4. Quick simple diagnostic and bed-side modalities to rapidly differentiate serious underlying medical emergencies

Patients presenting in the emergency department with chest pain, breathlessness, palpitation or sweating or with pre-syncope or syncope may have a wide range of differentials as a cause. Some of the conditions may be very serious and of grave outcomes if not managed immediately. Emergency physicians can use some important skills, tools and diagnostic tests to pick very serious underlying conditions which are the causes of these presentations. Timely management and disposition of these conditions may impact the overall outcome and prognosis. Here we will mention few tests and investigations which will help in differentiating the cause of cardiovascular symptoms.

#### a. ECG


4. Metabolic/electrolyte abnormalities

5. Management of important cardiac emergencies in the ED

criteria satisfying the diagnosis of acute, evolving or recent MI.

Acute coronary syndrome includes a spectrum of clinical presentations which range from unstable angina to non-ST elevation MI and ST elevation MI. They can be differentiated on the basis of history, ECG changes and blood investigations. The management started should be

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Unstable angina: It is referred to as pre-infarction angina or pre-occlusive syndrome. It is a

Myocardial infarction: It is defined as cell death and necrosis. Below mentioned are the

b. ECG changes (either Q waves or changes consistent with ischemia like ST or T wave

Diagnosis is done based on the history and physical examination and finally after diagnostic testing. The diagnostic testing includes ECG, chest X-Ray, serum cardiac markers, echocardiography, scintigraphy and CT angiography depending on the requirement and the availability.

The management goal is early revascularization and reperfusion using either fibrinolysis or primary angioplasty. In places where PCI is available, quick cardiologist consultation and activation of PCI code are needed so that the cardiologist is involved to decide which pathway to follow. Delay in getting PCI does not justify avoiding thrombolysis. If, for any reason, expected time for PCI is more than 90 min, then thrombolysis is the choice of treatment.

Oxygen should be administered when blood oxygen saturation is 90% or if the patient is in respiratory distress. In patients whose ischemic symptoms are not relieved by nitrates and

5.1. Acute coronary syndrome

according to the diagnosis.

warning sign of infarction.

changes)

5.1.2. Diagnosis

ECG findings of MI:

5.1.3. Management

1. Rise and fall of cardiac markers with

c. Coronary artery interventions

Medical management is divided into two categories:

5.1.3.1. Pharmacologic intervention

2. Pathological findings of acute MI

a. Symptoms of ischemia

5.1.1. Spectrum of ACS

5. Arrhythmias

#### b. Bed-side Ultrasound:


### c. Bed-side Echo


#### d. X-Ray:

