–Related Cardiac Disease | x | ||
| Cardiovascular Emergencies in Pregnancy | x | ||
| Blunt Cardiac Trauma Review | x | ||
| CARDIOLOGY CLINICS\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| May 2018 | xi | ||
| August 2018 | xi | ||
| November 2018 | xi | ||
| RECENT ISSUES | xi | ||
| November 2017 | xi | ||
| August 2017 | xi | ||
| May 2017 | xi | ||
| Preface\r | xiii | ||
| Emergency Cardiac Care: Rowing Together | xiii | ||
| Evaluation of Chest Pain and Acute Coronary Syndromes | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| Myocardial Ischemia is a Spectrum | 1 | ||
| RISK STRATIFICATION IN THE EMERGENCY DEPARTMENT | 2 | ||
| History | 2 | ||
| Cardiac Risk Factors | 2 | ||
| Prior Cardiac History | 2 | ||
| Physical Examination | 3 | ||
| Electrocardiogram | 3 | ||
| Imaging | 3 | ||
| Biomarkers | 3 | ||
| When Should Troponin Testing Be Done? | 3 | ||
| Risk Stratification Scores | 4 | ||
| DIAGNOSTIC TESTING | 7 | ||
| Coronary Computed Tomography Angiography | 7 | ||
| THIRTY-DAY EVENTS | 7 | ||
| LONGER TERM OUTCOMES | 8 | ||
| Triple Rule-out | 9 | ||
| SUMMARY | 9 | ||
| REFERENCES | 9 | ||
| Evolving Electrocardiographic Indications for Emergent Reperfusion | 13 | ||
| Key points | 13 | ||
| INTRODUCTION | 13 | ||
| WELLENS SYNDROME | 13 | ||
| POSTERIOR ACUTE MYOCARDIAL INFARCTION | 15 | ||
| LEFT BUNDLE BRANCH BLOCK | 16 | ||
| PACED RHYTHM | 19 | ||
| DE WINTER ELECTROCARDIOGRAPHIC PRESENTATION | 19 | ||
| ELEVATION IN LEAD AVR | 21 | ||
| DEPRESSION | 21 | ||
| ELEVATION | 23 | ||
| SUMMARY | 24 | ||
| REFERENCES | 24 | ||
| Cardiac Biomarkers in Emergency Care | 27 | ||
| Key points | 27 | ||
| BACKGROUND | 27 | ||
| ANALYTICAL CONSIDERATIONS | 27 | ||
| HIGH-SENSITIVITY TROPONIN ASSAYS | 28 | ||
| EARLY RULE-OUT STRATEGIES WITH HIGH-SENSITIVITY TROPONIN ASSAYS | 29 | ||
| Accelerated Serial Sampling | 29 | ||
| Single Test Rule-Out | 30 | ||
| Using Cardiac Troponin with Risk Scores | 30 | ||
| USING CARDIAC TROPONIN TO RULE IN ACUTE MYOCARDIAL INFARCTION | 30 | ||
| Clinical Context | 33 | ||
| Detection of an Increase and/or Decrease of Troponin Concentrations | 33 | ||
| Possible Exceptions to the Requirement for Serial Sampling | 33 | ||
| OTHER BIOMARKERS TO ENHANCE THE DIAGNOSIS OF ACUTE CORONARY SYNDROME | 33 | ||
| SUMMARY | 34 | ||
| REFERENCES | 34 | ||
| Non–ST-Segment Acute Coronary Syndromes | 37 | ||
| Key points | 37 | ||
| INTRODUCTION | 37 | ||
| Epidemiology | 37 | ||
| Pathophysiology | 38 | ||
| Risk Stratification | 38 | ||
| DIAGNOSIS | 39 | ||
| Management | 39 | ||
| Medical Therapy | 40 | ||
| Oxygen | 40 | ||
| Nitrates | 40 | ||
| Analgesics | 40 | ||
| β-Adrenergic Blockers | 40 | ||
| Calcium-Channel Blockers | 41 | ||
| Ranolazine | 41 | ||
| INHIBITORS OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM | 41 | ||
| NON–ST-ELEVATION MYOCARDIAL INFARCTION | 41 | ||
| Aspirin | 41 | ||
| P2Y12 Receptor Inhibitors | 42 | ||
| Clopidogrel | 42 | ||
| Prasugrel | 42 | ||
| Ticagrelor | 43 | ||
| Cangrelor | 43 | ||
| Intravenous Glycoprotein IIb/IIIa Receptor Inhibitors | 43 | ||
| NON–ST-ELEVATION MYOCARDIAL INFARCTION | 44 | ||
| Unfractionated Heparin | 44 | ||
| Low Molecular Weight Heparin or Enoxaparin | 45 | ||
| Bivalirudin | 45 | ||
