Common Presentations: Cardiac Patients.

ACS (Angina, NSTEMI, and STEMI)

• Generally the presenting complaint is chest pain. Classically, this will be described as sudden onset and gradually increasing in severity. The pain is often characterized as crushing, squeezing, heaviness or pressure, located retrosternal, constant, and not relieved with rest or nitro (with the exception or stable angina pain). The pain may radiate to the arm, shoulder, jaw, or upper back.

• Pallor.

• Diaphoresis.

• Dyspnea.

• Nausea and vomiting.

• Anterior-lateral MI usually presents with Tachycardia, and hypertension.

• Inferior MI usually presents with hypotension and either bradycardia or tachycardia if the SA node is not affected. Look for STE in ii, iii, and aVF.

Treatments:

• ASA

• 12-lead ECG

• IV cannulation

• Nitroglycerine unless inferior wall MI is present.

• If STEMI, Defibrillator pads should be placed immediately as a precaution.

• Transport STEMI to a Cath lab as per local protocols.

Thoracic Aortic Dissection:

• Sudden, maximal intensity, sharp tearing pain that is felt through to the mid scapula.

• Dypnea.

• Pallor.

• Diaphoresis.

• Nausea.

• May have bilateral BP differences.

• Will be hypertensive unless dissection has led to rupture.

• If the dissection occurs over a carotid artery branch, there may be stroke-like symptoms.

• If the dissection occurs into the pericardium, a tamponade will develop. Look for Beck's Triad, and electrical alternans on the ECG.

Treatments:

• Supplemental O2.

• 12-lead ECG.

• IV cannulation with potential bolus if hypotension develops.

• Rapid transport. This patient needs a surgeon.

Acute Cardiogenic Pulmonary Edema:

• Typically occurs in the setting of left ventricular infarction, so see ACS above for that presentation. Also occurs with patients who have existing CHF, in the form of an exacerbation.

• Patients usually report gradual increase in dyspnea over days to weeks, with orthopnea and paroxysmal nocturnal dyspnea.

• Usually patients are quite hypertensive, with SBP >170mmHg.

• Pedal edema, JVD, and evidence of right heart failure are also usually present.

• Patients usually report significant changes in weight due to fluid accumulation.

• Auscultation will generally reveal rales (course crackles) from the bases to the apices.

Treatments:

• Supplemental O2.

• IV cannulation.

• Nitroglycerine.

• 12-lead ECG.

• CPAP.

Cardiac Dysrhythmia:

• The 2 most common complaints associated with dysrhythmia are palpitations, and syncope.

• Dyspnea.

• Dizziness.

• Hypotension.

• Pallor.

• Weakness.

• Confusion.

Treatments:

• Supplemental O2 if needed.

• 3-lead ECG interpretation.

• 12-lead ECG to identify rhythm if the patient is stable.

• IV cannulation.

• ALS may correct the dysrhythmia if appropriate.

• BLS should transport to ED for cardioversion. Note: If the patient is in a wide complex tachycardia, place defibrillator pads as this can rapidly deteriorate.

Cardiac Tamponade:

• Chest pain.

• Weakness.

• Altered LOA.

• Hypotension with narrow pulse pressure.

• JVD.

• Diminished heart tones.

• Electrical alternans on ECG.

Treatments:

• IV cannulation.

• 12-lead ECG.

• Fluid bolus.

• Rapid transport.