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Cardiac chest pain

Keir McCutcheon, Andreas S Triantafyllis, Thomas Marynissen, Tom Adriaenssens, Johan Bennett, Christophe Dubois, Peter R Sinnaeve, Walter Desmet
BACKGROUND: The optimal therapeutic strategy for ST-segment elevation myocardial infarction (STEMI) patients found to have multi-vessel disease (MVD) is controversial but recent data support complete revascularisation (CR). Whether CR should be completed during the index admission or during a second staged admission remains unclear. Our main objective was to measure rates of major adverse cardiovascular events (MACEs) during the waiting period in STEMI patients selected for staged revascularisation (SR), in order to determine the safety of delaying CR...
March 21, 2018: Acta Cardiologica
Alicia Blackman, Wayne Mohammed
This case presents a woman in her early 20s who died after the sudden onset of chest pain. Five years earlier, she was investigated for a cardiac murmur during pregnancy and an echocardiogram revealed a 6.0×3.0 cm blood-filled sac compressing the left atrium and anterolateral aspect of the left ventricle with communication to the aortic root. She later had a CT scan of the chest with contrast, which showed aneurysmal dilatation of the left main coronary artery. She was placed on aspirin but defaulted from clinic 11 months post partum...
March 20, 2018: BMJ Case Reports
Robert Roehle, Viktoria Wieske, Georg M Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato, Juhani Knuuti, Matthijs F L Meijs, Harald Brodoefel, Shona M M Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp Kaufmann, Ronny Ralf Büchel, Bernhard Herzog, Melvin Clouse, David A Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean-Pierre Laissy, Roy Marcus, Simone Muraglia, Jean-Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)...
March 19, 2018: European Radiology
Israel Ugalde, Ibrar Anjum, Saberio Lo Presti, Alfonso Tolentino
Acute coronary syndrome usually presents with retrosternal chest pain, nausea, vomiting, sweating, and jaw and arm pain. Some patients only present with neck, epigastric, or ear discomfort. A 47-year-old male with a history of hypertension and coronary artery disease presented to the emergency department complaining of bilateral otalgia. He never felt chest pain, jaw pain, nausea, diaphoresis, or shortness of breath. He had a history of 2 acute coronary events and had a stress test 2 months prior to admission, which was unremarkable...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Fahad Syed Naseerullah, Hemangkumar Javaiya, Avinash Murthy
Primary tumours of the heart are often encountered in clinical practice. Different autopsy series estimate the incidence to be anywhere from 0.001% to 0.19%. Cardiac lipoma is a rare type of tumour of the heart and pericardium. It comprises approximately 10-19% of all cardiac tumours. We present a case of a large cardiac lipoma in a fifty-year-old female. She presented with sharp chest pains, palpitations, and dizziness. Acute coronary syndrome was ruled out. A transthoracic echocardiogram showed an abnormal, large, fixed right atrial mass...
2018: Case Reports in Cardiology
Tatiana Marcela Pérez, Sandra Milena García, Martha Lucía Velasco, Angela Paola Sánchez
Interrupted aortic arch is an extremely rare congenital malformation representing about 1% of congenital heart disease. Early symptoms usually occur early in the neonatal period and clinical deterioration is often rapid and long-term prognosis is limited. Nonetheless, this condition has been identified later in adult life in rare cases. We report a case in an adult male with absence of hypertension history and no further cardiac compromise, with a severe posterior chest pain alongside dyspnea and sweating. Computed tomography angiography revealed interrupted aortic arch type A, bivalve aorta, hemopericardium, aortic dissection Stanford A, and important collateral circulation...
February 2018: Radiology Case Reports
Francine Cl Tan, Jonathan Yap, John C Allen, Olivia Tan, Swee Yaw Tan, David B Matchar, Terrance Sj Chua
INTRODUCTION: Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology consultation. MATERIALS AND METHODS: Under the 'Triage Protocol', patients referred for chest pain were pretriaged using a standardised algorithm and subsequently referred for relevant functional diagnostic cardiology tests before their initial cardiology consultation...
February 2018: Annals of the Academy of Medicine, Singapore
Frantisek Nehaj, Juraj Sokol, Michal Mokan, Veronika Jankovicova, Frantisek Kovar, Marianna Kubaskova, Stanislav Mizera, Marian Mokan
The patient database at the First Department of Internal Medicine in Martin, the Central Slovak Institute for Cardiac and Vascular Diseases in Banska Bystrica, and the National Slovak Institute of Cardiovascular Diseases in Bratislava was searched to identify patients with benign tumors of the heart seen during the 5-year period between 2011 and 2016. Forty-one patients with primary cardiac myxomas were identified and their medical records were reviewed for details pertaining to presenting symptoms, staging modalities, treatment approaches, and outcomes...
2018: BioMed Research International
Mohamed A Mohamed, Rohit Abraham, Tareq I Maraqa, Samir Elian
Aortic dissection is a rare and fatal complication of cocaine-induced hypertension. The injury mechanism is through shear stress that penetrates the intimal vessel layer, allowing blood flow to separate intimal and medial layers. Due to its scarcity and the paucity of related literature, our knowledge of this condition is limited. We present a rare case of a cocaine-induced aortic dissection, which extended continuously from the aortic root to the common iliacs, along with a literature review of similar cases...
January 12, 2018: Curēus
Basmah Safdar, Gail D'Onofrio, James Dziura, Raymond R Russell, Caitlin Johnson, Albert J Sinusas
AIMS: Coronary microvascular dysfunction (CMD) is common in patients with non-obstructive coronary arteries but has not been described in low-risk symptomatic patients. We therefore assessed the prevalence and characteristics of CMD in low to moderate risk patients with chest pain in an emergency department. METHODS AND RESULTS: We used three-dimensional Rb82 cardiac positron emission tomography/computed tomography to diagnose coronary artery disease (known or new regional defect, any coronary calcification) and CMD (low coronary flow reserve without coronary artery disease) in chest pain patients after being ruled out for acute myocardial infarction...
