Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Cardiological Emergencies

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Cardiological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Myocardial Infarction (AMI)	Chest pain or discomfort, often described as pressure, tightness, or squeezing, radiating to the arm, neck, jaw, or back. Shortness of breath, diaphoresis (sweating), nausea, and lightheadedness. Symptoms may be atypical in women, elderly patients, and those with diabetes.	Electrocardiogram (ECG) showing ST-segment elevation, T-wave inversion, or new left bundle branch block. Serum cardiac biomarkers (troponin, CK-MB) elevated. Chest X-ray to rule out other causes of chest pain.	Immediate administration of aspirin, nitrates, and oxygen if hypoxic. Reperfusion therapy: Primary percutaneous coronary intervention (PCI) is preferred; thrombolytic therapy if PCI is not available. Beta-blockers, ACE inhibitors, and statins as part of long-term management. Anticoagulation with heparin or enoxaparin during acute management.
Cardiac Tamponade	Beck's triad: Hypotension, muffled heart sounds, and jugular venous distension (JVD). Tachycardia, pulsus paradoxus (a drop in systolic BP >10 mm Hg during inspiration), and dyspnoea. May follow trauma, malignancy, pericarditis, or myocardial rupture.	Echocardiography showing pericardial effusion with signs of tamponade (e.g., right atrial or ventricular diastolic collapse). ECG may show low voltage QRS complexes or electrical alternans. Chest X-ray showing an enlarged cardiac silhouette (water-bottle heart) in chronic cases.	Urgent pericardiocentesis to remove fluid from the pericardial sac. Volume expansion with IV fluids to increase cardiac output. Treatment of the underlying cause (e.g., pericarditis, malignancy).
Aortic Dissection	Sudden onset of severe, tearing chest or back pain, often radiating to the neck or abdomen. Asymmetry in blood pressure between arms, pulse deficits, and possible signs of shock. History of hypertension, connective tissue disorders, or bicuspid aortic valve.	CT angiography of the chest and abdomen showing the dissection flap and extent of the dissection. Transesophageal echocardiography (TEE) or MRI if CT is not available. Chest X-ray may show a widened mediastinum.	Immediate blood pressure control with IV beta-blockers (e.g., esmolol) and vasodilators (e.g., nitroprusside). Urgent surgical repair for type A dissections (involving the ascending aorta). Medical management and close monitoring for type B dissections (descending aorta) without complications.
Pulmonary Embolism (PE)	Sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis. Tachypnea, tachycardia, hypoxia, and signs of deep vein thrombosis (DVT) such as leg swelling or pain. Possible syncope or shock in massive PE.	CT pulmonary angiography (CTPA) showing filling defects in the pulmonary arteries. D-dimer test to rule out PE in low-risk patients. ECG may show sinus tachycardia, right heart strain (e.g., S1Q3T3 pattern).	Immediate anticoagulation with IV heparin or low-molecular-weight heparin (LMWH). Thrombolytic therapy for massive PE with hemodynamic instability. Consider surgical embolectomy or catheter-directed thrombolysis in severe cases. Long-term anticoagulation and investigation for underlying causes (e.g., malignancy, thrombophilia).
Ventricular Tachycardia (VT)	Palpitations, dizziness, syncope, or sudden cardiac arrest. Rapid, regular heart rate (usually >150 bpm) with wide QRS complexes on ECG. May occur in patients with underlying heart disease, electrolyte imbalances, or after an MI.	ECG showing wide QRS complex tachycardia. Serum electrolytes to check for abnormalities (e.g., hypokalemia, hypomagnesemia). Echocardiography or cardiac MRI to assess underlying structural heart disease.	If unstable, immediate synchronized cardioversion. If stable, antiarrhythmic medications (e.g., amiodarone, lidocaine) may be used. Correction of underlying electrolyte imbalances. Consideration of implantable cardioverter-defibrillator (ICD) in patients at high risk of recurrence.
Acute Heart Failure / Pulmonary Edema	Severe shortness of breath, orthopnea, and paroxysmal nocturnal dyspnoea. Crackles on lung auscultation, frothy sputum, and signs of fluid overload (e.g., peripheral edema, JVD). Tachycardia, hypotension, and possible cyanosis in severe cases.	Chest X-ray showing pulmonary congestion, interstitial edema, and possibly pleural effusions. BNP or NT-proBNP levels elevated, indicating heart failure. Echocardiography to assess ejection fraction and rule out structural abnormalities.	Immediate administration of IV diuretics (e.g., furosemide) to reduce fluid overload. Oxygen therapy or non-invasive ventilation (CPAP/BiPAP) for respiratory distress. Vasodilators (e.g., nitroglycerin) to reduce preload and afterload. Inotropic support (e.g., dobutamine) for patients with cardiogenic shock.
Hypertensive Emergency	Severe hypertension (typically >180/120 mm Hg) with evidence of end-organ damage. Symptoms may include chest pain, headache, visual changes, dyspnoea, or neurological deficits. May lead to complications such as stroke, myocardial infarction, or acute kidney injury.	Blood pressure measurement confirming severe hypertension. ECG, urinalysis, and blood tests (e.g., creatinine) to assess for end-organ damage. Head CT or MRI if neurological symptoms are present.	Immediate IV antihypertensive agents (e.g., labetalol, nitroprusside, nicardipine) to gradually reduce blood pressure. Monitoring in an ICU setting with continuous blood pressure monitoring. Treatment of the underlying cause (e.g., pheochromocytoma, renal artery stenosis).
Bradycardia with Hemodynamic Instability	Heart rate <60 bpm with signs of decreased perfusion (e.g., hypotension, altered mental status, chest pain). May be caused by sinus node dysfunction, AV block, or drug overdose. Symptoms include dizziness, syncope, fatigue, and shortness of breath.	ECG showing bradycardia and possible heart block. Serum electrolytes to rule out hyperkalemia or other metabolic causes. Drug levels if overdose is suspected (e.g., beta-blockers, digoxin).	Immediate administration of atropine IV; if ineffective, consider transcutaneous pacing. Dopamine or epinephrine infusion if bradycardia persists and pacing is not immediately available. Identify and treat the underlying cause (e.g. stop offending medications, correct electrolyte imbalances). Permanent pacemaker may be required for persistent symptomatic bradycardia.
Acute Coronary Syndrome (ACS) - Unstable Angina/NSTEMI	Chest pain or discomfort that is new, occurs at rest, or is worsening in frequency or intensity. May be associated with shortness of breath, diaphoresis, nausea, and lightheadedness. Symptoms may be atypical in women, elderly patients, and those with diabetes.	ECG showing ST-segment depression or T-wave inversion; may be normal in some cases. Serum cardiac biomarkers (troponin) may be elevated in NSTEMI, but not in unstable angina. Chest X-ray to rule out other causes of chest pain.	Immediate administration of aspirin, nitrates, and oxygen if hypoxic. Anticoagulation with heparin or enoxaparin, and dual antiplatelet therapy (e.g., aspirin and clopidogrel). Beta-blockers and statins as part of long-term management. Consideration of early invasive strategy (e.g., coronary angiography) in high-risk patients.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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