Cardiac Infarctions Under Disguise

This post was peer reviewed.
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Author: Joshua Bowers, DO 

Emergency Medicine Resident
Adena Regional Medical Center

Ischemic heart disease and coronary artery disease (CAD) are two of the leading causes of death among adults in developed countries.[6] Patients with these disorders can present to the emergency department with problems that fall anywhere along the spectrum of clinical diseases referred to as acute coronary syndrome (ACS). ACS is the result of myocardial ischemia and can range from unstable angina to ST-segment elevation myocardial infarction (STEMI) that requires emergent intervention. STEMI requires immediate recognition; however not all STEMIs present with elevations on the initial standard 12-lead electrocardiogram (ECG).[1]

In general, ECGs provide a rapid way to evaluate for signs of cardiac ischemia and rhythm disturbances. While the ECG is one of the best tests in the emergency department to assess and evaluate the evolution of ACS, ECGs have limitations. One of these limitations is the inability to evaluate the posterior wall.[3,6]

Resident Journal Review: Low Risk Chest Pain

Originally Published: Common Sense, Winter 2011

Original Authors: Susan Cheng, MD MPH; Jonathan Yeo, MD; Eli Brown, MD; Allison Regan, MD

Edited by Michael C. Bond, MD FAAEM; and Alena Lira, MD

This Resident Journal Review focuses on a common problem faced in the adult emergency department (ED) – the “low risk” chest pain patient. How do you efficiently evaluate chest pain and plan a safe disposition? What are the latest guidelines, methods of risk stratification, diagnostic aids and strategies for laboratory testing and imaging? Finally, what are the criteria for further cardiac testing?

Cardiology Pearl: Wellens' Syndrome

Photo: Wikimedia Commons
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Originally Published: Modern Resident, Aug/Sep 2011

Original Author: Alan Sielaff, MS IV Loyola University Chicago, Stritch School of Medicine

Submitted by: Rachel Engle, DO Communications Committee Co-Chair
 
A 63 year old female with a history of hepatitis C and diabetes mellitus presents to the emergency department after experiencing acute substernal chest pain, SOB and emesis during a routine visit to her PCP earlier this afternoon. All symptoms spontaneously resolved shortly prior to her arrival in the ED. She has no other complaints and a normal physical exam. Her EKG is shown above.