Chest pain
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This document discusses various causes of chest pain and their diagnostic characteristics. It describes angina pectoris as temporary myocardial ischemia usually due to atherosclerosis that presents as retrosternal chest pain and is diagnosed through ECG findings. Myocardial infarction is described as prolonged ischemia over 30 minutes that can cause hemodynamic changes. Pericarditis is identified as irritation of the parietal pleura near the pericardium causing sharp, knifelike pain relieved by leaning forward with potential pericardial friction rub on exam. Pulmonary embolism is outlined as a lodged blood clot in the pulmonary arterial tree that can cause dyspnea, fever, chest pain, and leg swelling. Pneumonia
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Chest pain
This document discusses various causes of chest pain and their diagnostic characteristics. It describes anginal chest pain caused by temporary myocardial ischemia, often due to atherosclerosis. Symptoms include retrosternal chest pain radiating to the shoulders, arms, neck or jaw. ECG findings in angina can include hyperacute T waves, ST elevation or significant Q waves. Treatment includes medications like antiplatelet drugs, beta-blockers, nitrates, calcium channel blockers, ACE inhibitors, and invasive strategies. Myocardial infarction results from prolonged ischemia over 30 minutes and is treated similarly. Pericarditis causes sharp, knifelike chest pain relieved by leaning forward, with a pericardial friction rub on exam.
Approachto cp
1. The document discusses the approach to evaluating and categorizing different types of chest pain, including acute coronary syndrome.
2. Key factors in the initial evaluation of chest pain include obtaining a detailed history, performing a physical exam, 12-lead EKG, and cardiac biomarker testing to help determine if the chest pain is caused by life-threatening conditions like myocardial infarction.
3. Patients are categorized as having possible acute ischemia, probable acute ischemia, or myocardial infarction based on their history, symptoms, physical exam findings, EKG results, and cardiac enzyme levels in order to determine the urgency of further testing and treatment.
Ischemic heart disease
Coronary heart disease is caused by inadequate blood flow to the heart muscle due to atherosclerotic plaques narrowing the coronary arteries or other non-atherosclerotic causes. The most common cause is coronary artery disease (CAD) due to plaque accumulation over time from risk factors like smoking, hypertension, diabetes, and hypercholesterolemia. Clinical manifestations range from stable angina to heart attack. Diagnosis involves ECG, cardiac enzymes, stress testing, and coronary angiography. Treatment depends on severity and includes medical management, percutaneous interventions, bypass surgery, and risk factor modification.
Chest Pain-case 2
A 60-year-old Chinese woman presented with chest pain. She had a history of hypertension and diabetes for 10 years. Her chest pain was central, tight, and radiated to her jaw and left arm. She experienced nausea, sweating, and dyspnea. Physical exam revealed she was obese. Electrocardiogram showed ST segment depression and T inversion. Blood tests showed elevated cardiac enzymes. She was diagnosed with a non-ST elevation myocardial infarction based on her symptoms, risk factors, and test results.
Acute coronary syndrome for undergraduates
Acute coronary syndrome (ACS) refers to conditions caused by reduced blood flow to the heart. It includes unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Symptoms include chest pain, shortness of breath, nausea, and fatigue. Diagnosis involves ECG changes such as ST elevation or T wave changes and elevated cardiac biomarkers. Treatment focuses on reperfusion with medications or procedures like PCI, along with anticoagulants, antiplatelets, and lifestyle modifications. Complications can be mechanical, arrhythmic, embolic or inflammatory.
Approach to the patient with chest pain
This document provides guidance on evaluating and diagnosing the causes of acute chest pain. It discusses:
- Myocardial ischemia/infarction and coronary artery disease are the most common serious causes of chest pain, but other cardiac, pulmonary, gastrointestinal, musculoskeletal, and psychiatric conditions can also cause chest pain.
- The clinical history and physical exam are important for determining if the chest pain is characteristic of cardiac ischemia or other potential life-threatening conditions like pulmonary embolism or aortic dissection. Atypical features make cardiac ischemia less likely.
- The initial evaluation of a patient with chest pain should assess clinical stability, immediate prognosis, and whether outpatient management or further testing is warranted based on cardiac
Clinical Assessment & Risk Stratification
Physical examination / clinical history
Electrocardiogram
Cardiac biomarkers
Risk stratification
Further investigations
Approach to chest pain
- Chest pain is a common reason for emergency department visits and hospitalizations, costing over $8 billion annually in the US. However, cardiac causes are only found in less than one third of patients.
