High-risk electrocardiogram presentations in the acute coronary syndrome patient - Beyond ST-segment elevation myocardial infarction.

This review considers high-risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST-segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short-and long-term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T-wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High-risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short-and long-term adverse outcome, include lead aVR ST-segment elevation and Wellens syndrome.

Emergency medicine updates: Sympathetic crashing acute pulmonary edema.

Introduction: Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.

Objective: This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.

Fibrinolytic uses in the emergency department: a narrative review.

Introduction: Several life-threatening conditions associated with thrombosis include acute ischemic stroke (AIS), acute myocardial infarction (AMI), and acute pulmonary embolism (PE). Fibrinolytics are among the treatment algorithms for these conditions.

Objective: This narrative review provides emergency clinicians with an overview of fibrinolytics for AIS, AMI, and PE in the emergency department (ED) setting.