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Emergency department chest pain

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https://www.readbyqxmd.com/read/28210363/using-the-electronic-medical-record-to-reduce-unnecessary-ordering-of-coagulation-studies-for-patients-with-chest-pain
#1
Jeremiah S Hinson, Binoy Mistry, Yu-Hsiang Hsieh, Nicholas Risko, David Scordino, Karolina Paziana, Susan Peterson, Rodney Omron
INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28198635/impact-of-comorbidities-by-age-on-symptom-presentation-for-suspected-acute-coronary-syndromes-in-the-emergency-department
#2
Larisa A Burke, Anne G Rosenfeld, Mohamud R Daya, Karen M Vuckovic, Jessica K Zegre-Hemsey, Maria Felix Diaz, Josemare Tosta Daiube Santos, Sahereh Mirzaei, Holli A DeVon
BACKGROUND: It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions. AIMS: Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis. METHODS: A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study...
February 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28197284/st-segment-elevation-myocardial-infarction-door-to-balloon-time-improvement-project
#3
Saad Al Bugami, Jamilah Alrahimi, Abdullah Almalki, Farqad Alamger, Ahmed Krimly, Wail Al Kashkari
BACKGROUND: The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC))...
August 2016: Cardiology Research
https://www.readbyqxmd.com/read/28196622/non-cardiac-chest-pain-a-review-for-the-consultation-liaison-psychiatrist
#4
Kirsti A Campbell, Elizabeth N Madva, Ana C Villegas, Eleanor E Beale, Scott R Beach, Jason H Wasfy, Ariana M Albanese, Jeff C Huffman
BACKGROUND: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers...
December 9, 2016: Psychosomatics
https://www.readbyqxmd.com/read/28195938/low-adverse-event-rates-but-high-emergency-department-utilization-in-chest-pain-patients-treated-in-an-emergency-department-observation-unit
#5
Anthony M Napoli, Janette Baird, Steven Tran, Jing Wang
OBJECTIVES: Nearly 40% of all previously admitted chest pain patients re-present to the emergency department (ED) within 1 year regardless of stress testing, and nearly 5% of patients return with a major adverse cardiac event (MACE). The primary objective of this study was to determine the prevalence of return visits to the ED among patients previously admitted to an ED chest pain observation unit (CPU). We also identified the patient characteristics and health risk factors associated with these return ED visits...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28191332/angiotensin-ii-type-1-receptor-gene-a1166c-polymorphism-was-not-associated-with-acute-coronary-syndrome-in-an-iranian-population
#6
Navid Delshad, Majid Ghayour-Mobarhan, Hamed Mirzaei, Kamal Razavi-Azarkhiavi, Mohsen Moohebati, Mitra Hassany, Jamal Kasaian, Mohammad Reza Etemadzadeh, Maryam Sadat Alavi, Javad Behravan
BACKGROUND: There are very limited data for Iranian populations on the predisposing genetic factors for acute coronary syndrome (ACS). OBJECTIVES: The objective of the present study was to investigate the association of the angiotensin II type 1 receptor (AT1R) gene polymorphism and ACS in an Iranian population. PATIENTS AND METHODS: This cross-sectional study was conducted among 263 subjects (97 men and 166 women). Patients (n = 128) aged 30 - 80 years with chest pain were recruited from the emergency department of Ghaem Hospital (Mashhad, Iran)...
November 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28186860/traumatic-rib-injury-patterns-imaging-pitfalls-complications-and-treatment
#7
Brett S Talbot, Christopher P Gange, Apeksha Chaturvedi, Nina Klionsky, Susan K Hobbs, Abhishek Chaturvedi
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures...
February 10, 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28167641/prognostic-utility-of-a-modified-heart-score-in-chest-pain-patients-in-the-emergency-department
#8
James McCord, Rafael Cabrera, Bertil Lindahl, Evangelos Giannitsis, Kaleigh Evans, Richard Nowak, Tiberio Frisoli, Richard Body, Michael Christ, Christopher R deFilippi, Robert H Christenson, Gordon Jacobsen, Aitor Alquezar, Mauro Panteghini, Dina Melki, Mario Plebani, Franck Verschuren, John French, Garnet Bendig, Silvia Weiser, Christian Mueller
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013...
February 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28166154/intrathoracic-accessory-lobe-of-liver-masquerading-as-a-paraesophageal-mass
#9
Christopher Ball, Jason Wayne Wachsmann
Heterotopic liver tissue is a relatively rare finding, which has historically been discovered incidentally during surgery or at autopsy. However, we present a 28-year-old woman who presented to the emergency department with shortness of breath and stabbing chest pain. An emergent CT angiogram of the chest was performed, which incidentally revealed a mediastinal paraesophageal mass. Subsequent endoscopic ultrasound showed a hypoechoic area that appeared to connect to the liver. A liver/spleen scan with SPECT/CT with Tc sulfur colloid demonstrated that the mass was paraesophageal heterotopic liver tissue with a connection to the orthotropic liver by a small stalk...
February 3, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28164636/diagnostic-and-prognostic-value-of-circulating-microrna-133a-in-patients-with-acute-myocardial-infarction
#10
Ling Yuan, Xiaoxiao Liu, Fang Chen, Lizhu Zhang, Xi Chen, Qiang Huang, Dan Wu, Chengjian Yang, Zhijun Han
BACKGROUND: The aim of this study was to examine the expression of circulating microRNA (miR)-133a in acute myocardial infarction (AMI) patients and assess its potential as a diagnostic and prognostic marker. METHODS: This study enrolled 222 consecutive patients who presented with chest pain symptoms suggestive of AMI in either the Department of Emergency or Department of Cardiology at Wuxi Second People's Hospital from October 2012 through December 2014. Of these, 102 were diagnosed with AMI and 120 with non-AMI chest pain...