- A thorough history and physical exam are important to determine the cause of chest pain and recognize life-threatening conditions like acute coronary syndrome. The character, location, radiation, timing and aggravating/relieving factors of the chest pain can provide clues to its origin.
- Electrocardiograms, blood tests, imaging studies and other diagnostic tests may be used to evaluate for conditions like heart attacks, pulmonary embolism, pneumonia and acid reflux as potential causes of chest pain. Recognizing these underlying
Recommended
Chest pain
This document discusses various causes of chest pain and their diagnostic characteristics. It describes anginal chest pain caused by temporary myocardial ischemia, often due to atherosclerosis. Symptoms include retrosternal chest pain radiating to the shoulders, arms, neck or jaw. ECG findings in angina can include hyperacute T waves, ST elevation or significant Q waves. Treatment includes medications like antiplatelet drugs, beta-blockers, nitrates, calcium channel blockers, ACE inhibitors, and invasive strategies. Myocardial infarction results from prolonged ischemia over 30 minutes and is treated similarly. Pericarditis causes sharp, knifelike chest pain relieved by leaning forward, with a pericardial friction rub on exam.
Approachto cp
1. The document discusses the approach to evaluating and categorizing different types of chest pain, including acute coronary syndrome.
2. Key factors in the initial evaluation of chest pain include obtaining a detailed history, performing a physical exam, 12-lead EKG, and cardiac biomarker testing to help determine if the chest pain is caused by life-threatening conditions like myocardial infarction.
3. Patients are categorized as having possible acute ischemia, probable acute ischemia, or myocardial infarction based on their history, symptoms, physical exam findings, EKG results, and cardiac enzyme levels in order to determine the urgency of further testing and treatment.
Ischemic heart disease
Coronary heart disease is caused by inadequate blood flow to the heart muscle due to atherosclerotic plaques narrowing the coronary arteries or other non-atherosclerotic causes. The most common cause is coronary artery disease (CAD) due to plaque accumulation over time from risk factors like smoking, hypertension, diabetes, and hypercholesterolemia. Clinical manifestations range from stable angina to heart attack. Diagnosis involves ECG, cardiac enzymes, stress testing, and coronary angiography. Treatment depends on severity and includes medical management, percutaneous interventions, bypass surgery, and risk factor modification.
Chest Pain-case 2
A 60-year-old Chinese woman presented with chest pain. She had a history of hypertension and diabetes for 10 years. Her chest pain was central, tight, and radiated to her jaw and left arm. She experienced nausea, sweating, and dyspnea. Physical exam revealed she was obese. Electrocardiogram showed ST segment depression and T inversion. Blood tests showed elevated cardiac enzymes. She was diagnosed with a non-ST elevation myocardial infarction based on her symptoms, risk factors, and test results.
Acute coronary syndrome for undergraduates
Acute coronary syndrome (ACS) refers to conditions caused by reduced blood flow to the heart. It includes unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Symptoms include chest pain, shortness of breath, nausea, and fatigue. Diagnosis involves ECG changes such as ST elevation or T wave changes and elevated cardiac biomarkers. Treatment focuses on reperfusion with medications or procedures like PCI, along with anticoagulants, antiplatelets, and lifestyle modifications. Complications can be mechanical, arrhythmic, embolic or inflammatory.
Approach to the patient with chest pain
This document provides guidance on evaluating and diagnosing the causes of acute chest pain. It discusses:
- Myocardial ischemia/infarction and coronary artery disease are the most common serious causes of chest pain, but other cardiac, pulmonary, gastrointestinal, musculoskeletal, and psychiatric conditions can also cause chest pain.
- The clinical history and physical exam are important for determining if the chest pain is characteristic of cardiac ischemia or other potential life-threatening conditions like pulmonary embolism or aortic dissection. Atypical features make cardiac ischemia less likely.
- The initial evaluation of a patient with chest pain should assess clinical stability, immediate prognosis, and whether outpatient management or further testing is warranted based on cardiac
Clinical Assessment & Risk Stratification
Physical examination / clinical history
Electrocardiogram
Cardiac biomarkers
Risk stratification
Further investigations
Approach to chest pain
- Chest pain is a common reason for emergency department visits and hospitalizations, costing over $8 billion annually in the US. However, cardiac causes are only found in less than one third of patients.
