title: "Week 6: Chest Pain"

Week 6: Chest Pain

1. Systematic Approach to Chest Pain

The First 3-4 Minutes Are Key

Allow the patient to tell their narrative with open questions. This often provides the majority of diagnostic information.

Chest Pain: First Hour Triage (ACS + Can’t-Miss)

Aim: don't miss the killers, stabilise physiology, and hand over a coherent plan. You don't need the perfect diagnosis in minute 5.

The ED Philosophy

"We can't always say what it is, but we can say what it's not."

The primary role in ED is to exclude life-threatening causes, not to diagnose every case of chest pain.

Cannot Miss Diagnoses

Chest Pain: Can't-Miss Diagnoses

Rule out the killers • Escalate early if unstable • Repeat ECG if ongoing pain

ACS

Pressure/heaviness ± diaphoresis

Dynamic ECG changes • CAD risks

Aortic dissection

Sudden severe pain • "ripping" to back

Pulse/BP differential • neuro deficit

PE

Pleuritic pain + dyspnoea • tachycardia

Hypoxia • VTE risk factors

Tension PTX

Severe dyspnoea • unilateral absent sounds

Hypotension • tracheal deviation late

Tamponade

Shock + raised JVP (may be subtle)

Muffled sounds/pulsus paradoxus

Oesophageal rupture

Post-vomiting chest pain • toxicity

Subcutaneous emphysema


2. Differential Diagnosis

CategoryConditions
CardiacACS (Acute Coronary Syndrome), Myocarditis, Pericarditis, Aortic dissection
RespiratoryPE (Pulmonary Embolism), Pneumothorax, Pneumonia, Pleuritis
GIGORD, Oesophageal spasm, Boerhaave syndrome
MSKCostochondritis (Tietze), Muscle strain, Rib fracture
OtherAnxiety/panic, Herpes zoster, Referred pain

3. Pain History - SOCRATES

SOCRATES
  • S - Site - Where is the pain?
  • O - Onset - When did it start? What were you doing?
  • C - Character - What does it feel like?
  • R - Radiation - Does it spread anywhere?
  • A - Associated symptoms - Nausea, dyspnoea, diaphoresis?
  • T - Time course - Constant? Intermittent? Duration?
  • E - Exacerbating/alleviating - What makes it better or worse?
  • S - Severity - Score out of 10

Classic Pain Patterns

DiagnosisCharacteristic Pain Features
ACS (Acute Coronary Syndrome)Central/left, crushing "elephant on chest," radiates to L arm/jaw, associated with nausea, diaphoresis, dyspnoea
Aortic DissectionSudden onset, tearing, radiates to back, worst pain of life, at rest
PericarditisSharp, pleuritic, worse lying flat, better sitting forward, preceded by viral illness
PE (Pulmonary Embolism)Pleuritic, sudden onset, associated dyspnoea, haemoptysis
PneumothoraxSudden onset pleuritic pain, dyspnoea, unilateral
MSKSharp, localized, worse with movement, reproducible on palpation
Clinical Pearl

Right arm/shoulder radiation is often MORE specific for severe cardiac pain than left arm radiation!


4. Risk Factors for ACS (Acute Coronary Syndrome)

Major Risk Factors (Coronary Artery Disease)

  • Male sex
  • Age >50 years
  • Known coronary artery disease
  • Hypertension
  • Diabetes mellitus
  • Dyslipidaemia
  • Current smoker
  • Family history of premature CAD
  • Chronic kidney disease
  • Alcohol/recreational drug use
  • Autoimmune conditions

Clinical Examination in ACS (Acute Coronary Syndrome)

Often unremarkable! The money is in the history and risk factors. Look for:

  • Haemodynamic instability
  • Signs of heart failure (if severe MI (Myocardial Infarction))
  • Features that support or refute differentials

5. ECG (Electrocardiogram) Interpretation in Chest Pain

Warning

Don't overcall isolated changes. In chest pain, look for a territorial pattern with reciprocal changes and compare with prior ECG (Electrocardiogram)s before calling STEMI.

