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Category: Emergency Medicine Articles

Multifocal Atrial Tachycardia ?>

Multifocal Atrial Tachycardia

Multifocal Atrial Tachycardia Introduction Background Multifocal atrial tachycardia (MAT) is an irregular cardiac rhythm caused by at least 2 different sites of competing atrial activity. Pathophysiology MAT most often is found in the elderly patient with decompensated chronic lung disease and should be thought of as a hypoxic complication of underlying heart conduction pathology. However, other underlying causes may be present, such as congestive heart failure, sepsis, or methylxanthine toxicity. The effect of MAT on the heart conduction system may…

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Mitral Stenosis ?>

Mitral Stenosis

Mitral Stenosis Introduction Background Mitral stenosis (MS) is a narrowing of the inlet valve into the left ventricle that prevents proper opening during diastolic filling. Patients with mitral stenosis typically have mitral valve leaflets that are thickened, commissures that are fused, and/or chordae tendineae that are thickened and shortened.

Mitral Regurgitation ?>

Mitral Regurgitation

Mitral Regurgitation Introduction Background Mitral regurgitation, in the acute and chronic decompensated states, is commonly encountered in the emergency department. An understanding of the underlying etiologies and pathophysiology of the condition is critical to direct appropriate treatment. Pathophysiology

Mesenteric Ischemia ?>

Mesenteric Ischemia

Mesenteric Ischemia Introduction Background Mesenteric ischemia is a relatively rare disorder seen in the emergency department (ED); however, it is an important diagnosis to make because of its high mortality rate. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. Moreover, delays in diagnosis lead to increased mortality rates. Despite recent advances in diagnosis and treatment, mortality rates continue to remain high. Pathophysiology

Hypertensive Emergencies ?>

Hypertensive Emergencies

Hypertensive Emergencies Introduction Background Approximately 50 million people in the United States are affected by hypertension (HTN).1, 2 Substantial improvements have been made with regards to improving awareness and treatment of hypertension. However, approximately 30% of adults are still unaware of their hypertension; up to 40% of people with hypertension are not receiving treatment; and, of those treated, up to 67% do not have their blood pressure (BP) controlled to less than 140/90 mm Hg.3 

Heart Block, Third Degree ?>

Heart Block, Third Degree

Heart Block, Third Degree Introduction Background Complete heart block, also referred to as third-degree heart block, or third-degree atrioventricular (AV) block, is a disorder of the cardiac conduction system, where there is no conduction through the AV node. Therefore, complete disassociation of the atrial and ventricular activity exists. The ventricular escape mechanism can occur anywhere from the AV node to the bundle-branch Purkinje system. It is important to realize, however, that not all patients with AV dissociation have complete heart…

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Heart Block, Second Degree ?>

Heart Block, Second Degree

Heart Block, Second Degree Introduction Background Second-degree heart block, or second-degree atrioventricular (AV) block, refers to a disorder of the cardiac conduction system in which some atrial impulses are not conducted to the ventricles. Electrocardiographically, some P waves are not followed by a QRS complex. Second-degree AV block is composed of 2 types: Mobitz I or Wenckebach block, and Mobitz II. The Mobitz I second-degree AV block is characterized by a progressive prolongation of the PR interval, which results in…

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Dissection, Vertebral Artery ?>

Dissection, Vertebral Artery

Dissection, Vertebral Artery Introduction Background Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Pathophysiology

Dissection, Carotid Artery ?>

Dissection, Carotid Artery

Dissection, Carotid Artery Introduction Background Carotid artery dissection is a significant cause of ischemic stroke in all age groups. Spontaneous carotid dissection can occur, most frequently in the fifth decade of life. Dissection of the internal carotid artery can occur intracranially or extracranially, with the latter being more frequent. Internal carotid artery dissection can be caused by major or minor trauma, or it can be spontaneous in which case genetic, familial, and/or heritable disorders are likely etiologies. Patients can present…

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Dissection, Aortic ?>

Dissection, Aortic

Dissection, Aortic Introduction Background Much has been written on the subject of aortic dissections, from the first well-documented case of aortic dissection, when King George II of England died while straining on the commode, to the first successful operative repairs by DeBakey in 1955, to modern techniques of diagnosing and repairing thoracic aortic dissections. More recently, this has come to light with the diagnosis of aortic dissection in Princess Diana, actor John Ritter, and Dr. DeBakey himself.