Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2022
ReviewPacemaker Malfunction-Review of Permanent Pacemakers and Malfunctions Encountered in the Emergency Department.
Pacemaker malfunction refers to a failure of the pacemaker to perform the desired cardiac pacemaking function. These malfunctions can occur anywhere within the system from the pulse generator and leads to the electrode-myocardium interface. These failures of sensing, capture, and inadequate pacing can have severe hemodynamic consequences, so rapid identification of specific dysfunction is critical to intervention and stabilization. Emergency providers should be aware of pacemaker components, function, basic programming, and types of malfunctions to adequately assess, stabilize, and disposition patients.
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The workup and diagnosis of cardiovascular emergencies represent the present and future risk to emergency physicians. Eliciting and documenting key details of a cardiovascular complaint, as well as following established standards for accurate and timely diagnosis of emergencies, is central to the medico-legal aspects of cardiovascular emergencies. ⋯ Key elements of medical malpractice include the existence of a legal duty, breach of the legal duty, causation, and presence of damages. All 4 legal elements must be present for medical malpractice to be proven in a court of law.
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Although still a rare bacterial infection of the endocardium of the heart, the incidence of infective endocarditis continues to increase with the increased use of intracardiac devices, indwelling lines, and surgical procedures being done on patients. The diagnosis of infective endocarditis remains challenging and requires a high level of suspicion to initiate the appropriate investigation and treatment. Serious complications can still occur despite optimal care, so it is helpful that these patients be managed by a team that includes infectious disease, cardiology, and cardiac surgeons.
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Sudden cardiac death (SCD) describes the unexpected natural death from a cardiac cause within a short time period, generally 1 hour or lesser from the onset of symptoms, often due to a cardiac dysrhythmia. Overall, the most common cause of SCD is coronary artery disease but for patients aged younger than 35 years, the most common cause of SCD is a dysrhythmia in the setting of a structurally normal heart. This article will review the background, diagnosis, and management of the common hereditary channelopathies and cardiomyopathies associated with an increased risk of SCD in patients without ischemic heart disease.