12-lead ECG placement (limb leads + V1–V6)

Key ECG (Electrocardiogram) Patterns

ECG (Electrocardiogram) FindingInterpretation
ST elevation + reciprocal changesSTEMI (ST-Elevation Myocardial Infarction) - territorial distribution
Diffuse ST elevation, PR depression, NO reciprocal changesPericarditis
T wave inversion V1-V4 + inferior leadsRight ventricular strain (PE (Pulmonary Embolism))
S1Q3T3 patternClassically taught for PE (Pulmonary Embolism) but not specific
New LBBB with ischaemic symptomsMay mask occlusion MI — apply (modified) Sgarbossa criteria + clinical picture
Clinical Pearl

S1Q3T3 is often taught for PE (Pulmonary Embolism) but is not very specific. The T wave inversion in V1-V4 + inferior leads (right heart strain pattern) is more reliable.

Pericarditis vs STEMI (ST-Elevation Myocardial Infarction) on ECG (Electrocardiogram)

FeaturePericarditisSTEMI (ST-Elevation Myocardial Infarction)
ST elevationDiffuse, widespreadTerritorial (follows coronary distribution)
Reciprocal changesAbsent (except aVR, V1)Present
PR segmentDepressed (elevated in aVR)Normal
ST morphologyConcave ("smiley face")Often convex ("frowny face")
Acute pericarditis (example ECG)LITFL ECG Library (CC BY-NC-SA 4.0)
Inferior STEMI (example ECG)LITFL ECG Library (CC BY-NC-SA 4.0)
Anterior STEMI (example ECG)Wikimedia Commons

STEMI Localization (12-lead)

Leads with ST elevationTerritoryCulprit artery (most common)
II, III, aVFInferiorRCA (sometimes LCx)
V1-V4Anteroseptal/anteriorLAD
I, aVL, V5-V6LateralLCx or diagonal
V7-V9 (posterior leads)PosteriorLCx or RCA

ST elevation must be in contiguous leads (adjacent leads viewing the same territory)

Inferior STEMI can involve the RV: check V4R and avoid nitrates if hypotensive

Posterior MI often shows ST depression with tall R waves in V1-V3. Confirm with V7-V9 leads and treat as STEMI

STEMI Equivalents and High-Risk Patterns

de Winter T waves (upsloping ST depression with tall symmetric T waves in V2-V4) indicate proximal LAD occlusion - treat as STEMI

Wellens pattern (biphasic or deep T wave inversion in V2-V3 after pain resolves) indicates critical LAD stenosis - avoid stress testing

Wellens pattern (critical LAD stenosis)Wikimedia Commons

ST elevation in aVR with diffuse ST depression suggests left main or triple-vessel ischemia

In LBBB or paced rhythms, concordant ST elevation ≥1 mm is a high-risk occlusion MI sign (Sgarbossa)

ACS Pharmacology Essentials

Initial ACS (Acute Coronary Syndrome) management: antiplatelet therapy (aspirin) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) plus anticoagulation (heparin).

STEMI (ST-Elevation Myocardial Infarction) requires reperfusion therapy: primary PCI (Percutaneous Coronary Intervention) (preferred) or fibrinolysis if PCI delayed.

Avoid nitrates in suspected RV infarction or hypotension (preload dependent) — give IV fluids instead.

ACS first-line antiplatelet: aspirin 300 mg chewed/dissolved (if no contraindication).

Q: STEMI (ST-Elevation Myocardial Infarction) with PCI (Percutaneous Coronary Intervention) within 60 min: load [], [], and a [___] inhibitor. A: aspirin; heparin; P2Y12

Q: PCI (Percutaneous Coronary Intervention) delay >60 min with thrombolysis planned: give [] + [] + anticoagulation. A: aspirin; clopidogrel

Q: Clopidogrel loading dose for thrombolysis: age under 75 = [] mg; age 75+ = [] mg. A: 300; 75

DAPT + Anticoagulation Doses (adult, local protocol)

MedicationLoading doseMaintenance
Aspirin300 mg chewed/dissolved100 mg daily
Ticagrelor180 mg90 mg BD
Clopidogrel600 mg for PCI; 300 mg for thrombolysis (75 mg if age 75+)75 mg daily
UFH (heparin)60-70 units/kg IV bolus (max 5000)Infusion with aPTT monitoring

UFH bolus in ACS/PCI is 60-70 units/kg IV (max 5000 units), followed by infusion with aPTT titration.