- A thorough history and physical exam are important to determine the cause of chest pain and recognize life-threatening conditions like acute coronary syndrome. The character, location, radiation, timing and aggravating/relieving factors of the chest pain can provide clues to its origin.
- Electrocardiograms, blood tests, imaging studies and other diagnostic tests may be used to evaluate for conditions like heart attacks, pulmonary embolism, pneumonia and acid reflux as potential causes of chest pain. Recognizing these underlying
Acute coronary syndrome updates 2012
- The document provides guidelines for the management of acute coronary syndrome (ACS), including definitions, risk stratification, diagnostic criteria, treatment protocols for STEMI, NSTEMI/UA, and secondary prevention strategies.
- It outlines the pathophysiology of ACS as resulting from atherosclerotic plaque rupture and thrombus formation, and differentiates between STEMI, NSTEMI, and UA based on ECG changes and cardiac biomarker levels.
- Initial management involves optimal medical therapy, while risk stratification determines whether conservative treatment or an invasive strategy including angiography and revascularization is most appropriate for intermediate-to-high risk NSTEMI/
Andrew Crouch, DO- Cardiac Emergencies...Emergency Medicine Board Review 2014...
A 12-year-old boy presented unresponsive after being struck in the chest by a baseball. Commotio cordis most commonly causes this and is associated with ventricular fibrillation. Commotio cordis occurs when an object strikes the chest and causes sudden death, most often in children aged 5 to 15 without known heart conditions. The document then discusses various cardiac conditions and emergencies including ischemic heart disease, ECG findings, treatments for acute coronary syndrome, and cardiomyopathies.
Chest pain
This document provides an overview of evaluating and managing chest pain. It discusses the many potential causes of chest pain including cardiac, pulmonary, gastrointestinal and psychiatric conditions. Key points include that up to 30% of cardiac catheterizations for suspected coronary artery disease are negative. The diagnostic workup involves considering the patient's history, symptoms, physical exam, ECG, cardiac biomarkers, imaging and ruling out life-threatening causes like aortic dissection and pulmonary embolism. For suspected acute coronary syndrome, treatment involves antiplatelet agents, anticoagulants, nitroglycerin, beta-blockers, oxygen and considering cardiac catheterization if within 90 minutes of symptoms.
Valvular heart disease
This document discusses various types of valvular heart disease including stenosis, regurgitation, and specific valve diseases like mitral stenosis. It covers the etiology, pathophysiology, clinical manifestations and diagnostic studies for each type. Treatment options discussed include medications, percutaneous balloon valvuloplasty, various surgical repair procedures like valvuloplasty, annuloplasty and chordoplasty, and valve replacements using mechanical or biologic prosthetic valves. Nursing management focuses on assessment, monitoring, education, and addressing diagnoses like activity intolerance and fluid overload.
Chest pain differentials
This document lists multiple potential pathologies that should be considered for patients presenting with chest pain, including cardiovascular issues like acute myocardial infarction, respiratory problems such as pneumonia, gastrointestinal issues like pancreatitis, musculoskeletal conditions like costochondritis, and other miscellaneous diagnoses including malignancy, hyperventilation, and post-herpetic neuralgia. It emphasizes that over 50% of emergency department presentations for chest pain are non-cardiac in nature.
Challenging case in acute coronary syndrome
Mr. Y, a 63-year-old male, presented with chest pain for 6 hours. His ECG, bloodwork, and cardiac markers were abnormal. He was found to have NSTEMI based on his symptoms, risk factors of smoking, elevated troponin and CK-MB levels, and unremarkable ECG. Angiography revealed a 90% stenosis in the proximal LAD, which was treated with PCI and stent placement. He was started on dual antiplatelet therapy with ticagrelor and aspirin according to ESC guidelines for management of NSTEACS.
