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https://www.readbyqxmd.com/read/27892881/comparison-of-visual-assessment-of-coronary-stenosis-with-independent-quantitative-coronary-angiography-findings-from-the-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain-promise-trial
#1
Rohan Shah, Eric Yow, William Schuyler Jones, Louis P Kohl, Andrzej S Kosinski, Udo Hoffmann, Kerry L Lee, Christopher B Fordyce, Daniel B Mark, Alicia Lowe, Pamela S Douglas, Manesh R Patel
: The outcomes in patients by visual assessment and quantitative coronary angiography (QCA) for obstructive coronary artery disease (CAD) are not known. Our objectives were to compare visual and QCA estimates of obstructive CAD and to assess their relationship to outcomes in stable patients with symptoms of CAD. METHODS: The PROMISE trial randomized 10,003 patients with CAD symptoms to anatomical or functional testing. Site reports of invasive angiography detailing visual stenosis and independent, blinded QCA were performed for obstructive CAD (≥50% stenosis)...
October 26, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27865322/thoracic-trauma-which-chest-tube-when-and-where
#2
REVIEW
Tamas F Molnar
Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system...
February 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/27849321/evaluation-of-patients-diagnosed-with-acute-blunt-aortic-injury-and-their-bedside-plain-chest-radiography-in-the-emergency-department-a-retrospective-study
#3
Funda Karbek Akarca, Tanzer Korkmaz, Celal Çınar, Elif Dilek Çakal, Murat Ersel
BACKGROUND: The purpose of our study was to retrospectively evaluate traumatic aortic transection patients and their bedside plain chest radiographs for signs of aortic injury. METHODS: Emergency department (ED) patients from a 5-year period with traumatic aortic transection who were over 18 years of age were included in the study. Demographic characteristics, mechanism of trauma, Revised Trauma Score, Glasgow Coma Score, vital signs, physical exam findings, laboratory parameters, length of stay in the ED, and patient outcomes were documented...
September 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/27842619/congenital-coronary-artery-anomalies-in-adults-review-of-111-cases-from-a-single-centre-experience
#4
Yiğit Çanga, Tolga S Güvenç, Mehmet B Karataş, Ali N Çalık, Tolga Onuk, Veysel O Tanık, Barış Güngör, Osman Bolca
BACKGROUND: Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre...
November 15, 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/27797440/the-association-of-electrocardiographic-abnormalities-and-major-adverse-cardiac-events-in-emergency-patients-with-chest-pain
#5
Thomas Knowlman, Jaimi H Greenslade, William Parsonage, Tracey Hawkins, Lorcan Ruane, Paul Martin, Sandhir Prasad, Daniel Lancini, Louise Cullen
OBJECTIVES: The electrocardiograph (ECG) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome (ACS). A six-point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department (ED) with suspected ACS. We set out to evaluate the efficacy of these criteria in identifying patients with major adverse cardiac events (MACE), Type 1 myocardial infarction (T1MI), Type 2 myocardial infarction (T2MI), and one-year mortality in a cohort of emergency patients with chest pain...
October 31, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27762526/unstable-angina-a-serious-adverse-event-following-gemcitabine-cisplatin-based-chemotherapy
#6
H S Rehan, M Andley, P Nagar, V Maharshi
A 29 year male, with an inoperable adenocarcinoma of gall bladder was initiated on gemcitabine and a platinum compound based chemotherapy. During 4th cycle of chemotherapy, patient complained of chest pain following cisplatin and gemcitabine infusion. ECG was suggestive of acute coronary syndrome, which was successfully managed by antianginal therapy. Fifth cycle of chemotherapy was uneventful. Patient died of cardiovascular collapse before receiving the 6th cycle of chemotherapy. As per Naranjo adverse drug reaction probability scale, causal association of the event with cisplatin and gemcitabine was probable and possible respectively...
September 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27751289/apical-hypertrophic-cardiomyopathy-with-hemodynamically-unstable-ventricular-arrhythmia-atypical-presentation
#7
Hemant Chaturvedi, Rudra Dev Pandey, Krishna Kumar Sharma, Jitendra Singh Makkar, Sanjeev K Sharma
We present a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who recently developed cardiac arrhythmias, and shortly discuss the diagnostic modalities, differential diagnosis, and treatment strategy for this condition. AHCM is a rare form of hypertrophic cardiomyopathy, which usually involves the apex of the left ventricle. AHCM can occur with varied presentations such as chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation, and congestive heart failure...