Primary PCI is preferred when it can be delivered promptly. If PCI will be delayed and there are no contraindications, fibrinolysis is appropriate, followed by transfer for angiography and possible rescue PCI if reperfusion fails.

Major contraindications to thrombolysis include prior intracranial haemorrhage, known intracranial lesion, suspected aortic dissection, and active bleeding.

Fibrinolysis reduces mortality in eligible STEMI but carries a bleeding risk (including intracranial haemorrhage), so careful selection is essential.

Q: When is supplemental oxygen indicated in ACS? A: If hypoxaemic (SpO2 <94%) or in shock; avoid routine oxygen if normoxaemic.

Persistent chest pain: consider IV opioid (fentanyl or morphine) after initial measures.

GTN spray is sublingual and may be repeated every 5 minutes if pain persists.

Contraindications to GTN: allergy, HR under 50 or over 150, SBP under 100, acute CVA, head trauma.

Opioid Analgesia in ACS: Morphine vs Fentanyl

Fentanyl and morphine are not hemodynamically equivalent. Fentanyl is much cleaner cardiovascularly, which is why NSW (and most modern ACS protocols) prefer it in patients near the hypotension cliff.

The key difference is histamine release:

PropertyMorphineFentanyl
Histamine releaseYes (non-IgE mediated)Minimal to none
Peripheral effectVasodilation + venodilationLargely neutral
BP effect↓↓ (dose-dependent, unpredictable)↔ / mild ↓
Onset (IV)5-10 min1-2 min
TitrationSlowerTight, incremental

Morphine causes non-IgE-mediated histamine release → vasodilation + venodilation → ↓SVR + ↓preload → BP drops. This can tip marginal MI patients into hypotension.

Fentanyl has minimal histamine release → less peripheral vasodilation → BP effect is mostly neutral at analgesic doses. Same opioid receptor class, different peripheral chemistry.

Warning

Morphine unloads the venous system (↓preload), which can be catastrophic in:

  • RV infarction (preload-dependent)
  • Volume-dependent states
  • Elderly patients

Fentanyl largely spares preload.

Both opioids blunt sympathetic tone (↓pain → ↓sympathetic drive), but morphine's peripheral vasodilation stacks on top of this central effect. Fentanyl's effect is mostly central analgesia.

Clinical Pearl

Avoid opioids if SBP under 100 mmHg (NSW Health rule)

Fentanyl is safer, not safe. At low BP, any opioid can remove compensatory sympathetic tone, and respiratory depression → hypercapnia → further vasodilation.

Fix the physiology first.

In MI analgesia:

  • Morphine = analgesia + hemodynamic gamble
  • Fentanyl = analgesia with guardrails
SBAmediumACSanalgesiaopioids
95y
Chest pain

What is the most appropriate next step for analgesia?

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SBAmediumACSanalgesiapharmacology
Which property best explains why fentanyl is preferred over morphine in hemodynamically borderline ACS (Acute Coronary Syndrome) patients?
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SBAmediumACSSTEMIfibrinolysisreperfusion
A STEMI (ST-Elevation Myocardial Infarction) patient is in a small hospital without onsite PCI (Percutaneous Coronary Intervention). Transfer would cause a long delay and there are no contraindications. What is the best reperfusion strategy?
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SBAmediumACSSTEMIfibrinolysiscontraindications
Which is an absolute contraindication to fibrinolysis in STEMI (ST-Elevation Myocardial Infarction)?
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SBAmediumACSSTEMInitrates
BP

What is the best next step?

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SBAeasyACSantiplatelet
Which medication class is routinely added to aspirin in ACS (Acute Coronary Syndrome) to reduce platelet activation?
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SBAeasyACSaspirin
What is the standard initial aspirin dose in suspected ACS (Acute Coronary Syndrome) (if no contraindications)?
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SBAmediumACSSTEMIclopidogrel
78y
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SBAmediumACSheparinanticoagulation
What is the typical unfractionated heparin bolus dose for ACS (Acute Coronary Syndrome)/PCI (Percutaneous Coronary Intervention)?
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SBAeasyACSaspirincontraindications
Which is a contraindication to aspirin in suspected ACS (Acute Coronary Syndrome)?
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SBAeasyACSoxygen
Which patient should receive supplemental oxygen in suspected ACS (Acute Coronary Syndrome)?
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SBAeasyACSGTN
Which is a contraindication to sublingual GTN?
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6. Troponin Physiology

Structure and Function

Cardiac troponin is a complex of 3 subunits:

  • Troponin I - exclusive to cardiac muscle (what we measure)
  • Troponin T
  • Troponin C

Function: Controls actin-myosin interaction through calcium binding. When calcium binds troponin, it moves tropomyosin away from myosin binding sites, allowing muscle contraction.

