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AFib

Pulse tachy & random: ECG shows random and NO P waves

Hemodynamically Stable Hemodynamically unstable

Rate control

Lone Afib: CHADS2 score =0 Cardioversion (50 % back to Afib in 1 year) Afib < 48 Hr

Afib > 48 Hr

Low risk of embolization, consider aspirin

TEE shows thrombus? Anticoagulate for 3 weeks

No Cardioversion (50 % back to Afib in 1 year)

Yes

have baseline ST depression. have pacemaker. Thallium uptake: •↓ uptake during stress= ischemia •↓ uptake always = infarct Throbolytics (TPA) w/I 12 Hr Or new LBBB DON’T if bleeding risk: •Active bleed •Recent surgery Angioplasty (PCI) < 90 min Angiography & stint/ ballon/ bipass Unstable angina Statins.5 major Cardiac risk factors: Chest Pain: esp > 30 min. DM 3. Stress ECHO: •↓ wall motion = ischemia 2. ACE inhibitor. . beta blockers. morphine. ECG: ST depression Enzymes (+) ECG: ST depression Enzymes (-) ECG: ST elevation in 2 contiguous leads: Enzymes (-) 1st aspirin & Clopidogrel NSTEMI: BMOAN cath if <90 min but can be delayed 2 days: IV heparin: if procedure LMWH: if no procedure 1. asprin. HTN If obvious: Tx 1st: 5. FMH “Bmoan”:Beta block. Smoking substernal. O2. diaphoresis 2. Cholesterol >200. 1. CKMB for reninfact Stress test Positive: ST ↓ ≥ 2mm or ↓ BP of 10 mm Can’t exercise. HDL < 40 4. nitrates Positional (relived sitting forward/ worse lying down) Pericarditis  ECG ST-elivation in all leads + friction rub TTP  Costochondritis Pluritic: PE – V/Q scan pleuritis Pneumonia  CXR pnuomthorax All negative but still suspect 1st ECG & enzymes: Troponin.