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ACEP released acute heart failure syndrome (AHFS) consensus recommendations that cover: diagnosis with lung ultrasound, risk stratification, high-dose nitroglycerin, and early diuretics.

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Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes: Approved by ACEP Board of Directors, June 23, 2022. Ann Emerg Med. 2022 Oct;80(4):e31-e59. doi: 10.1016/j.annemergmed.2022.05.027.

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Decompensated right heart failure (RHF) increases morbidity and mortality, but it can be challenging to diagnose and treat. This review summarizes the unique physiology of RHF and treatment implications.

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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are known to have cardioprotective effects and are now recommended for all heart failure patients no matter their baseline ejection fraction (EF) or starting medication regimens.

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SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022 Sep 3;400(10354):757-767. doi: 10.1016/S0140-6736(22)01429-5. Epub 2022 Aug 27.

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This is the latest on how to work up possible acute coronary syndrome in the ED.

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This is an EM-focused review of pericardial tamponade, including the bedside echo.

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Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med. 2022 Aug;58:159-174. doi: 10.1016/j.ajem.2022.05.001. Epub 2022 May 6.

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In patients with acute pulmonary embolism, only supraventricular tachycardia was an independent predictor of clinical deterioration; however, other ECG findings (below) were associated with abnormal RV function on echo.

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Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism. Acad Emerg Med. 2022 Jun 24. doi: 10.1111/acem.14554. Online ahead of print.

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There are two distinct ECG patterns to know for isolated right ventricular myocardial infarctions (IRVMI).

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Diagnostic Traps—Noteworthy Electrocardiogram Patterns. JAMA Intern Med. 2022 May. doi:10.1001/jamainternmed.2022.1925

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The Seamens’ Sign performs better than commonly used criteria for ruling in left ventricular hypertrophy (LVH) by ECG.

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A single high sensitivity cardiac troponin T (hs-cTnT) measurement less than the limit of quantitation (the lowest reportable concentration) appears to be sufficient in ruling out acute MI in a low risk population.

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Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation. Circulation. 2022 Jun 7;145(23):1708-1719. doi: 10.1161/CIRCULATIONAHA.122.059235. Epub 2022 May 10.

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These are the take home points for emergency medicine from the AHA heart failure guidelines. There are some novel therapies for heart failure you need to know.

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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063. Epub 2022 Apr 1. Erratum in: Circulation. 2022 May 3;145(18):e1033.