Emergency Cardiology: Challenges, Controversies, and Advances
William J. Brady, MD
Wyatt W. Decker, MD Guest Editors
Amal Mattu, MD
Theemergency physician faces signiﬁcant clinical challenges on a regular basis. One particular area of clinical challenge concerns cardiovascular emergencies, ranging from the patient with acutemyocardial infarction (AMI) complicated by bradycardia to the child with respiratory failure due to a congenital heart lesion. The dyspneic patient with bradycardia and pulmonary congestion: cardiotoxicingestion or acute coronary syndrome? The chest pain patient with the left bundle branch block electrocardiogram (ECG) pattern: AMI or noncoronary presentation? The cyanotic neonate with tachycardia:sepsis or congenital heart defect? The elderly patient with back pain presenting in shock: abdominal aortic aneurysm or pyelonephritis? The middle-aged female with headache and elevated blood pressure: ahypertensive emergency or elevated blood pressure due to cephalgia? These scenarios depict only a few diagnostic cardiovascular challenges encountered daily by the emergency physician. The mostappropriate diagnostic and therapeutic approach to the patient in these and other cardiovascular presentations is constantly changing as research continues to improve emergency cardiovascular care. Thepatient with acute coronary syndrome (ACS) represents numerous challenges to the emergency physician. Clearly, the diagnosis of ACS is a daily challenge; numerous obstacles are encountered by theclinician, including atypical histories, confounding ECG patterns, and equivocal
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