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...PROFESSOR DR. MD. TOUFIQUR RAHMAN
This document provides information on evaluating and diagnosing chest pain, including differential diagnoses and case scenarios. It outlines objectives of establishing a differential diagnosis for chest pain and knowing how to diagnose conditions like myocardial infarction (MI), pulmonary embolism (PE), pneumothorax, and aortic dissection. Common etiologies of chest pain are described. Case scenarios provide examples of applying history, physical exam findings, and test results to arrive at probable diagnoses for various patient presentations of chest pain. Key investigations and management strategies for conditions like MI are also reviewed.Chest pain
This document discusses the evaluation and management of chest pain. It begins by listing the goals of rapid recognition of acute coronary syndrome, recognition of other life-threatening causes, and minimizing costs for patients with benign chest pain. It then provides statistics on chest pain visits and discusses the importance of not missing acute MIs. The remainder of the document discusses the evaluation of chest pain, including history, exam, ECG, cardiac enzymes, and differential diagnosis of potential causes of chest pain. It emphasizes assuming cardiac ischemia until proven otherwise and provides guidelines on management of NSTEMI, unstable angina, and STEMI.
Acute Coronary Syndrome
The document discusses acute coronary syndrome (ACS), including the clinical presentation, risk factors, diagnostic testing such as electrocardiograms and cardiac enzymes, and treatment approaches for ACS depending on whether it presents with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS such as unstable angina or non-STEMI. For STEMI patients, reperfusion therapy through either fibrinolysis or primary percutaneous coronary intervention is recommended to open the blocked vessel within specific time goals in order to reduce mortality.
Palpitation
This document discusses palpitations, which are an uncomfortable awareness of heartbeat caused by alterations in heart rate, rhythm, or contractions. It describes approaches to evaluating palpitations by determining if they are cardiac or non-cardiac in origin, if they are paroxysmal or persistent, and associated symptoms. Potential causes of palpitations include arrhythmias, valvular lesions, structural heart disease, drugs, electrolyte imbalances, and extracardiac factors like anxiety. The examination should include vitals and cardiac auscultation, with ECG, Holter monitoring, or event monitoring used to document any arrhythmias.
Approach to patient with a chest pain
This document discusses the approach to evaluating and managing a patient presenting with chest pain. It covers taking a history and performing a physical exam, investigating the cause which could be cardiac, pulmonary, gastrointestinal or musculoskeletal in nature. Specific cardiac conditions discussed include acute coronary syndrome, cardiac tamponade, aortic dissection, coronary artery vasospasm and pulmonary embolism. Pneumonia and pneumothorax are also reviewed. The presentation provides guidance on differential diagnosis, risk factors, signs and symptoms, diagnostic testing and treatment options for a patient with chest pain.
2 cardiac emergencies
This document discusses various cardiac emergencies including bradycardia, acute coronary syndromes, wide-complex tachycardias and ventricular tachycardia, pericardial tamponade, and more. It provides details on clinical presentation, differential diagnosis, ECG findings, and initial management for each condition. The treatment for unstable and pulseless rhythms like ventricular tachycardia involves immediate defibrillation, CPR, intubation, medications like epinephrine, amiodarone, lidocaine, and considering causes of electrolyte imbalances.
Cardiac emergencies
This document discusses various cardiac emergencies including myocardial infarction, angina pectoris, congestive cardiac failure, sudden cardiac arrest, cardiac tamponade, and cardiogenic shock. It provides details on the causes, symptoms, diagnostic measures, and management of these conditions. Specifically, it describes angina pectoris as chest pain caused by partial blockage of the coronary arteries, acute myocardial infarction as damage to the heart muscle caused by a blockage of blood supply, and cardiac tamponade as a life-threatening condition where fluid builds up in the space between the heart muscle and the sac surrounding the heart. The document emphasizes the importance of early recognition, CPR, defibrillation and medications in managing cardiac arrest and
Approach to chest pain
This document provides guidance on evaluating and managing patients presenting with chest pain. It outlines the general approach which includes ensuring patient stability, providing oxygen and analgesia. It describes performing a focused history and physical exam, as well as relevant investigations. It discusses life-threatening causes of chest pain including acute coronary syndrome, cardiac tamponade, pulmonary embolism, tension pneumothorax, and aortic dissection. For each condition, it details symptoms, signs, diagnostic tests, and general treatment approaches.
Tricuspid valve disease by T.N. Shanta
Tricuspid valve disease involves the valve on the right side of the heart. It can be caused by structural abnormalities present from birth (congenital) or acquired later in life. The two main types are tricuspid stenosis, where the valve does not open fully, and tricuspid regurgitation, where the valve does not close properly and allows blood to flow backward. Symptoms include fatigue, swelling, and pain. Diagnosis involves echocardiography and Doppler ultrasound of the heart. Treatment options include medical management or surgical repair or replacement of the tricuspid valve.