Troponin Timeline

  • Detectable: 2-4 hours after MI
  • Peak: 18-24 hours
  • Returns to baseline: 10-14 days

Non-ACS (Acute Coronary Syndrome) Causes of Raised Troponin

  • Pulmonary embolism (right heart strain)
  • Myocarditis/Pericarditis
  • Sepsis
  • Renal failure
  • Heart failure
  • Tachyarrhythmias
  • Cardiac contusion
  • Post-cardiac surgery
  • Stroke/SAH (Subarachnoid Haemorrhage)
  • Burns
  • Extreme exertion
Warning

A patient with chest pain, dyspnoea, and raised troponin is NOT always an ACS (Acute Coronary Syndrome)! Consider PE (Pulmonary Embolism) causing right heart strain with secondary troponin release.


7. Risk Stratification Scores

EDACS (Emergency Department Assessment of Chest pain Score)

CriterionPoints
Age 18-45+2
Age 46-50+4
Age 51-55+6
Age 56-60+8
Age 61-65+10
Age 66-70+12
Age 71-75+14
Age 76-80+16
Age 81-85+18
Age >85+20
Male sex+6
Known CAD or ≥3 risk factors (if age 18-50)+4
Diaphoresis+3
Pain radiates to arm/shoulder/neck/jaw+5
Pain worsens with inspiration-4
Pain reproduced by palpation-6

Low risk: Score less than 16

HEART Score (6-week MACE risk)

HEART Score
  • H - History - Slightly (0), Moderately (1), Highly (2) suspicious
  • E - ECG (Electrocardiogram) - Normal (0), Non-specific ST changes (1), Significant ST deviation (2)
  • A - Age - Under 45 (0), 45-64 (1), Over 64 (2)
  • R - Risk factors - None (0), 1-2 (1), >2 or known CAD (2)
  • T - Troponin - Normal (0), 1-3x normal (1), >3x normal (2)

Interpretation:

  • 0-3: Low risk (1.7% MACE) - consider discharge
  • 4-6: Intermediate risk (12% MACE) - observation
  • 7-10: High risk (65% MACE) - admission for intervention

8. PAXA Pathway (NSW)

Pathway for Acute Coronary Syndrome Assessment

Algorithm Flow

  1. Initial ECG (Electrocardiogram) - STEMI (ST-Elevation Myocardial Infarction)? Yes -> Cath lab. No -> Continue
  2. Non-ischemic cause? Yes -> Senior review, exit pathway
  3. Risk stratify using clinical criteria and validated scores
  4. Serial troponins at 0 and 2 hours
  5. Disposition based on risk category

High-Sensitivity Troponin Interpretation

Positive Troponin: >50 ng/L at any time

Positive Delta Troponin: Change of >15 ng/L between 0 and 2 hour samples (up OR down)

Risk Categories and Disposition

RiskCriteriaDisposition
High RiskPositive troponin, dynamic ECG (Electrocardiogram) changes, haemodynamic instability, ongoing chest painAdmit cardiology, consider cath lab
IntermediateNot high or low riskAdmit without invasive monitoring OR discharge with early follow-up
Low RiskAge under 45, atypical symptoms, no CAD, non-ischaemic ECG (Electrocardiogram), symptom-free, OR low validated risk scoreDischarge with GP follow-up

Low Clinical Risk Criteria (all must be present)

  • Age under 45 years
  • Symptoms atypical for angina
  • No known coronary artery disease
  • Non-ischaemic ECG (Electrocardiogram)
  • Symptom-free at assessment

