ACLS Revision: Subtle ECG findings in ACS

acs

  • ST-segment elevation in lead aVR portends a worse prognosis in ACS and often predicts the need for CABG.
  • Hyperacute T-waves are not necessarily tall, and small T-waves can still be hyperacute when paired with a low-amplitude QRS complex.
  • The tall T-waves associated with hyperkalemia are sharp, pointy, symmetric, and have a narrow base.
  • When in doubt, get serial ECGs (every 15 minutes) and use adjunctive information.

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Where else is there evidence of STEMI?

Inferior STEMI

There is obvious inferior ST elevation, with reciprocal ST Depression in aVL (inferior STEMI). There is also ST Depression in lead I.  This is good evidence that the inferior STEMI is caused by an RCA occlusion. There is ST depression maximal in lead V2.  Thus, there is a posterior STEMI. There is also ST depression in V5 and V6.

Where else is there evidence of STEMI?

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Acute Heart Failure Management

Acute Heart Failure Management

  • Treatment of pulmonary edema should be focused on ‘fluid redistribution’ and not ‘fluid removal’.
  • First line: Nitroglycerin and NIV (start ASAP)
  • Second line: ACE-I (in addition or instead of NTG)
  • Third line: Diuretic like furosemide
  • Morphine has NO ROLE in modern management of cardiogenic pulmonary edema

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