Nauru CDS

Cardiovascular Emergencies

Evidence-based protocols and drug infusion guidelines

Category 2
Acute Coronary Syndrome (ACS)
Category 2
Acute Heart Failure
Category 1
Acute Mitral Regurgitation
Category 3
Acute Pericarditis
Category 1
Acute Peripheral Arterial Occlusion
Category 2
Acute Right Heart Failure
Category 1
Aortic Dissection
Category 2
Atrial Fibrillation (AF)
Category 2
Atrial Flutter
Category 2
Brugada Syndrome
Category 2
Cardiac Arrhythmias
Category 2
Cardiac Contusion (Blunt Cardiac Injury)
Category 1
Cardiac Tamponade
Category 1
Cardiogenic Shock
Category 1
Complete Heart Block (3rd Degree AV Block)
Category 2
Critical Aortic Stenosis
Category 3
Deep Vein Thrombosis (DVT)
Category 2
Dilated Cardiomyopathy (DCM)
Category 2
Hypertensive Emergency
Category 2
Hypertrophic Cardiomyopathy (HCM)
Category 3
Infective Endocarditis
Category 2
Long QT Syndrome (LQTS)
Category 2
Myocarditis
Category 2
Pulmonary Embolism
Category 2
Supraventricular Tachycardia (SVT)
Category 2
Syncope — Cardiac vs Non-Cardiac
Category 2
Takotsubo (Stress) Cardiomyopathy
Category 1
Ventricular Tachycardia (VT)
Acute Coronary Syndrome (ACS)
ATS Category 2 - Evidence Grade A

Background & Epidemiology

ACS accounts for approximately 1 in 300 ED presentations. Mortality ranges from 5-10% depending on type and treatment.

Results from rupture of atherosclerotic plaque with subsequent thrombosis and myocardial ischemia.

Risk Factors

  • •Age >40 (men) or >50 (women)
  • •Smoking
  • •Hypertension
  • •Diabetes
  • •Hyperlipidemia
  • •Family history
  • •Obesity
  • •Sedentary lifestyle

Clinical Features

Typical Presentation:

  • • Chest pain or pressure (substernal, radiating to arm/jaw/back)
  • • Dyspnea
  • • Diaphoresis
  • • Nausea/vomiting
  • • Palpitations
  • • Syncope (rare)

Atypical Presentation:

  • • Isolated dyspnea
  • • Fatigue
  • • Epigastric discomfort
  • • Jaw/tooth pain
  • • Shoulder pain
  • • More common in women, elderly, diabetics

Investigations

Immediate:

  • • 12-lead ECG (within 10 minutes)
  • • Troponin (high-sensitivity preferred)
  • • Full blood count
  • • Urea and electrolytes
  • • Coagulation studies
  • • Glucose
  • • Chest X-ray

Additional:

  • • Repeat troponin at 3 hours
  • • Echocardiography (if complications suspected)
  • • Coronary angiography (if STEMI or high-risk NSTEMI)

Management

Immediate Actions:

  • • Oxygen to maintain SpO2 >94%
  • • IV access
  • • Continuous cardiac monitoring
  • • Aspirin 300-500 mg PO (if no contraindications)
  • • Sublingual nitroglycerin (if SBP >90 mmHg)
  • • Analgesia (morphine 2-4 mg IV, titrate)
  • • Beta-blocker (if no contraindications)

Medications:

  • • Dual antiplatelet therapy (Aspirin + P2Y12 inhibitor)
  • • Anticoagulation (Heparin or LMWH)
  • • Beta-blockers
  • • ACE inhibitors
  • • Statins

Evidence Base

Evidence Level: 1 | Grade: A

[1] Collet, J. P., et al. (2020). 2020 ESC Guidelines for acute coronary syndromes. European Heart Journal, 42(14), 1289-1367.

[2] Amsterdam, E. A., et al. (2014). 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes. Journal of the American College of Cardiology, 64(24), e139-e228.