9. Bedside Investigation Summary

TestPurpose
ECG (Electrocardiogram)Ischaemia, arrhythmia, pericarditis, PE (Pulmonary Embolism) strain
CXR (Chest X-Ray)Pneumothorax, pneumonia, heart failure, wide mediastinum (dissection)
Bilateral BP (Blood Pressure)>20 mmHg difference suggests aortic dissection
TroponinMyocardial injury (serial 0h and 2h)
D-dimerPE (Pulmonary Embolism) (only if low/intermediate Wells; use a validated pathway)
POCUSEffusions, RV (Right Ventricle) strain, pneumothorax
Warning

D-dimer caveats:

  • Only useful if low-risk Wells score - high risk needs CTPA regardless
  • Do not use D-dimer to "rule out" PE (Pulmonary Embolism) when pre-test probability is high

10. Practice Questions

SBAmediumaortic dissectionchest pain
45y|M
Potassium
Chest pain

What is the most likely diagnosis?

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SBAmediumECGpericarditisSTEMI
Which ECG (Electrocardiogram) feature best differentiates pericarditis from STEMI (ST-Elevation Myocardial Infarction)?
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SBAhardPEECG
DyspnoeaChest pain

What is the most likely diagnosis?

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SBAmediumECGSTEMIposterior MI
A patient with acute chest pain has horizontal ST (ST Segment) depression with tall R waves in V1-V3. What does this pattern most strongly suggest?
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SBAhardECGSTEMIde Winter
ECG (Electrocardiogram) shows upsloping ST (ST Segment) depression at the J point in V2-V4 with tall, symmetric T waves and no classic ST (ST Segment) elevation. What does this pattern indicate?
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SBAhardECGSTEMIWellens
A pain-free patient after chest pain has deeply inverted or biphasic T waves in V2-V3 with minimal ST (ST Segment) changes. What is the best next step?
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SBAhardECGleft mainSTEMI
ECG (Electrocardiogram) shows ST (ST Segment) elevation in aVR with diffuse ST (ST Segment) depression in multiple leads in a patient with ongoing chest pain. What does this pattern most strongly suggest?
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SBAeasytroponinACS
At what time point does troponin peak after myocardial infarction?
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SBAeasyrisk stratificationHEART score
In the HEART score, what does 'H' represent?
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SBAeasyrisk stratificationHEART score
Which set correctly lists the components of the HEART score?
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SBAeasyrisk stratificationHEART score
Which clinical score is commonly used for ED (Emergency Department) chest pain risk stratification to estimate short-term major adverse cardiac event (MACE) risk?
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SBAmediumrisk stratificationHEART scoredisposition
In HEART score risk stratification, which range is typically considered LOW (Loss of Weight) risk for short-term major adverse cardiac events (MACE)?
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SBAhardrisk stratificationHEART score
55y
Chest pain
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SBAmediumPAXAtroponin
In the PAXA pathway, what defines a 'positive delta troponin'?
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SBAmediumtroponin
Which of the following does NOT typically cause elevated troponin?
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SBAmediumPED-dimer
When should D-dimer NOT be relied upon to exclude PE (Pulmonary Embolism)?
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SBAeasychest painMSK
A 32-year-old female has right-sided chest pain that is sharp, worse with breathing and movement, and reproducible on palpation. What is the most likely diagnosis?
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SBAeasyaortic dissection
Which bedside test is most helpful for detecting aortic dissection?
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SBAhardHEART Score
52yED
Chest pain

What is the most appropriate ED (Emergency Department) disposition?

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11. Atrial Fibrillation

Atrial fibrillation (AF (Atrial Fibrillation)) is the most common sustained cardiac arrhythmia. Most morbidity/mortality is from thromboembolic complications (stroke).

Classification

TypeDefinition
ParoxysmalSelf-terminating, usually within 48 hours
PersistentLasts >7 days, or requires cardioversion
Long-standing persistentContinuous AF (Atrial Fibrillation) >1 year
PermanentAF (Atrial Fibrillation) accepted by patient and physician

Management Principles

AF Management - 4 Steps
  1. Rate vs rhythm control
  2. Anticoagulation (prevent stroke)
  3. Treat underlying cause (sepsis, thyroid, etc.)
  4. Lifestyle (weight loss, reduce alcohol)