| Fondaparinux | 45 | ||
| Argatroban | 46 | ||
| TREATMENT STRATEGY | 46 | ||
| SUBGROUPS | 47 | ||
| SUMMARY | 48 | ||
| REFERENCES | 48 | ||
| Cardiogenic Shock | 53 | ||
| Key points | 53 | ||
| INTRODUCTION | 53 | ||
| DIAGNOSIS | 53 | ||
| EPIDEMIOLOGY | 53 | ||
| ETIOLOGIES | 54 | ||
| INITIAL EVALUATION | 54 | ||
| Physical Examination | 54 | ||
| Electrocardiogram | 55 | ||
| Chest Radiography | 55 | ||
| Laboratory Studies | 55 | ||
| Echocardiography | 55 | ||
| INITIAL RESUSCITATION AND MANAGEMENT | 56 | ||
| Medical Therapies | 56 | ||
| Intravenous fluids | 57 | ||
| Vasopressors | 57 | ||
| Inotropes | 58 | ||
| Reperfusion Therapy | 58 | ||
| Mechanical Support | 59 | ||
| SUMMARY | 60 | ||
| REFERENCES | 60 | ||
| Acute Dyspnea and Decompensated Heart Failure | 63 | ||
| Key points | 63 | ||
| INTRODUCTION | 63 | ||
| Background | 63 | ||
| Diagnosis | 64 | ||
| Initial Classification in the Emergency Department | 64 | ||
| Preserved Versus Reduced Ejection Fraction | 64 | ||
| A Framework for Initial Management: The 6-Axis Approach | 65 | ||
| Clinical Severity | 65 | ||
| Blood Pressure | 66 | ||
| Heart Rate and Rhythm | 66 | ||
| Precipitants | 67 | ||
| Comorbidities | 67 | ||
| De Novo Versus Decompensated Chronic Heart Failure | 67 | ||
| RISK-STRATIFICATION AND DISPOSITION | 67 | ||
| Observation Units for Heart Failure | 67 | ||
| Other Considerations | 68 | ||
| Future Directions | 68 | ||
| SUMMARY | 70 | ||
| DISCLOSURE | 70 | ||
| REFERENCES | 70 | ||
| Evolving Strategies in Cardiac Arrest Management | 73 | ||
| Key points | 73 | ||
| INTRODUCTION | 73 | ||
| CHEST COMPRESSIONS | 74 | ||
| Compression-Only Cardiopulmonary Resuscitation | 74 | ||
| Mechanical Cardiopulmonary Resuscitation | 74 | ||
| Alternative Manual Cardiopulmonary Resuscitation Techniques | 75 | ||
| PHARMACOLOGY | 75 | ||
| Epinephrine | 75 | ||
| Vasopressin | 76 | ||
| Amiodarone Versus Lidocaine | 76 | ||
| Corticosteroids | 76 | ||
| Thrombolytics | 76 | ||
| AIRWAY MANAGEMENT | 77 | ||
| Advanced Airway Techniques | 77 | ||
| Devices as Adjuncts to Ventilation | 77 | ||
| DEFIBRILLATION | 78 | ||
| PHYSIOLOGIC MONITORING OF THE QUALITY OF CARDIOPULMONARY RESUSCITATION | 78 | ||
| End-Tidal Carbon Dioxide | 78 | ||
| Near-Infrared Spectroscopy | 78 | ||
| Invasive Hemodynamics | 78 | ||
| EXTRACORPOREAL MEMBRANE OXYGENATION | 78 | ||
| SYSTEMS OF CARE | 79 | ||
| REFERENCES | 80 | ||
| Multidisciplinary Management of the Post–Cardiac Arrest Patient | 85 | ||
| Key points | 85 | ||
| OVERVIEW AND GOALS OF CARE | 85 | ||
| PATHOPHYSIOLOGY | 85 | ||
| Hypoxic Brain Injury | 86 | ||
| Systemic Ischemia–Reperfusion Injury | 86 | ||
| Myocardial Dysfunction | 87 | ||
| Underlying Etiology of Cardiac Arrest | 87 | ||
| NEUROLOGIC SUPPORT | 87 | ||
| Minimizing Secondary Brain Injury | 87 | ||
| Targeted Temperature Management | 88 | ||
| Seizures | 90 | ||
| Neurologic Prognostication | 90 | ||
| CARDIOVASCULAR SUPPORT | 93 | ||
| Medical Management | 93 | ||
| Emergency Revascularization Strategies | 93 | ||
| Mechanical Circulatory Support | 94 | ||
| REGIONALIZATION OF CARE | 94 | ||
| REFERENCES | 95 | ||
| Acute Myopericardial Syndromes | 103 | ||
| Key points | 103 | ||
| INTRODUCTION | 103 | ||
