Archive for category: Cardiovascular

The Death of MONA in ACS: Part III – Nitroglycerin

05 Nov
November 5, 2017

Background: Nitroglycerin is a first line agent in the treatment of ACS. The physiologic basis for it’s use rests on it’s ability to promote coronary vasodilation resulting in increased blood flow to the coronary arteries . Nitroglycerin, is typically given as sublingual tablets or sublingual spray of 0.3 – 0.4mg q5min x3 for ischemic chest […]

The Death of MONA in ACS: Part II – Oxygen

05 Nov
November 5, 2017

Background: The first report for supplemental oxygen for angina was in 1900, and since then oxygen therapy has been a commonly used treatment of patients with ST-Elevation Myocardial Infarction (STEMI).  The reason for this is the belief that supplemental oxygen will increase oxygen delivery to ischemic myocardium and help reduce myocardial injury.  This belief is […]

The Death of MONA in ACS: Part I – Morphine

05 Nov
November 5, 2017

Background: Morphine is a commonly used medication in acute coronary syndromes (ACS) to help relieve pain which in turn can help reduce sympathetic tone.  Over the past few years however, there has been some concern raised about the drug-drug interactions with antiplatelet agents causing impaired platelet inhibition as well as an association with worsened clinical […]

NSTEMIs Are Not All the Same

30 Oct
October 30, 2017

Background: Acute coronary syndrome (ACS) is a true spectrum of disease: STEMI, NSTEMI, Unstable Angina (UA), and Stable Angina (SA).  The history and physical plus ECG help us to differentiate patients with STEMI from NSTEMI.  Classically, STEMI represents complete occlusion of a culprit artery and this finding requires immediate coronary angiography and revascularization.  It turns […]

The ADvISED Trial: A Novel Clinical Algorithm for the Diagnosis of Acute Aortic Syndromes

23 Oct
October 23, 2017

Background: Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence.  They are diagnostic challenges due to the clinical presentation being highly non-specific.  Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large […]

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