Prehospital Assessment and Systems of Care
Case Vignette A 56-year-old riverboat captain experienced sudden onset of shortness of breath and diaphoresis at 1:30 am while on his boat near Red Wing, Minnesota ( Figure 5-e1 )….
Clinical Practice/Controversy: Selection of Reperfusion Therapy and Transfer Strategies for Patients with ST-Elevation Myocardial Infarction
Case Presentation A 57-year-old man presents to a community hospital without capability for primary percutaneous coronary intervention (PPCI) in the early morning (4 am ) with a 1.5-hour history of…
Other Biomarkers and the Evaluation of Patients with Suspected Myocardial Ischemia
Introduction Cardiac troponin (cTn) is the preferred biomarker for the evaluation of patients with suspected acute myocardial infarction (MI) (see Chapter 7 ). In addition, it makes sense that other…
Risk Stratification in Acute Myocardial Infarction
Introduction Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide (see Chapter 2 ). Although an estimated 157,000 patients will die each year in the United…
Management Principles in Myocardial Infarction
Introduction The key principles that underlie management of myocardial infarction (MI) are based on the pathophysiology of the condition and the time course of irreversible myocardial injury. The fundamental goals…
Cardiac Imaging for Patients with Acute Chest Pain in the Emergency Department
Introduction Previous chapters have detailed the important roles of clinical presentation (see Chapter 6 ), cardiovascular risk factors, electrocardiography (ECG), and biomarkers (see Chapter 7 and Chapter 8 ) in…
Fibrinolytic Therapy for Patients with ST-Elevation Myocardial Infarction
Introduction A ST-segment myocardial infarction (STEMI) is caused by the occlusion of a major epicardial coronary artery and is generally triggered by rupture of a vulnerable plaque, with subsequent formation…
Clinical Practice/Controversy: Emergency Department Evaluation of the Lower-Risk Patient: Whom Can You Send Home?
Introduction Of the more than 8 million visits to emergency departments (EDs) in the United States for chest pain or other potential ischemic symptoms, only a small minority will yield…
Optical Coherence Tomography and Other Emerging Diagnostic Procedures for Vulnerable Plaque
Introduction Outcomes after percutaneous coronary intervention (PCI) have improved significantly over the past few decades, in large part because of newer stent platforms, better implantation techniques, and improved adjunctive medical…
New and Emerging Insights into the Pathobiology of Acute Myocardial Infarction
Introduction Atherosclerosis is a lipoprotein-driven chronic inflammatory disease of arteries that leads to the accumulation of fibrotic, necrotic, and calcified tissue in the arterial intima, which is described as an…