Cardiac Dysrhythmias.
This document summarizes disorders of heart rate, rhythm, and conduction. It discusses various types of arrhythmias including their causes, symptoms, diagnosis using electrocardiograms, and potential treatments. Specific arrhythmias covered include sinus bradycardia, sinus tachycardia, atrial fibrillation, atrial flutter, and supraventricular and ventricular rhythms. Management strategies such as electrical cardioversion, antiarrhythmic medications, catheter ablation, and anticoagulation are described.
Palpitations
Palpitations are defined as an uncomfortable awareness of the heartbeat. They can be caused by cardiac arrhythmias, psychiatric conditions like anxiety, or other miscellaneous factors like drugs or hyperthyroidism. The goal in evaluating patients with palpitations is to determine if they are caused by a potentially life-threatening arrhythmia. The physician takes a history on the nature of the palpitations and performs an examination and initial testing like an ECG or holter monitor. Depending on the results, further testing with echocardiogram, event recorder, or mobile cardiac telemetry may be used to diagnose the underlying cause, which is important to guide management and reassurance of the patient.
Rheumatic heart disease
Rheumatic heart disease is a chronic condition that results from rheumatic fever, which causes inflammation of all layers of the heart. It is characterized by scarring and deformity of the heart valves, most commonly affecting the mitral and aortic valves. Rheumatic fever is caused by an untreated streptococcal infection and occurs most often in children aged 5-15 from low socioeconomic backgrounds. It leads to 40-60% of cases developing rheumatic heart disease. Medical management focuses on preventing recurrent streptococcal infections with long-term antibiotic prophylaxis while surgical intervention may be needed for severe valve damage or heart failure.
Ischemic heart disease
The document discusses ischemic heart disease (IHD), including its causes, symptoms, types (such as stable angina, unstable angina, and myocardial infarction), risk factors, diagnosis, and management. IHD is caused by reduced blood flow to the heart muscle, usually due to coronary artery disease. It presents with chest pain and other symptoms and is diagnosed through electrocardiograms, exercise tolerance tests, echocardiograms, isotope scans, and coronary angiography. Investigation aims to determine the severity and location of arterial blockages for guiding revascularization procedures.
Acute coronary syndrome ppt
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
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2) PacBio sequencing generated over 15 billion bases of long read data, which was used to assemble the genome into contigs over 15 Mb in length with fewest errors compared to the reference.
3) The PacBio assemblies helped close gaps in the reference genome and generated large contigs from heterochromatic regions that were previously unassembled.
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The document provides tips and advice for media relations and digital content strategies. It suggests knowing your audience and their interests to develop an effective content strategy. It also emphasizes the importance of creating content once and publishing it across multiple platforms, using metrics to evaluate performance and make revisions, and treating content creation as an ongoing, iterative process of execution, assessment, and improvement.
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Acute coronary syndrome updates 2012
- The document provides guidelines for the management of acute coronary syndrome (ACS), including definitions, risk stratification, diagnostic criteria, treatment protocols for STEMI, NSTEMI/UA, and secondary prevention strategies.
- It outlines the pathophysiology of ACS as resulting from atherosclerotic plaque rupture and thrombus formation, and differentiates between STEMI, NSTEMI, and UA based on ECG changes and cardiac biomarker levels.
- Initial management involves optimal medical therapy, while risk stratification determines whether conservative treatment or an invasive strategy including angiography and revascularization is most appropriate for intermediate-to-high risk NSTEMI/
Andrew Crouch, DO- Cardiac Emergencies...Emergency Medicine Board Review 2014...
A 12-year-old boy presented unresponsive after being struck in the chest by a baseball. Commotio cordis most commonly causes this and is associated with ventricular fibrillation. Commotio cordis occurs when an object strikes the chest and causes sudden death, most often in children aged 5 to 15 without known heart conditions. The document then discusses various cardiac conditions and emergencies including ischemic heart disease, ECG findings, treatments for acute coronary syndrome, and cardiomyopathies.
