Angina Pectoris (chest pain)

If the patient feels pain in their chest, they must immediately call an ambulance and go to the nearest hospital where and ECG will be performed. Blood tests will be carried out to evaluate cardiac markers and blood pressure will be measured.

After the doctor at the Accident and Emergency Department provides primary care, a cardiologist , who is available 24 hours a day, will take care of the patient and determine how serious their conditions are.
In the event of a heart attack, the patient is given appropriate pharmaceutical therapy and then transferred to the emergency room of the Department of Hemodynamics, set up for emergency coronary artery angiography.
During this procedure, the clogged vessel is re-opened and a stent implanted. The patient has an immediate feeling of relief and well-being.
After this one-hour procedure, the patient is taken to the Intensive Coronary Artery Therapy Unit (UTIC) and hospitalized for 24-48 hours.
 

Dyspnea (shortness of breath)


When shortness of breath occurs, lasts more than 10-15 minutes and gets even  worse, it is recommendable to call an ambulance or go to the nearest hospital to receive oxygen. Receiving oxygen is fundamental, whatever the cause of short  breath may be, because major organs like the brain, the heart and the kidneys need it.


Once the patient gets to the Accident and Emergency Department, it is key to make a diagnosis as soon as possible, to determine if  the dyspnea depends on heart or lung  conditions ( maybe a lung infection) or if it has other causes. Both the doctor at the Accident and Emergency Department and the cardiologist base their diagnosis of Acute decompensated heart failure on four main factors: clinical examinations, blood tests (B-type naturetic peptide or BNP), thoracic radiography and ECG.

Acute Decompensated Heart Failure

Even in the event of acute decompensated heart failure, a diagnosis is necessary to determine the seriousness of the disease. ADHF can result from cardiac ischemia, a damaged heart valve, untreated high blood pressure, impaired pulmonary circulation (pulmonary embolism), etc. Making a precise diagnosis may require a few days, but immediate care is given to the patient at the Intensive Cardiac Care Unit. Already after a few days the patient breathes better and short breath is relieved. Initial therapy includes intravenous diuretics and other drugs to control blood pressure and the patient’s general hemodynamic conditions. However, additional treatment to help lungs (continuous positive airway pressure, CPAP), kidneys (hemodialysis) and, in the most serious cases, the heart (Extra Corporeal Membrane Oxygenation).



Syncope

If the patient suddenly loses consciousness, but rapidly recovers, they must immediately call an ambulance or go to the nearest hospital. Accident and Emergency Department staff must promptly assess if the patient breathes well,  if the blood pressure is altered and if the patient is injured after falling.
Urgent blood tests, and ECG and a head CT scan are performed.
After first scrutiny, the physician can make a diagnosis although it is not always easy. The two main events are:
a) a cerebrovascular accident (stroke);
b) slow or fast arrythmia. This often occurs in elderly patients with a pathologically slow heartbeat that cause slow blood pressure.

If heartbeat slows down, new examinations are carried out, according to the patient’s conditions. Young patients  undergo the Tilting test, an examination that reproduces the slowing down of the heartbeat  functional as a functional cause of the syncope.
In these cases patients are given medical and behavioural therpaies. However, when the main cause of the syncope is old age, a Pacemaker will be implanted to guarantee constant and unlimited control of the heartbeat.


When the main cause of a syncope is a stroke, the only option is to give the patient medical therapy and hospitalize  them in the Intensive Care Unit  and then, when their conditions are stable, in Neurology. Rehabilitation is the next step and helps the patient recover those brain functions that have been damaged by the ischemic or hemorragic event.

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