| ANATOMY AND FUNCTION OF THE PERICARDIUM | 103 | ||
| PATHOPHYSIOLOGY OF THE PERICARDIUM | 104 | ||
| BACKGROUND/DEFINITIONS/CRITERIA | 104 | ||
| EPIDEMIOLOGY | 106 | ||
| CAUSE | 106 | ||
| CLINICAL PRESENTATION | 106 | ||
| History | 106 | ||
| Physical Examination | 106 | ||
| Electrocardiographic Changes | 106 | ||
| Imaging and Laboratory Findings | 111 | ||
| Chest radiograph | 111 | ||
| Echocardiography | 111 | ||
| Computed tomography and MRI | 111 | ||
| Myocardial biopsy | 112 | ||
| TREATMENT | 112 | ||
| Urgent Treatment of Tamponade Physiology | 112 | ||
| Symptomatic Treatment of Pericarditis | 112 | ||
| Disposition | 113 | ||
| Prognosis | 113 | ||
| SUMMARY | 113 | ||
| SUPPLEMENTARY DATA | 113 | ||
| REFERENCES | 113 | ||
| Acute Valvular Heart Disease | 115 | ||
| Key points | 115 | ||
| INTRODUCTION | 115 | ||
| INITIAL EVALUATION | 115 | ||
| AORTIC REGURGITATION | 116 | ||
| Etiology and Pathophysiology | 116 | ||
| Clinical Presentation | 116 | ||
| Diagnosis | 116 | ||
| Treatment | 116 | ||
| SEVERE MITRAL REGURGITATION | 119 | ||
| Etiology and Pathophysiology | 119 | ||
| Clinical Presentation | 119 | ||
| Diagnosis | 120 | ||
| Treatment | 120 | ||
| Surgical Timing | 121 | ||
| SEVERE DECOMPENSATED AORTIC STENOSIS | 121 | ||
| Etiology and Pathophysiology | 121 | ||
| Clinical Presentation | 121 | ||
| Treatment | 122 | ||
| Surgery | 122 | ||
| ACUTELY DECOMPENSATED SEVERE MITRAL STENOSIS | 122 | ||
| Etiology and Pathophysiology | 122 | ||
| Clinical Presentation | 123 | ||
| Treatment | 123 | ||
| ACUTE PROSTHETIC VALVE DYSFUNCTION | 123 | ||
| Valve Thrombosis, Thromboembolic Events, and Obstruction | 123 | ||
| Acute Valvular Regurgitation | 124 | ||
| Hemolytic Anemia | 124 | ||
| SUMMARY | 124 | ||
| REFERENCES | 124 | ||
| Ventricular Arrhythmias | 129 | ||
| Key points | 129 | ||
| INTRODUCTION | 129 | ||
| Definitions of Ventricular Arrhythmia | 130 | ||
| DIAGNOSIS OF VENTRICULAR ARRHYTHMIA | 130 | ||
| Differentiation of Ventricular Tachycardia from Supraventricular Tachycardia on the 12-Lead Electrocardiograph | 130 | ||
| A 12-Lead Electrocardiograph After Termination of Ventricular Tachycardia | 130 | ||
| Specific Etiologies of Ventricular Arrhythmia | 130 | ||
| Clinical Evaluation | 132 | ||
| MANAGEMENT | 133 | ||
| Immediate Considerations | 133 | ||
| Definitive Management | 133 | ||
| VENTRICULAR ARRHYTHMIA IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS | 134 | ||
| Recognizing the Implantable Cardioverter-Defibrillator | 134 | ||
| Symptoms of Ventricular Arrhythmia in Patients with Implantable Cardioverter-Defibrillators | 134 | ||
| Implantable Cardioverter-Defibrillator Interrogation and Interpretation | 134 | ||
| Appropriate Implantable Cardioverter-Defibrillator Therapies | 135 | ||
| Inappropriate Implantable Cardioverter-Defibrillator Therapies | 136 | ||
| Electrical Storm | 136 | ||
| Miscellaneous Issues in Implantable Cardioverter-Defibrillator Management | 137 | ||
| REFERENCES | 138 | ||
| Acute Management of Atrial Fibrillation | 141 | ||
| Key points | 141 | ||
| INTRODUCTION | 141 | ||
| Definition | 141 | ||
| Epidemiology and Economic Implications | 142 | ||
| Morbidity and Mortality | 142 | ||
| Pathophysiology | 143 | ||
