Emergency Medicine and Cardiology in World Heart Month

Colin A Graham
Editor-in-Chief, European Journal of Emergency Medicine
Professor, Emergency Medicine, Chinese University of Hong Kong
cagraham@cuhk.edu.hk

Emergency medicine and cardiology share a vast amount of common ground in the patients we treat and the diseases we research and manage. The epidemic of coronary heart disease in the western (and increasingly, eastern) world remains active, although the clinical impact of ischaemic heart disease has been modified by new therapies: thrombolysis, percutaneous coronary intervention (PCI), statins, defibrillation and cardiac rehabilitation.

Many of these treatments are time dependent, and then they enter the realm of the emergency physician working in partnership with cardiologists. In particular, PCI offers significant advantages over thrombolysis for many patients with ST elevation myocardial infarction, but the timely delivery of such patients to the catheter lab demands a well coordinated process of care from the point of contact with emergency medical services, through the emergency department to the catheter lab.

In many parts of the world, PCI is not available 24 hours a day or seven days a week, and these organisational and staffing issues are pressing if we are to further improve the quality of care delivered to acute coronary syndrome patients. Cardiologists need to engage with their emergency physician colleagues to streamline models of care and eliminate unnecessary delays in treatment and investigation. Equally, emergency physicians need to be proactive and highlight areas of poor practice within their own systems to optimise care for these critically ill patients.

Chest pain is one of the commonest presenting complaints to emergency physicians and we cannot admit all these patients to hospital for expensive work up. We need to have a rapid but safe way to exclude serious coronary heart disease and other life threatening conditions in these patients to minimise risk. The use of cardiac troponins has made this 'rule-out' process much safer compared to clinical judgement, but new markers and new imaging techniques (such as CT coronary angiography) will continue to change the way we manage these patients.

Sudden cardiac death (SCD) continues to be a major cause of premature loss of life worldwide. The epidemiology of SCD is changing, with many countries reporting lower proportions of patients presenting in ventricular fibrillation or pulseless ventricular tachycardia than in the past. This may lead to changes in resuscitation practice, with the American Heart Association recently discussing a change to compression only basic life support for the initial management of cardiac arrest. The International Liaison Committee on Resuscitation (ILCOR) is due to report in late 2010 and will give the most comprehensive overview to date of the evidence base for cardiopulmonary resuscitation.

Continuing collaboration between emergency physicians, cardiologists and other critical care professionals can only enhance the care provided to our cardiac patients. In World Heart Month, we should make that collaboration a top priority.

 Further Reading

This article is freely avaible on our website

Prehospital treatment of ACS
Goldstein et al
European Journal of Emergency Medicine 2009 
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