March 1, 2018: European Heart Journal. Acute Cardiovascular Care
Mehrshad Vafaie, Matthias Hochadel, Thomas Münzel, Birgit Hailer, Burghard Schumacher, Gerd Heusch, Thomas Voigtländer, Harald Mudra, Michael Haude, Sebastian Barth, Claus Schmitt, Harald Darius, Lars S Maier, Hugo A Katus, Jochen Senges, Evangelos Giannitsis
BACKGROUND: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. METHODS: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society...
March 1, 2018: European Heart Journal. Acute Cardiovascular Care
Masaki Izumo, Yoshihiro J Akashi
Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology. TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications...
February 2018: Cardiovascular Diagnosis and Therapy
Jeong Won Lee, Se-Whan Lee, Sung-Hae Chang, Sang Mi Lee
OBJECTIVE: The purpose of the study is to evaluate the clinical usefulness of bone scintigraphy for etiological diagnosis of patients with atypical chest pain. PATIENTS AND METHODS: We retrospectively enrolled 225 patients with atypical chest pain who underwent bone scintigraphy for etiological diagnosis. No patients showed any symptoms or signs other than chest pain and had low-to-intermediate Framingham risk with insignificant findings on initial cardiac evaluation...
March 13, 2018: Nuclear Medicine Communications
Aaron Lear, Merritt Huber, Amy Canada, Jessica Robertson, Evan Bosman, Stephen Zyzanski
OBJECTIVE: To determine whether admission, and provocative stress testing of patients who have ruled out for acute coronary syndrome put patients with low-risk category for coronary artery disease (CAD) at risk for false-positive provocative stress testing and unnecessary coronary angiogram/imaging. METHODS: A retrospective chart review was performed on patients between 30 and 70 years old, with no pre-existing diagnosis of CAD, admitted to observation or inpatient status chest pain or related complaints...
March 2018: Journal of the American Board of Family Medicine: JABFM
Marjorie A Bowman, Anne Victoria Neale, Dean A Seehusen
This issue includes several excellent observational studies prompted by physicians' clinical questions. Many people use lots of menthol cough drops-does the menthol overall lengthen the cough duration? When should we intensify treatment of older individuals with diabetes? Do occipital nerve blocks work for acute migraine headaches? Did you know that the plantar fascia can rupture? What happens to those patients with chest pain but low pretest probability for serious cardiac disease who are admitted to the hospital? Acupuncture can work well-for the patients-but how can we incorporate it into the usual pace of the family medicine office? Is it a win-lose situation when medical assistant roles are expanded? How many practice sites do physicians have and does that make a difference in the number or type of health personnel shortage areas? What would you guess on the presence of humor in the medical office-more or less than half of the visits; introduced by doctors or patients; primary care or specialty doctors?...
March 2018: Journal of the American Board of Family Medicine: JABFM
Philippa Howlett, Jane K Cleal, Huihai Wu, Nikunj Shah, Alex Horton, Nick Curzen, Michael Mahmoudi
Objective: MicroRNAs (miRNAs) may serve as potential biomarkers in a variety of pathologies. The aim of this study was to determine whether miRNAs could serve as blood-based markers of isolated coronary artery calcification (CAC) defined as CAC in the absence of an underlying metabolic abnormality. Methods: 24 age-matched and sex-matched patients who had been referred for elective CT coronary calcium score and angiography as part of investigation for cardiac chest pain were recruited...
2018: Open Heart
Shannon N Nees, Jonathan N Flyer, Anjali Chelliah, Jeffrey D Dayton, Lorraine Touchette, David Kalfa, Paul J Chai, Emile A Bacha, Brett R Anderson
OBJECTIVES: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare cardiac anomaly associated with sudden cardiac death (SCD). Single-center studies describe surgical repair as safe, although medium- and long-term effects on symptoms and risk of SCD remain unknown. We sought to describe outcomes of surgical repair of AAOCA. METHODS: We reviewed institutional records for patients who underwent AAOCA repair, from 2001 to 2016, at 2 affiliated institutions...
February 8, 2018: Journal of Thoracic and Cardiovascular Surgery
Nils Arne Sörensen, Johannes Tobias Neumann, Francisco Ojeda, Sarina Schäfer, Christina Magnussen, Till Keller, Karl J Lackner, Tanja Zeller, Mahir Karakas, Thomas Münzel, Stefan Blankenberg, Dirk Westermann, Renate B Schnabel
BACKGROUND: The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men. METHODS AND RESULTS: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately...
March 10, 2018: Journal of the American Heart Association
Udaya Ralapanawa, Thilak Jayalath, Dhanusha Senadhira
BACKGROUND: Acute pancreatitis is an inflammatory condition with varying severity and a range of local and systemic complications. Here we report a patient with acute necrotizing pancreatitis complicated with a true non ST elevation myocardial infarction. CASE PRESENTATION: A 58 year old lady was admitted to our unit with acute onset epigastric pain and vomiting for 4 h duration. Following admission she complained of retrosternal tightening type of a chest pain...
March 9, 2018: BMC Research Notes
Amartya Kundu, Aditya Vaze, Partha Sardar, Ahmed Nagy, Wilbert S Aronow, Naomi F Botkin
PURPOSE OF REVIEW: Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD)...
March 8, 2018: Current Cardiology Reports
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