September 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27718140/prediction-of-clinical-outcome-by-myocardial-ct-perfusion-in-patients-with-low-risk-unstable-angina-pectoris
#8
Jesper J Linde, Mathias Sørgaard, Jørgen T Kühl, Jens D Hove, Henning Kelbæk, Walter B Nielsen, Klaus F Kofoed
The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations)...
October 7, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27671996/resistance-training-exercises-with-different-stability-requirements-time-course-of-task-specificity
#9
Atle Hole Saeterbakken, Vidar Andersen, David G Behm, Espen Krogseth Krohn-Hansen, Mats Smaamo, Marius Steiro Fimland
PURPOSE: The aim of the study was to assess the task-specificity (greater improvements in trained compared to non-trained tasks), transferability and time-course adaptations of resistance-training programs with varying instability requirements. METHOD: Thirty-six resistance-trained men were randomized to train chest press 2 days week(-1) for 10 week (6 repetitions × 4 series) using a Swiss ball, Smith machine or dumbbells. A six-repetition maximum-strength test with the aforementioned exercises and traditional barbell chest press were performed by all participants at the first, 7th, 14th and final training session in addition to electromyographic activities of the prime movers measured during isometric bench press...
September 26, 2016: European Journal of Applied Physiology
https://www.readbyqxmd.com/read/27665208/clinical-evaluation-versus-undetectable-high-sensitivity-troponin-for-assessment-of-patients-with-acute-chest-pain
#10
Juan Sanchis, Sergio García-Blas, Arturo Carratalá, Ernesto Valero, Anna Mollar, Gema Miñana, Vicente Ruiz, Jose Vicente Balaguer, Mercé Roqué, Xavier Bosch, Julio Núñez
Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (<14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE...
August 31, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27595697/readmission-after-inpatient-percutaneous-coronary-intervention-in-the-medicare-population-from-2000-to-2012
#11
Christian McNeely, Stephen Markwell, Christina M Vassileva
BACKGROUND: Since year 2000, reducing hospital readmissions has become a public health priority. In addition, there have been major changes in percutaneous coronary intervention (PCI) during this period. METHODS: The cohort consisted of 3,250,194 patients admitted for PCI from January 2000 through November 2012. RESULTS: Overall, 30-day readmission was 15.8%. Readmission rates declined from 16.1% in 2000 to 15.4% in 2012 (adjusted odds ratio for readmission 1...
September 2016: American Heart Journal
https://www.readbyqxmd.com/read/27587928/predictors-of-adverse-outcomes-of-patients-with-chest-pain-and-primary-diagnosis-of-non-cardiac-pain-at-the-time-of-discharge-from-emergency-department-a-30-days-prospective-study
#12
Mohammadhossien Soltani, Masoud Mirzaei, Ahmad Amin, Mahmoud Emami, Reza Aryanpoor, Farimah Shamsi, Mohammadtaghi Sarebanhassanabadi
BACKGROUND: Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. METHODS: Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50...
July 2016: Ethiopian Journal of Health Sciences
https://www.readbyqxmd.com/read/27575901/an-unusual-cause-of-pericardial-effusion
#13
Christina Lamkin, Lawrence R Hamner
A patient who presented with chest pain, shortness of breath, and a purulent pericardial effusion became hemodynamically unstable after recurrent accumulation of fluid in the pericardial sac despite treatment. Surgical exploration revealed an aortic ulcer created by an ingested porcupine quill that perforated the esophagus. Sharp foreign body ingestion is extremely rare but poses devastating complications, and should be considered in the differential diagnosis of patients with otherwise unexplained chest pain...
September 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/27574681/unstable-cardiac-injury-complicated-with-septic-shock-a-challenge
#14
Neha Garg, Kapil Dev Soni, Richa Aggarwal
BACKGROUND: Road traffic accident accounts for 70 % to 80 % of the blunt cardiac injury. The true incidence varies in the literature due to non-uniform criteria for diagnosis. CASE PRESENTATION: Here, we describe the case of a young male presenting after blunt chest injury and hemodynamic instability. Initially, the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se. However, he was stabilized by day 2. Subsequently, patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury...