Rate Control vs Rhythm Control

Rate ControlRhythm Control
Beta-blocker (metoprolol, atenolol)Electrical cardioversion (higher success)
Non-DHP CCB (diltiazem, verapamil)Chemical cardioversion (flecainide if no heart disease)
Digoxin (if above don't work)Amiodarone if LVEF <40% or CAD
Target <110 bpmCatheter ablation for refractory cases
Warning

Rate control preferred if:

  • AF (Atrial Fibrillation) >48 hours AND not anticoagulated (risk of left atrial thrombus)
  • Asymptomatic
  • Elderly

Rhythm control preferred if:

  • Symptomatic
  • Recent onset (<12 months)
  • Reduced LVEF

Anticoagulation

CHA₂DS₂-VASc Score - assess stroke risk to guide anticoagulation

  • Oral anticoagulation unless very low stroke risk
  • DOACs preferred (apixaban, rivaroxaban, dabigatran)
  • Warfarin for valvular AF (Atrial Fibrillation) (mechanical valve, rheumatic mitral stenosis)

Do NOT use antiplatelets (aspirin, clopidogrel) for stroke prevention in AF (Atrial Fibrillation) — they do not reduce stroke risk and add bleeding.

SBAeasyAFanticoagulation
Which therapy is appropriate for stroke prevention in atrial fibrillation?
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Unstable AF (Atrial Fibrillation)

Warning

Rapid AF (Atrial Fibrillation) with hypotension/hypoperfusion is a medical emergency.

  • Follow ALS (Advanced Life Support) guidelines
  • Consider synchronized DC cardioversion
  • Look for underlying cause (ACS (Acute Coronary Syndrome), PE (Pulmonary Embolism), sepsis)
SBAmediumAFcardioversion
3d

What is the appropriate management?

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12. Stroke and TIA

Stroke is the #1 cause of AF (Atrial Fibrillation)-related mortality. AF (Atrial Fibrillation) increases stroke risk 5-fold due to left atrial thrombus formation.

Transient Ischaemic Attack (TIA)

A TIA is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia without acute infarction.

Warning

TIA is a medical emergency - 10-15% of TIA patients have a stroke within 90 days, with highest risk in the first 48 hours.

FAST Recognition

FAST - Stroke Recognition
  • F - Face drooping (ask to smile)
  • A - Arm weakness (raise both arms)
  • S - Speech difficulty (slurred, confused)
  • T - Time to call emergency services

Amaurosis Fugax

Amaurosis fugax = painless, transient monocular vision loss ("curtain descending over vision")

  • Caused by retinal artery embolism (usually from carotid atherosclerosis or cardiac source)
  • Classically lasts seconds to minutes
  • A form of retinal TIA - requires urgent investigation
Clinical Pearl

Amaurosis fugax is monocular (one eye) because it affects the retinal artery. Binocular visual symptoms suggest posterior circulation (vertebrobasilar) pathology.

TIA Workup

InvestigationPurpose
CT (Computed Tomography) headExclude haemorrhage, identify established infarct
Carotid Doppler/CTAAssess for carotid stenosis (surgical candidate?)
ECG (Electrocardiogram)Identify AF (Atrial Fibrillation) as embolic source
EchoCardiac source of embolism (thrombus, PFO, valvular disease)
BloodsFBC (Full Blood Count), coagulation, lipids, glucose, HbA1c

ABCD² Score - TIA Risk Stratification

ABCD² Score
  • A - Age ≥60 years (+1)
  • B - Blood pressure ≥140/90 at presentation (+1)
  • C - Clinical features: unilateral weakness (+2), speech disturbance without weakness (+1)
  • D - Duration: ≥60 min (+2), 10-59 min (+1)
  • D - Diabetes (+1)

Risk interpretation:

  • Score 0-3: Low risk (~1% 2-day stroke risk)
  • Score 4-5: Moderate risk (~4% 2-day stroke risk)
  • Score 6-7: High risk (~8% 2-day stroke risk)
SBAmediumstrokeTIAamaurosis fugaxAF
70y|M

What is the most likely diagnosis?

