Shortness of breath (dyspnea) is the subjective sensation of breathlessness which is excessive for any given level of activity. It is important to remember that any component of the respiratory system can cause dyspnea.
Diuretics may not be the preferred initial therapy, however, for those patients with vascular failure, who are often euvolemic, or those with cardiogenic shock, who are often hypovolemic. In these patients, the emergency provider should first optimize preload and afterload reduction with the use of noninvasive positive pressure ventilation (NPPV), nitrates, or inotropes as indicated.
Always check what the patient means by "palpitations" or clarify what you mean, as the word means different things to different people. It is usually understood as an awareness of the heartbeat. The most common cause is an arrhythmia, although other causes include conditions causing an increase in stroke volume (e.g., regurgitant valvular disease) or conditions causing an increase in cardiac output, often noncardiac causes (e.g., exercise, thyrotoxicosis, anemia, or anxiety).
In recent years, there are increasing data that support the use of high-dose vasodilator therapy as the initial treatment for patients with acute decompensated heart failure (ADHF)
Coughing is a nonspecific reaction to irritation anywhere in the respiratory tract from the pharynx to the lungs, and it is the most common manifestation of lower respiratory tract disease. Any cough that persists for over 3 weeks merits further investigation in the absence of an obvious cause.
Acetylcholine (ACh) is too rapidly hydrolyzed and inactivated by acetylcholinesterase (AChE) to be of any therapeutic use; however, its action can be mimicked by other substances, namely direct or indirect parasympathomimetics (cholinomimetics).
There are numerous conditions that cause ST-segment elevation (STE) on an ECG that are not attributable to an acute coronary syndrome. In order to avoid errors in diagnosis or management, it is important for the EP to know the differential diagnosis for STE.
Heart murmurs are due to vibrations caused by turbulent flow within the heart. The most common causes are due to left-sided valvular heart disease and tricuspid regurgitation.
Substances acting antagonistically at the M-cholinoceptor are designated parasympatholytics (prototype: the alkaloid atropine; actions shown in red in the panels). Therapeutic use of these agents is complicated by their low organ selectivity.
Approximately 1% to 2% of patients with hypertension will present with a hypertensive emergency, defined as organ dysfunction due to an elevated blood pressure. Importantly, there is no specific blood pressure threshold that identifies a patient with a hypertensive emergency.