Emergency Cardiology

Care for patients with acute cardiac disease is central to emergency medicine. Cardiac disease remains a leading killer of Americans, and millions of patients present to emergency departments every year with possible acute cardiac diseases.

Duke Emergency Medicine investigators collaborate frequently with our colleagues in the various branches of cardiology to investigate novel methods for diagnosing and treating acute cardiac diseases.  We are able to leverage our unique position in the patient care spectrum and our institutional and health system strengths to innovate new approaches to acute cardiac disease such as acute coronary syndrome, heart failure, and cardiac arrest.

Program Highlights

Below is a partial list of current research studies.

  • RELAX 2: This is a multicenter, randomized, double-blind, placebo-controlled phase IIIb clinical trial designed to evaluate the efficacy and safety of an intravenous infusion of serelaxin when added to standard therapy in acute congestive heart failure patients.
  • Stress Delta Biomarkers: Conceptually, stress testing consists of two components.  The first component, cardiac stress, uses either drugs or a graded exercise protocol to “stress” the heart, attempting to transiently induce cardiac ischemia.  The second component, assessment, uses imaging to identify defects due to lack of sufficient blood flow to the heart during stress.  In this study, we attempt to ascertain whether there are changes in blood biomarkers incurred by cardiac stress.
  • Stress-Delta Metabolomics: In this study, we propose to use metabolic profiling (metabolomic) analysis from peripheral blood samples to identify blood-borne markers associated with myocardial ischemia.
  • Global Health: Our colleagues in Emergency Medicine Global Health have generated countless opportunities to explore the diagnosis and treatment of acute coronary syndrome in different health care systems. We are currently exploring the use of stress testing and socioeconomic factors associated with cardiac outcomes using a nationalized health care database from Brazil.
  • Carolinas CTSA Collaborative: This project leverages Carolinas Collaborative infrastructure to collect data specific to the HEART Pathway from all 4 health systems of the Carolinas CTSA Collaborative, establishing rates of healthcare utilization and ACS outcomes for Emergency Department patients with chest pain in the Carolinas. In addition, we will engage key stakeholders at each health system to develop an implementation strategy.
  • Cardiac Biomarkers: We conduct several prospective diagnostic studies to evaluate the utility of novel cardiac biomarkers, including the introduction of high-sensitivity troponin assays.
  • Study Assessing Nitroxyl Donor Upon Presentation with Acute Heart Failure: This is a multicenter, randomized, double-blind, dose-ranging, phase 2b study of the safety and efficacy of continuous 48-hour intravenous infusions of BMS-986231 in hospitalized patients with heart failure and impaired systolic function.  The goal was to evaluate the effects of various doses of BMS-986231 compared to placebo on clinically relevant hypotension.
  • MicroRNAs To Identify Myocardial Ischemia During Stress Testing In The Emergency Department: Transcriptomics have been studied in patients with acute myocardial infarction to identify specific microRNAs that are present. We studied select microRNA levels in patients earlier in the Acute Coronary Syndrome spectrum, who have inducible myocardial ischemia during stress testing. Furthermore, we sought to expand on the molecular characterization of this condition through the combination of the proposed data set with our existing metabolomic findings to determine whether a combined “–omics” model can provide improved discrimination of myocardial ischemia from normal controls. 
  • Ye Cardiac Arrest Singapore: Expert guidelines have identified criteria for the termination of resuscitation in out of hospital cardiac arrest. This study will quantify the economic value of adopting termination of resuscitation in out of hospital cardiac arrest to guide prehospital systems.




  • S. Michelle Griffin
  • Chandra Quigley
  • Dana Weeks
  • Clancy Leahy
  • Tiffany Smith
  • Thomas Irons
  • Diana Parise

Ongoing Collaborations

  • Cardiology- Heart Failure
  • Cardiology- CCU
  • Cardiology- Magnetic Resonance Imaging
  • Nuclear Cardiology
  • Center for Applied Genomics and Precision Medicine
  • Duke Molecular Physiology Institute
  • Carolinas CTSA Collaborative: Duke University, University of North Carolina at Chapel Hill, Wake Forest University, Medical University of South Carolina
  • Duke Emergency Medicine Global Health

Advanced Training

Our team has served to support 3rd year medical student and resident research projects.  We currently have several trainee-led projects underway.

Collaborate with Us

Contact: Alexander Limkakeng, MD, MHSc.