Chest pain
This document provides an overview of evaluating and managing chest pain. It discusses the many potential causes of chest pain including cardiac, pulmonary, gastrointestinal and psychiatric conditions. Key points include that up to 30% of cardiac catheterizations for suspected coronary artery disease are negative. The diagnostic workup involves considering the patient's history, symptoms, physical exam, ECG, cardiac biomarkers, imaging and ruling out life-threatening causes like aortic dissection and pulmonary embolism. For suspected acute coronary syndrome, treatment involves antiplatelet agents, anticoagulants, nitroglycerin, beta-blockers, oxygen and considering cardiac catheterization if within 90 minutes of symptoms.
Valvular heart disease
This document discusses various types of valvular heart disease including stenosis, regurgitation, and specific valve diseases like mitral stenosis. It covers the etiology, pathophysiology, clinical manifestations and diagnostic studies for each type. Treatment options discussed include medications, percutaneous balloon valvuloplasty, various surgical repair procedures like valvuloplasty, annuloplasty and chordoplasty, and valve replacements using mechanical or biologic prosthetic valves. Nursing management focuses on assessment, monitoring, education, and addressing diagnoses like activity intolerance and fluid overload.
Chest pain differentials
This document lists multiple potential pathologies that should be considered for patients presenting with chest pain, including cardiovascular issues like acute myocardial infarction, respiratory problems such as pneumonia, gastrointestinal issues like pancreatitis, musculoskeletal conditions like costochondritis, and other miscellaneous diagnoses including malignancy, hyperventilation, and post-herpetic neuralgia. It emphasizes that over 50% of emergency department presentations for chest pain are non-cardiac in nature.
Challenging case in acute coronary syndrome
Mr. Y, a 63-year-old male, presented with chest pain for 6 hours. His ECG, bloodwork, and cardiac markers were abnormal. He was found to have NSTEMI based on his symptoms, risk factors of smoking, elevated troponin and CK-MB levels, and unremarkable ECG. Angiography revealed a 90% stenosis in the proximal LAD, which was treated with PCI and stent placement. He was started on dual antiplatelet therapy with ticagrelor and aspirin according to ESC guidelines for management of NSTEACS.
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...PROFESSOR DR. MD. TOUFIQUR RAHMAN
This document provides information on evaluating and diagnosing chest pain, including differential diagnoses and case scenarios. It outlines objectives of establishing a differential diagnosis for chest pain and knowing how to diagnose conditions like myocardial infarction (MI), pulmonary embolism (PE), pneumothorax, and aortic dissection. Common etiologies of chest pain are described. Case scenarios provide examples of applying history, physical exam findings, and test results to arrive at probable diagnoses for various patient presentations of chest pain. Key investigations and management strategies for conditions like MI are also reviewed.Chest pain
This document discusses the evaluation and management of chest pain. It begins by listing the goals of rapid recognition of acute coronary syndrome, recognition of other life-threatening causes, and minimizing costs for patients with benign chest pain. It then provides statistics on chest pain visits and discusses the importance of not missing acute MIs. The remainder of the document discusses the evaluation of chest pain, including history, exam, ECG, cardiac enzymes, and differential diagnosis of potential causes of chest pain. It emphasizes assuming cardiac ischemia until proven otherwise and provides guidelines on management of NSTEMI, unstable angina, and STEMI.
Acute Coronary Syndrome
The document discusses acute coronary syndrome (ACS), including the clinical presentation, risk factors, diagnostic testing such as electrocardiograms and cardiac enzymes, and treatment approaches for ACS depending on whether it presents with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS such as unstable angina or non-STEMI. For STEMI patients, reperfusion therapy through either fibrinolysis or primary percutaneous coronary intervention is recommended to open the blocked vessel within specific time goals in order to reduce mortality.
Palpitation
This document discusses palpitations, which are an uncomfortable awareness of heartbeat caused by alterations in heart rate, rhythm, or contractions. It describes approaches to evaluating palpitations by determining if they are cardiac or non-cardiac in origin, if they are paroxysmal or persistent, and associated symptoms. Potential causes of palpitations include arrhythmias, valvular lesions, structural heart disease, drugs, electrolyte imbalances, and extracardiac factors like anxiety. The examination should include vitals and cardiac auscultation, with ECG, Holter monitoring, or event monitoring used to document any arrhythmias.
