How to identify that patient having a heart attack

Clinical factors that INCREASE likelihood of ACS/AMI:
  1. CP radiating bilaterally > right > left
  2. Diaphoresis associated with CP
  3. N/V associated with CP
  4. Pain with exertion

Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:

  1. Pleuritic
  2. Positional
  3. Sharp, stabbing
  4. Reproducible with palpation

Wellens’ Syndrome STEMI

What is Wellens’ Syndrome?

  1. History of Angina
  2. ECG Changes (T-wave Inversions/Biphasic T-waves in leads V2 – V4)
  3. Normal to Minimally elevated Cardiac Enzymes
  4. No pathologic precordial q waves
  5. No loss of precordial R wave progression


 

Shock, syncope, sweating… and severe chest pain!

A 67-year old male is brought to hospital following an episode of syncope at home. He had just finished eating lunch at home when he developed severe crushing retrosternal chest pain radiating to his left arm, profuse sweating and vomiting. Shortly after the onset of the pain he lost consciousness and awoke to find himself on the floor. En route, he has several brief episode of dizziness and an impalpable radial pulse.


Chest Pain…

A man in his 60’s presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. There was some SOB. He had walked into the ED (did not use EMS). He was in no distress and vital signs were normal.

Latest guidelines for the management of STEMI patients

Practice Guideline |

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

J Am Coll Cardiol. 2013;61(4):e78-e140.

Lipid-Modifying Therapy: A New Paradigm

For all those who love ordering lipid profiles…PLEASE STOP!!!! This is the latest evidence on statin therapy and risk for 10-year risk for first atherosclerotic cardiovascular disease events (ASCVD; nonfatal myocardial infarction, coronary heart disease