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Susceptibility to arrhythmias results from genetic abnormalities (most often affecting ion channels) and acquired structural heart disease. Susceptibility may be increased by electrolyte abnormalities, hormonal imbalances (thyrotoxicosis, hypercatecholamine states), hypoxia, drug effects (such as…

Electrocardiographic Monitoring

The ideal way of establishing a causal relationship between a symptom and a rhythm disturbance is to demonstrate the presence of the rhythm during the symptom. Unfortunately, this is not…

Abnormalities of cardiac rhythm and conduction can be lethal (sudden cardiac death), symptomatic (syncope, near syncope, dizziness, or palpitations), or asymptomatic.

They are dangerous to the extent that they reduce cardiac…

A. Aspirin

All patients with definite or suspected myocardial infarction should receive aspirin at a dose of 162 mg or 325 mg at once regardless of whether thrombolytic therapy is being considered…

Twenty percent of patients with acute myocardial infarction die before they reach the hospital. Mortality rates in hospitalized patients range from 5% to 15% and are determined chiefly by the size of the infarction and…

A variety of complications can occur after myocardial infarction even when treatment is initiated promptly.

A. Postinfarction Ischemia

Approximately 30% of patients will have angina postinfarction. This is more common in…

1. General
Patients usually appear anxious and are often sweating profusely. The heart rate may range from marked bradycardia (most commonly in inferior infarction) to tachycardia resulting from increased sympathetic nervous system…

Clinical Findings

Symptoms
1. Premonitory pain
One-third of patients give a history of alteration in the pattern of angina, recent onset of typical or atypical angina, or unusual…

Essentials of Diagnosis

• Sudden but not instantaneous development of prolonged (> 30 minutes) anterior chest discomfort (sometimes felt as “gas” or pressure) that may produce arrhythmias, hypotension, shock, or cardiac failure.
• Rarely…

Most clinicians use the term “unstable angina” to denote an accelerating or “crescendo” pattern of pain in cases where previously stable angina occurs with less exertion or at rest, lasts longer, and is less responsive…

A. Treatment of Acute Attack
Sublingual nitroglycerin is the drug of choice; it acts in about 1-2 minutes. Nitrates decrease arteriolar and venous tone, reduce preload and afterload, and lower the oxygen…

Indications
The indications for coronary artery revascularization in patients with angina pectoris are often debated. There is general agreement that otherwise healthy patients in the following groups should…

The prognosis of angina pectoris has improved with advances in the understanding of its pathophysiology and in pharmacologic therapy. Mortality rates vary depending on the number of vessels diseased, the severity of obstruction, the…

Although most symptoms of myocardial ischemia result from fixed stenosis of the coronary arteries or intraplaque hemorrhage or thrombosis at the site of lesions, some ischemic events may be…

Differential Diagnosis
Angina can usually be diagnosed from a proper history. When atypical features are present - such as prolonged duration (hours or days) or darting, knifelike pains at the apex…

A. Laboratory Findings

Serum lipid levels should be determined in all patients with suspected angina. Anemia and diabetes may also be investigated if clinically appropriate.

B. Electrocardiography