| Classification | 143 | ||
| INITIAL MANAGEMENT OF PATIENTS WITH ATRIAL FIBRILLATION | 143 | ||
| Atrial Fibrillation in Unstable Patients | 143 | ||
| Atrial Fibrillation in Stable Patients | 144 | ||
| Acute rhythm control | 145 | ||
| Chronic rhythm control | 148 | ||
| Acute rate control | 148 | ||
| Chronic rate control | 148 | ||
| Oral anticoagulation | 149 | ||
| Emergency department discharge versus admission | 152 | ||
| Management in Specific Situations | 154 | ||
| Atrial fibrillation complicating acute coronary syndrome | 154 | ||
| Atrial fibrillation and bradycardia | 155 | ||
| Wolfe-Parkinson-White syndrome | 155 | ||
| Pregnancy | 156 | ||
| REFERENCES | 156 | ||
| A New Face of Cardiac Emergencies | 161 | ||
| Key points | 161 | ||
| INTRODUCTION | 161 | ||
| CORONARY ARTERY DISEASE | 161 | ||
| Clinical Presentation and Management | 162 | ||
| Prognosis | 164 | ||
| HUMAN IMMUNODEFICIENCY VIRUS–ASSOCIATED CARDIOMYOPATHY | 164 | ||
| Epidemiology | 164 | ||
| Clinical Presentation | 164 | ||
| Management and Prognosis | 164 | ||
| PERICARDIAL DISEASE | 165 | ||
| Clinical Presentation in the Emergency Department | 165 | ||
| Prognosis and Therapy | 165 | ||
| INFECTIVE ENDOCARDITIS | 166 | ||
| Clinical Presentation in the Emergency Department | 166 | ||
| Prognosis and Therapy | 166 | ||
| MISCELLANEOUS CONDITIONS | 167 | ||
| Pulmonary Embolism | 167 | ||
| Arrhythmias | 167 | ||
| Cardiac Tumors | 167 | ||
| SUMMARY | 167 | ||
| REFERENCES | 167 | ||
| Cardiovascular Emergencies in Pregnancy | 171 | ||
| Key points | 171 | ||
| INTRODUCTION | 171 | ||
| CHEST PAIN SYNDROMES IN PREGNANCY | 171 | ||
| Acute Myocardial Infarction in Pregnancy | 171 | ||
| Risk factors | 172 | ||
| Clinical presentation | 172 | ||
| Diagnosis and management | 172 | ||
| Spontaneous Coronary Artery Dissection | 173 | ||
| Medical management | 173 | ||
| Percutaneous intervention | 173 | ||
| Surgical management | 173 | ||
| HYPERTENSIVE EMERGENCIES IN PREGNANCY | 174 | ||
| Gestational Hypertension and Preeclampsia: Definitions | 174 | ||
| Management | 174 | ||
| MANAGEMENT OF MITRAL STENOSIS IN PREGNANCY | 175 | ||
| Clinical Presentation of Mitral Stenosis | 175 | ||
| Diagnosis | 176 | ||
| Management | 177 | ||
| MANAGEMENT OF ACUTE HEART FAILURE IN PREGNANCY | 177 | ||
| Heart Failure Definitions | 178 | ||
| Presentation of Acute Heart Failure | 178 | ||
| Counseling | 178 | ||
| Management in the Emergency Department | 178 | ||
| Acute Heart Failure Therapy | 178 | ||
| Angiotensin Inhibition | 179 | ||
| Aldosterone Antagonists | 179 | ||
| Vasodilators | 179 | ||
| Diuretics | 179 | ||
| Digoxin | 179 | ||
| Beta-Blockers | 179 | ||
| Intravenous Inotropes | 180 | ||
| SUMMARY | 180 | ||
| REFERENCES | 180 | ||
| Blunt Cardiac Trauma Review | 183 | ||
| Key points | 183 | ||
| INTRODUCTION | 183 | ||
| TYPES OF BLUNT CARDIAC INJURY | 184 | ||
| Myocardial Injury | 184 | ||
| Septal Injury | 184 | ||
| Pericardial Injury | 185 | ||
| Valvular Injury | 185 | ||
| Myocardial Contusion | 186 | ||
| Commotio Cordis | 187 | ||
| DIAGNOSTIC APPROACH | 187 | ||
| Electrocardiography | 187 | ||
| Echocardiography | 188 | ||
| Computed Tomography | 189 | ||
| Disposition | 189 | ||
| SUMMARY | 189 | ||
| REFERENCES | 189 |