Advertisement

Echocardiographic Assessment of Acute Chest Pain in the CCU

Chapter

Abstract

The field of critical care cardiology has evolved considerably over the past few decades. Cardiac units in the 1970s and the 1980s were practically coronary care units, where the units most frequently were populated by patients with acute and often uncomplicated myocardial infarction or unstable angina. Detection and rapid treatment of arrhythmias were the primary goals of therapy. Contemporary cardiac care units (CCU) have transformed into Cardiac intensive care units (CICU) where the focus has since shifted towards the management of patients with multisystem diseases, advanced hemodynamics compromise, complex ventricular arrhythmias, and established or incipient multi-organ failure. The two most common clinical scenarios leading to acute chest pain syndrome in CCU patients are acute coronary syndrome and acute aortic syndrome.

Keywords

Chest pain Aortic dissection Acute coronary syndrome Myocardial infarction 

References

  1. 1.
    Lancellotti P, Price S, Edvardsen T, et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Cardiovasc Imaging. 2015;16(2):119–46.CrossRefGoogle Scholar
  2. 2.
    Panjrath GS, Herzog E, Chaudhry F. Introduction: acute coronary syndrome and echocardiography. In: Herzog E, Chaudhry F, editors. Echocardiography in ACS from prevention to diagnosis and treatment. London: Springer; 2009. p. 1–4.Google Scholar
  3. 3.
    Saric M. Echo assessment of systolic and diastolic function in acute coronary syndrome. In: Herzog E, Chaudhry F, editors. Echocardiography in ACS from prevention to diagnosis and treatment. London: Springer; 2009. p. 37–57.Google Scholar
  4. 4.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.CrossRefGoogle Scholar
  5. 5.
    Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med. 1983;49(6):331–6.CrossRefGoogle Scholar
  6. 6.
    Carlson MD, Krishen A. Risk assessment for ventricular arrhythmias after extensive myocardial infarction: what should I do? ACC Curr J Rev. 2003;12(2):90–3.CrossRefGoogle Scholar
  7. 7.
    Ansari A, Puthumana J. The “Ischemic Cascade”. In: Herzog E, Chaudhry F, editors. Echocardiography in ACS from prevention to diagnosis and treatment. London: Springer; 2009. p. 149–60.Google Scholar
  8. 8.
    Hauser AM, Vellappillil G, Ramos RG, et al. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol. 1985;5:193–7.CrossRefGoogle Scholar
  9. 9.
    Nesto RW, Kowalchuk MD. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol. 1987;57:23C–4C.CrossRefGoogle Scholar
  10. 10.
    Amsterdam EA, Wenger NK, Brindis RG, et al. AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cariology/American Heart Association Task Force on Practice Guideline. J Am Coll Cardiol. 2014;64:e139–228.CrossRefGoogle Scholar
  11. 11.
    Roffi M, Patrono C, Collet JP, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267–315.CrossRefGoogle Scholar
  12. 12.
    Becker RC, Gore JM, Lambrew C, et al. for the National Registry of Myocardial Infarction Participants. A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. J Am Coll Cardiol. 1996;27:1321.CrossRefGoogle Scholar
  13. 13.
    Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ. Ventricular septal rupture after acute myocardial infarction. N Engl J Med. 2002;347(18):1426–32.CrossRefGoogle Scholar
  14. 14.
    Buda AJ. The role of echocardiography in the evaluation of mechanical complications of acute myocardial infarction. Circulation. 1991;84(3 Suppl):109–21.Google Scholar
  15. 15.
    Kinch JW, Ryan TJ. Right ventricular infarction. N Engl J Med. 1994;34:1211–9.CrossRefGoogle Scholar
  16. 16.
    Tcheng JE, Jackman JD, Nelson CL, et al. Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med. 1992;117:18.CrossRefGoogle Scholar
  17. 17.
    Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998;32:557.CrossRefGoogle Scholar
  18. 18.
    Vilacosta I, San Roman JA. Acute aortic syndrome. Heart. 2001;85:365–8.CrossRefGoogle Scholar
  19. 19.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.CrossRefGoogle Scholar
  20. 20.
    Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55:e27–e129.CrossRefGoogle Scholar
  21. 21.
    Debakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:14–49.Google Scholar
  22. 22.
    Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237–47.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Mount Sinai St. Luke’s HospitalNew YorkUSA

Personalised recommendations