Essential Cardiovascular Emergencies and Management

Posted on Jul 6, 2026 in Medicine

1. STEMI and NSTEMI

Initial Management (MONA): Morphine (if severe pain), Oxygen (if sats < 94%), Nitrates (contraindicated in hypotension), Aspirin 300mg.
Secondary Prophylaxis: Dual antiplatelet therapy (aspirin + clopidogrel), statins, ACE inhibitors, and beta-blockers.

Clinical Presentation: Pleuritic chest pain, worse on inspiration and lying down; bending forward improves symptoms. Often follows a viral illness.
ECG Changes: Widespread ST elevation (saddle-shaped) and PR depression (most specific).
Investigations: Observations, ECG, FBC, CRP/ESR, U&Es, LFTs, Troponin (rule out ACS), D-dimer (rule out PE), Chest X-ray, Echocardiogram, and Cardiac CT/MRI.
Management: Rule out complications (tamponade). Symptomatic relief with NSAIDs + PPI and colchicine (3 months). Corticosteroids + colchicine as second-line.

Clinical Presentation: Sudden onset, tearing chest pain radiating to the back; history of hypertension.
Investigations: Observations, ECG, FBC, U&Es, LFTs, coagulation screen, troponins, ABG (lactate), Group and Save, D-dimer, Chest X-ray (widened mediastinum), CT angiogram, and TOE.
Management: A-E assessment, maintain O2 > 94%, morphine for pain, IV labetalol (target systolic BP 100-120 mmHg). Involve cardiothoracic surgery early.

Clinical Presentation: Triad of SAD (Syncope, Angina, Dyspnoea).
Investigations: Observations, ECG, FBC, U&Es, LFTs, BNP/NTproBNP, lipid profile, HbA1c, Chest X-ray, TTE (gold standard), Cardiac CT/angiogram, and Cardiac MRI.
Management: Lifestyle modifications, beta-blockers for angina, loop diuretics for heart failure. Definitive treatment is Aortic Valve Replacement (AVR) via open surgery or TAVI.

Investigations: Observations, BMI, ECG, FBC, U&Es, LFTs, CRP/ESR, Troponin, HbA1c, lipid profile, Chest X-ray, Echocardiogram, and CT angiogram.
Management: Lifestyle modifications, GTN spray, and first-line beta-blocker or rate-limiting CCB. Revascularisation (PCI/CABG) if complications like MI occur.

Investigations: Observations, ECG, FBC, U&Es, LFTs, coagulation screen, CRP, Troponins, D-dimer, ABG, Chest X-ray, CTPA (gold standard), V/Q scan (if renal impairment), and bedside echocardiogram (if unstable).
Management: A-E assessment, maintain O2 > 94%, morphine for analgesia, anticoagulation (DOACs or LMWH), and treatment of underlying causes.

Investigations: Observations, ECG, ambulatory ECG (if paroxysmal), FBC, U&Es, LFTs, TFTs, and echocardiogram.
Management: A-E assessment, rule out ACS, continuous ECG monitoring, rate vs. rhythm control, anticoagulation (CHAD-VASC and ORBIT scores), and treatment of underlying causes (e.g., hyperthyroidism). DC cardioversion if haemodynamically unstable.