Approach to patient with a chest pain
This document discusses the approach to evaluating and managing a patient presenting with chest pain. It covers taking a history and performing a physical exam, investigating the cause which could be cardiac, pulmonary, gastrointestinal or musculoskeletal in nature. Specific cardiac conditions discussed include acute coronary syndrome, cardiac tamponade, aortic dissection, coronary artery vasospasm and pulmonary embolism. Pneumonia and pneumothorax are also reviewed. The presentation provides guidance on differential diagnosis, risk factors, signs and symptoms, diagnostic testing and treatment options for a patient with chest pain.
2 cardiac emergencies
This document discusses various cardiac emergencies including bradycardia, acute coronary syndromes, wide-complex tachycardias and ventricular tachycardia, pericardial tamponade, and more. It provides details on clinical presentation, differential diagnosis, ECG findings, and initial management for each condition. The treatment for unstable and pulseless rhythms like ventricular tachycardia involves immediate defibrillation, CPR, intubation, medications like epinephrine, amiodarone, lidocaine, and considering causes of electrolyte imbalances.
Cardiac emergencies
This document discusses various cardiac emergencies including myocardial infarction, angina pectoris, congestive cardiac failure, sudden cardiac arrest, cardiac tamponade, and cardiogenic shock. It provides details on the causes, symptoms, diagnostic measures, and management of these conditions. Specifically, it describes angina pectoris as chest pain caused by partial blockage of the coronary arteries, acute myocardial infarction as damage to the heart muscle caused by a blockage of blood supply, and cardiac tamponade as a life-threatening condition where fluid builds up in the space between the heart muscle and the sac surrounding the heart. The document emphasizes the importance of early recognition, CPR, defibrillation and medications in managing cardiac arrest and
Approach to chest pain
This document provides guidance on evaluating and managing patients presenting with chest pain. It outlines the general approach which includes ensuring patient stability, providing oxygen and analgesia. It describes performing a focused history and physical exam, as well as relevant investigations. It discusses life-threatening causes of chest pain including acute coronary syndrome, cardiac tamponade, pulmonary embolism, tension pneumothorax, and aortic dissection. For each condition, it details symptoms, signs, diagnostic tests, and general treatment approaches.
Tricuspid valve disease by T.N. Shanta
Tricuspid valve disease involves the valve on the right side of the heart. It can be caused by structural abnormalities present from birth (congenital) or acquired later in life. The two main types are tricuspid stenosis, where the valve does not open fully, and tricuspid regurgitation, where the valve does not close properly and allows blood to flow backward. Symptoms include fatigue, swelling, and pain. Diagnosis involves echocardiography and Doppler ultrasound of the heart. Treatment options include medical management or surgical repair or replacement of the tricuspid valve.
Cardiac Dysrhythmias.
This document summarizes disorders of heart rate, rhythm, and conduction. It discusses various types of arrhythmias including their causes, symptoms, diagnosis using electrocardiograms, and potential treatments. Specific arrhythmias covered include sinus bradycardia, sinus tachycardia, atrial fibrillation, atrial flutter, and supraventricular and ventricular rhythms. Management strategies such as electrical cardioversion, antiarrhythmic medications, catheter ablation, and anticoagulation are described.
Palpitations
Palpitations are defined as an uncomfortable awareness of the heartbeat. They can be caused by cardiac arrhythmias, psychiatric conditions like anxiety, or other miscellaneous factors like drugs or hyperthyroidism. The goal in evaluating patients with palpitations is to determine if they are caused by a potentially life-threatening arrhythmia. The physician takes a history on the nature of the palpitations and performs an examination and initial testing like an ECG or holter monitor. Depending on the results, further testing with echocardiogram, event recorder, or mobile cardiac telemetry may be used to diagnose the underlying cause, which is important to guide management and reassurance of the patient.
Rheumatic heart disease
Rheumatic heart disease is a chronic condition that results from rheumatic fever, which causes inflammation of all layers of the heart. It is characterized by scarring and deformity of the heart valves, most commonly affecting the mitral and aortic valves. Rheumatic fever is caused by an untreated streptococcal infection and occurs most often in children aged 5-15 from low socioeconomic backgrounds. It leads to 40-60% of cases developing rheumatic heart disease. Medical management focuses on preventing recurrent streptococcal infections with long-term antibiotic prophylaxis while surgical intervention may be needed for severe valve damage or heart failure.
