Cardiac Emergencies – Updated Overview
Cardiac Emergencies – Updated Overview
Source: Medscape, Last Updated: October 1, 2025
Aligned with 2025 ACC/AHA/ACEP/SCAI Guidelines for Acute Cardiac Care.
Keynotes :
1. Definition and Scope
Cardiac emergencies include acute coronary syndromes (ACS), cardiac arrest, arrhythmias, acute heart failure, and cardiogenic shock.
2. Major Types of Cardiac Emergencies
• Acute Coronary Syndrome (ACS):
• Includes STEMI, NSTEMI, and unstable angina.
• Symptoms: chest pain, shortness of breath, diaphoresis, or nausea.
• Perform ECG and troponin testing immediately; initiate reperfusion (PCI preferred).
• Cardiac Arrest and Pulseless Rhythms:
• Present as VF, pulseless VT, PEA (Pulseless Electrical Activity), or asystole.
• Follow ACLS 2025 algorithms — early CPR, defibrillation, airway management, and epinephrine administration.
• PEA (Pulseless Electrical Activity): a cardiac arrest rhythm with organized electrical activity but no palpable pulse; treat immediately with CPR and correction of reversible causes — the 5 H’s (Hypoxia, Hypovolemia, Hydrogen ion [acidosis], Hypo-/Hyperkalemia, Hypothermia) and the 5 T’s (Tension pneumothorax, Tamponade, Toxins, Thrombosis–coronary, Thrombosis–pulmonary).
• Life-Threatening Arrhythmias:
• Bradyarrhythmia: treat with atropine or pacing if unstable.
• Tachyarrhythmia: synchronized cardioversion for unstable VT; antiarrhythmics if stable.
• Acute Heart Failure / Pulmonary Edema:
• Symptoms: dyspnea, pulmonary congestion, elevated BNP.
• Manage with oxygen, nitrates, diuretics, and treat underlying causes.
• Cardiogenic Shock:
• Hypotension (SBP <90 mmHg) with organ hypoperfusion.
• Manage using inotropes, vasopressors, and mechanical support (IABP, Impella, ECMO).
3. Diagnostic Essentials
• 12-lead ECG: within 10 minutes of arrival.
• High-sensitivity troponin: rapid detection of myocardial injury.
• Bedside echocardiography (TTE, ICE): assess cardiac function, effusion, and valve integrity.
• POCUS and cardiac CT: identify mechanical and vascular causes.
4. Initial Management Priorities (ABCDE)
1. A – Airway: maintain patency; intubate if needed.
2. B – Breathing: provide oxygen; monitor saturation.
3. C – Circulation: establish IV access, monitor ECG, treat arrhythmias.
4. D – Drugs: follow ACLS pharmacologic protocols.
5. E – Evaluate: search for reversible causes (5H’s & 5T’s).
5. Emerging Trends (2025 Updates)
• Intracardiac Echocardiography (ICE): expanding use in emergency structural interventions (ASD closure, valve repair).
6. Key Takeaways
• Early diagnosis and prompt intervention save lives in cardiac emergencies.
• PEA recognition and cause correction are essential steps in ACLS.
• Imaging tools like POCUS and ICE are transforming emergency cardiac care.