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SBAmediumstrokeTIAcarotid stenosis
Which investigation is MOST important in a patient presenting with amaurosis fugax to identify a surgically treatable cause?
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13. Rapid Response and MET Criteria

Between-the-Flags System (NSW):

Vital SignYellow Zone (Clinical Review)Red Zone (MET/Rapid Response)
Heart Rate (Heart Rate)<50 or >120<40 or >140
Systolic BP (Systolic Blood Pressure)<100 or >180<90 or >200
Respiratory Rate (Respiratory Rate)<10 or >25<8 or >30
Oxygen Saturation (Peripheral Oxygen Saturation)<95%<90%
Temperature<35.5°C or >38.5°C<35°C or >39.5°C
ConsciousnessNew confusionUnresponsive (P or U)
Urine output<0.5 mL/kg/hr for 2 hoursNil output

Escalation Pathways

MET Call Triggers:

  • Any vital sign in the red zone
  • Staff member concerned about a patient (clinical worry criterion)
  • Seizure
  • Cardiac arrest

Clinical Review Triggers:

  • Any vital sign in the yellow zone
  • Failure to respond to treatment within 30 minutes

14. Acute Pulmonary Oedema (APO)

APO = fluid in the lungs from cardiac failure

Clinical features: Acute dyspnoea, orthopnoea, pink frothy sputum, bilateral crackles, elevated JVP, peripheral oedema.

APO Management

PriorityInterventionMechanism
PositionSit upright, legs dependent↓ venous return (preload)
OxygenTarget SpO₂ ≥94%Correct hypoxia
GTNSublingual then IV infusionVenodilation → ↓preload; arteriodilation → ↓afterload
Frusemide40-80 mg IVVenodilation (acute) + diuresis (delayed 30-60 min)
NIVCPAP 10 cmH₂O or BiPAP↑ alveolar recruitment, ↓ work of breathing, ↓ preload
MorphineControversial — avoid routinelyAnxiolysis but ↑ mortality in some studies
Warning

Morphine in APO is controversial.

Evidence suggests morphine may increase mortality in APO (respiratory depression, delayed NIV). Avoid routine use — use GTN and NIV as primary therapies instead.

SBAmediumAPOheart-failuremanagement
150y
Oedema

Which is the most appropriate first-line vasodilator?

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15. Capacity Assessment and Ethics

Capacity Assessment

Four criteria for decision-making capacity:

  1. Understand — Can the patient understand the relevant information?
  2. Retain — Can they hold the information long enough to make a decision?
  3. Weigh — Can they weigh the risks and benefits?
  4. Communicate — Can they express their decision?

All four must be present for the patient to have capacity for that specific decision.

Clinical Pearl

Capacity ≠ agreement with the doctor.

A patient with capacity can refuse treatment even if the doctor believes it's unwise — this is the principle of autonomy. Document the discussion thoroughly.

Not-For-Resuscitation (NFR) Orders

NFR is NOT 'do nothing' — it's a plan for appropriate care:

  • Specifies which interventions are appropriate and which are not
  • Must be reviewed regularly and when clinical status changes
  • Should reflect the patient's values and goals of care
  • Requires documentation, communication to the team, and ideally patient/family involvement

Advance Care Directives (ACD)

ComponentDescription
ACDWritten document outlining patient's wishes for future care when they lose capacity
Enduring GuardianPerson appointed to make health decisions when patient lacks capacity
Person ResponsibleHierarchy: spouse → carer → close friend/relative (NSW Guardianship Act)

Ethical Principles

PrincipleDefinitionExample in Critical Care
AutonomyPatient's right to make informed decisionsRefusing intubation
BeneficenceActing in the patient's best interestRecommending surgery
Non-maleficence"First, do no harm"Avoiding futile treatment
JusticeFair allocation of resourcesICU bed allocation
SBAhardethicscapacityadvance-care-directive
82yICU
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Week 6 Study Checklist

Click to expand or view deep dives

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Cannot-miss diagnoses in chest pain
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SOCRATES history framework
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Classic chest pain patterns
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Troponin timeline
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Pericarditis vs STEMI on ECG
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Risk stratification scores
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PAXA pathway thresholds
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Stroke/TIA and Amaurosis Fugax
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Between-the-Flags MET criteria
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APO management
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Capacity assessment (4 criteria)
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NFR orders and advance care directives

Sources

  • CC Bible
  • CSANZ ACS guidelines
  • EDACS + HEART score derivation/validation studies
  • NSW Health chest pain pathways (incl. accelerated troponin protocols like PAXA)