Ischemic heart disease
The document discusses ischemic heart disease (IHD), including its causes, symptoms, types (such as stable angina, unstable angina, and myocardial infarction), risk factors, diagnosis, and management. IHD is caused by reduced blood flow to the heart muscle, usually due to coronary artery disease. It presents with chest pain and other symptoms and is diagnosed through electrocardiograms, exercise tolerance tests, echocardiograms, isotope scans, and coronary angiography. Investigation aims to determine the severity and location of arterial blockages for guiding revascularization procedures.
Acute coronary syndrome ppt
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
What's hot (20)
Andrew Crouch, DO- Cardiac Emergencies...Emergency Medicine Board Review 2014...
Andrew Crouch, DO- Cardiac Emergencies...Emergency Medicine Board Review 2014...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
Chest pain evaluation dr md toufiqur rahman dm fcps facc frcp fesc faha fscai...
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2) PacBio sequencing generated over 15 billion bases of long read data, which was used to assemble the genome into contigs over 15 Mb in length with fewest errors compared to the reference.
3) The PacBio assemblies helped close gaps in the reference genome and generated large contigs from heterochromatic regions that were previously unassembled.
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IEDC's Leadership Summit is the only annual conference exclusively for Certified Economic Developers and senior managers in the profession. What draws attended to this unique conference and what can you expect for 2017? Find out this and more with this captivate SlideShare. For more details and to register visit iedconline.org/LeadershipSummit
Ashoka the great....
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ITIL ServiceNow offerings
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Template design credits - http://www.slidescarnival.com
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Visceral pain from chest organs is poorly localized and described as dull, while parietal pain from the chest wall is sharp and localized. Chest pain evaluations start with ABCs and aspirin, then involve EKG, monitoring, and pain relief. A thorough history and physical exam aim to differentiate causes like acute coronary syndrome, aortic dissection, pulmonary embolism, pneumonia, or musculoskeletal issues. Diagnostic testing may include markers, echocardiogram, Wells criteria, CT scans, and management depends on the specific diagnosis and stability of the patient.
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This document discusses the approach to evaluating and managing chest pain. It notes that chest pain is a common reason for emergency department visits and hospitalizations. A thorough history and physical exam is important to determine the likely cause, such as cardiac, pulmonary, gastrointestinal, or musculoskeletal origins. Initial testing may include an ECG, cardiac enzymes, chest x-ray, and echocardiogram. Life-threatening causes like myocardial infarction, pulmonary embolism, and aortic dissection require rapid diagnosis and treatment. Management depends on the identified condition but may include medications, procedures, or surgery.
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This document provides a summary of a cardiology lecture covering various topics including chest pain, shortness of breath, atrial fibrillation, acute coronary syndrome, heart failure, and management strategies. Specific cases are discussed including a 72-year-old man presenting with chest pain and a 72-year-old woman presenting with shortness of breath. Differentials, examinations, investigations, and treatment plans are outlined for various cardiac conditions.
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Qualifications:
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ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
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Learning objectives:
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2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Chest pain
- 1. The Medical Beast Page 1 CHEST PAIN Diagnostic Pathophysiology Past history Complains Physical signs ECG Chest X-Ray Treatment CARDIOVASCULAR Angina pectoris Temporary myocardial ischemia, usually secondary to atherosclerosis Man of > 50 years with Cardiovascular risk factors Retrosternal, radiating to the shoulders, arms, neck, lower jaw or upper abdomen Normal OK IN ANGINA -hyper acute T waves(tall and symmetric) -ST elevation -significant Q waves (>40msec OR >1/3 QRS) -inverted T waves NORMAL -General measures -Antiplatelet therapy -B-blockers -Nitrates -CCB -ACE inhibitors -Invasive strategies Myocardial infarction Prolong ischemia >30 min Same as in angina, but >30 min Possible hemodynamic changes NORMAL Pericarditis Irritation of the parietal pleura adjacent to the pericardium Viral infection, Autoimmune disorders, post- myocardial infarction Sharp, knifelike pain, relieve when leaning forward Pericardial friction rub -Diffuse ST elevation -PR segment depression -upright T waves -isoelectric ST, flat or inverted T waves Cardiomegaly, rounded cardiac countour -treat underlying disease -high dose NSAIDs -colchicine rate of incessant/recurrent pericarditis Aortic dissection A splitting within the layers of the aortic wall Hypertension Marfan syndrome tearing chest pain, radiating to the neck, back or abdomen Aortic insufficiency murmur, Weak pulses normal Enlargement of the aortic arc Surgery PULMONARY
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