Category Archives: Chest pain

ACS Updates

By Amy Sanghvi, MD Please refer to EMRAP Updated UA on NSTEMI guidelines. Focused update from Guidelines from 2007. Done to focus on new issues relative to antiplatelet medications: Ticagralor and Prasugrel (Effient). Many using Prasugrel instead of clopidogrel. P2Y12 … Continue reading

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Posterior MI: The Dark Side of the Moon

Goreselen et al. Neth Heart J. 2007 January; 15(1): 16–21. By Vincent Roddy, MD Background: True posterior MI is difficult to recognize bc the leads of the standard EKG are not a direct representation of the area involved.   Only with indirect changes … Continue reading

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Treatment of Aortic Dissection

By Paolo Hernandez, MD Please refer to EMCrit Most import thing is to lower dP/Dt, change in pressure seen by aorta over time, by decreasing heart rate, ionotropy and afterload.  This can be done by: -        Step 1:  Control pain!!! … Continue reading

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LBBB and Sgarbossa Criteria

By Christie Lech, MD Please refer to EMRAP Current recommendations for acute reperfusion treatment: Patient presenting with chest pain or other concerning symptoms Patient with a STEMI on EKG, a STEMI equivalent i.e. posterior MI, new or presumed new LBBB, … Continue reading

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Coronary CT’s for low-risk chest pain patients in the ED

By Will Fleischman, MD Refer to SMARTEM General comments Coronary CT and coronary angiography are anatomical tests and say nothing of the clinical significance of whatever it finds. And angiography has been made the gold standard without ever having been … Continue reading

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Early Repol vs STEMI

By Kei Ko, MD EKG differentiation of early repolarization from subtle anterior STEMI By Smith, S et al. Annals of EM, vol. 60:1, pages 45-56, July 2-12 Objective Differentiating anterior STEMI from early repolarization. Authors hypothesized that ST-segment elevation, T-wave … Continue reading

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The Value of Symptoms and Signs in the Emergent Diagnosis of Acute Coronary Syndromes

By Christie Lech, MD The Value of Symptoms and Signs in the Emergent Diagnosis of Acute Coronary Syndromes. Body R, Carley S, Wibberley C, et al. Resuscitation 2010;81:281-286. Purpose: To assess the value of individual symptoms and exam findings for … Continue reading

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SMARTEM: Updates

By William Fleishman MD, edited by David Newman MD                                                               … Continue reading

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SMART Stress Testing

by William Fleishman MD This is a little bit of a behemoth lecture and summary –  but well worth it. Stress Test: A test to determine whether a patient has myocardial ischemia during tachycardia   Exercise stress: looking for ECG … Continue reading

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Afib Unleashed

Head on over to ERCAST.org and search for Afib Unleashed. What is the optimal pad placement? – Optimal pad placement for cardioversion depends on the rhythm you are converting – For cardioversion of Afib, optimal placement will direct the energy to … Continue reading

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