2016: Burns and trauma
https://www.readbyqxmd.com/read/27558904/is-the-incidence-of-heart-attack-still-decreasing-in-australia-developing-reliable-methods-for-monitoring-trends-in-myocardial-infarction-and-coronary-heart-disease-aus-mocha-a-study-protocol
#15
Lee Nedkoff, Matthew Knuiman, Michael S T Hobbs, Joseph Hung, Sushma Mathur, John Beilby, Anna Reynolds, Tom G Briffa, Derrick Lopez, Frank M Sanfilippo
INTRODUCTION: Accurate monitoring of acute coronary heart disease (CHD) is essential for understanding the effects of primary and secondary prevention and for planning of healthcare services. The ability to reliably monitor acute CHD has been affected by new diagnostic tests for myocardial infarction (MI) and changing clinical classifications and management of CHD. Our study will develop new and reliable methods for monitoring population trends in incidence, outcomes and health service usage for acute CHD and chest pain...
August 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27553197/penetrating-thoracic-trauma-patients-with-gross-physiological-derangement-a-responsibility-for-the-general-surgeon-in-the-absence-of-trauma-or-cardiothoracic-surgeon
#16
Dietrich Doll, Markus Eichler, Pantelis Vassiliu, Kenneth Boffard, Tim Pohlemann, Elias Degiannis
BACKGROUND: Penetrating trauma is becoming increasingly common in parts of the world where previously it was rare. At the same time, general surgeons and surgical trainees are becoming more specialized, and less comfortable operating within areas beyond their zone of specialization. OBJECTIVE: The purpose of this manuscript is to assess the technical difficulties encountered in operating on patients who have sustained penetrating trauma, and to prove to general surgeons that the technical skills and techniques required are no different to those required for abdominal surgery, and do not require additional dexterity...
August 23, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27528647/state-of-the-art-evaluation-of-emergency-department-patients-presenting-with-potential-acute-coronary-syndromes
#17
Judd E Hollander, Martin Than, Christian Mueller
It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia...
August 16, 2016: Circulation
https://www.readbyqxmd.com/read/27471140/diagnostic-accuracy-of-high-sensitivity-cardiac-troponin-t-at-presentation-combined-with-history-and-ecg-for-ruling-out-major-adverse-cardiac-events
#18
Arash Mokhtari, Bertil Lindahl, J Gustav Smith, Martin J Holzmann, Ardavan Khoshnood, Ulf Ekelund
STUDY OBJECTIVE: We evaluate the diagnostic accuracy of a high-sensitivity cardiac troponin T (hs-cTnT) level less than 5 ng/L or less than or equal to 14 ng/L at emergency department (ED) presentation, combined with the emergency physician's assessment of history and ECG, for ruling out major adverse cardiac events within 30 days. METHODS: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians' assessments of patient history and ECG were collected...
December 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27435910/septic-pulmonary-embolism-caused-by-infected-pacemaker-leads-after-replacement-of-a-cardiac-resynchronization-therapy-device
#19
Salah A M Said, Rogier Nijhuis, Anita Derks, Herman Droste
BACKGROUND Cardiac resynchronization therapy (CRT) has been demonstrated to reduce morbidity and mortality in patients with advanced, drug-refractory heart failure. Procedure-related mortality is less than 1% in larger studies. Approximately10% of CRT patients have to undergo surgical revision because of infections, dislocations, or unacceptable electrical behavior manifested as high threshold, unstable sensing, or unwanted phrenic nerve stimulation. CASE REPORT A 70-year-old man with symptomatic congestive heart failure underwent implantation of a biventricular pacemaker on the left anterior chest wall in 2003 and pulse generator exchange in August 2009...
2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27399610/anomalous-origin-of-a-stenosed-left-circumflex-coronary-artery-in-a-patient-presenting-with-unstable-angina-a-case-report
#20
Hossein Vakili, Isa Khaheshi, Mehdi Memaryan, Mohammadreza Naderian
A 73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina...
July 8, 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
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