July 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28164616/age-and-gender-tailored-cutoff-value-of-hs-ctnt-contributes-to-rapidly-diagnose-acute-myocardial-infarction-in-chest-pain-patients
#11
Shuo Yang, Wei Huai, Rui Qiao, Liyan Cui, Guihua Liu, Jian Wu, Aiwei Li, Jie Zhang
BACKGROUND: Hs-cTnT concentrations are age and gender related, therefore establishment of age and gender optimized cutoff values for hs-cTnT might be essential. We aimed to define the age and gender specific hs-cTnT 99th percentile in reference population and assess its diagnostic and prognostic performance in patients with suspected AMI. METHODS: In this prospective study, 1725 healthy individuals (18 - 97 years old) and 812 patients (15 - 98 years old) with chest pain with suspected AMI presenting to the emergency department were enrolled...
August 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28139353/suspected-acs-patients-presenting-with-myocardial-damage-or-a-type-2-myocardial-infarction-have-a-similar-late-mortality-to-patients-with-a-type-1-myocardial-infarction-a-report-from-the-australian-and-new-zealand-2012-snapshot-acs-study
#12
Aisha Etaher, Derek Chew, Julie Redfern, Tom Briffa, Chris Ellis, Christopher Hammett, Jeffrey Lefkovits, John Elliott, Louise Cullen, David Brieger, John K French
BACKGROUND: Cardiac troponin (T and I) are considered the standard markers for detection of myocardial damage and the diagnosis of acute coronary syndrome (ACS) among patients who present to an emergency department with chest pain. However, these markers can be released in other situations and may be associated with short- and long-term clinical outcomes. In this study, we examine late mortality rates among patients presenting with a suspected ACS due to an unstable coronary plaque and those patients having a non-ACS...
December 31, 2016: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28131609/geriatric-syncope-and-cardiovascular-risk-in-the-emergency-department
#13
Nissa J Ali, Shamai A Grossman
BACKGROUND: Syncope is a transient loss of consciousness that is caused by a brief loss in generalized cerebral blood flow. OBJECTIVE: This article reviews the background, epidemiology, etiologies, evaluation, and disposition considerations of geriatric patients with syncope, with a focus on cardiovascular risk. DISCUSSION: Although syncope is one of the most common symptoms in elderly patients presenting to the emergency department, syncope causes in geriatric patients can present differently than in younger populations, and the underlying etiology is often challenging to discern...
January 25, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28127121/interpretation-of-positive-troponin-results-among-patients-with-and-without-myocardial-infarction
#14
Kristen M Tecson, William Arnold, Tyler Barrett, Robert Birkhahn, Lori B Daniels, Christopher DeFilippi, Gary Headden, W Frank Peacock, Michael Reed, Adam J Singer, Jeffrey M Schussler, Stephen Smith, Martin P Than, Peter A McCullough
Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal...
January 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28123626/an-unusual-emergency-department-case-ruptured-ectopic-pregnancy-presenting-as-chest-pain
#15
Eric Dichter, James Espinosa, James Baird, Alan Lucerna
No abstract text is available yet for this article.
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28123617/clinical-and-historical-features-of-emergency-department-patients-with-pericardial-effusions
#16
Lori Stolz, Josephine Valenzuela, Elaine Situ-LaCasse, Uwe Stolz, Nicolas Hawbaker, Matthew Thompson, Srikar Adhikari
BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram...
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28117110/hemorrhagic-pericardial-cyst-diagnosis-accelerated-by-emergency-physician-echocardiography-a-case-report
#17
Michael F Yip, Brooks M Walsh
BACKGROUND: The differential diagnosis for chest pain in the emergency department is broad and includes both benign and life-threatening conditions-with pericardial cyst as a rare example. Emergency physician-performed point-of-care focused cardiac ultrasound (FOCUS) is increasingly recognized as a useful modality in the evaluation of patients with chest pain. CASE REPORT: We report a case of hemorrhagic pericardial cyst in a young woman presenting with chest pain in which findings on FOCUS contradicted findings on chest x-ray study and thus, accelerated diagnosis and definitive treatment...
January 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28108220/missed-myocardial-infarctions-in-ed-patients-prospectively-categorized-as-low-risk-by-established-risk-scores
#18
A J Singer, M P Than, S Smith, P McCullough, T W Barrett, R Birkhahn, M Reed, H C Thode, W D Arnold, L B Daniels, C de Filippi, G Headden, W F Peacock
STUDY OBJECTIVES: Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. METHODS: We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED)...
January 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28099107/case-238-spontaneous-pneumothorax-secondary-to-intrapulmonary-necrobiotic-rheumatoid-nodule
#19
Ammar A Chaudhry, Maryam Gul, Abbas A Chaudhry, William Moore
History A 54-year-old white woman with a history of rheumatoid arthritis who was taking glucocorticoids and methotrexate presented to the emergency department in December with worsening shortness of breath and chest heaviness for 1 week. She reported additional symptoms of weakness, headache, and arthralgia primarily involving her bilateral hands, wrist, ankles, and feet. She denied experiencing fevers, syncope or presyncope, focal neurologic deficits, chest pain, nausea, vomiting, unintentional weight loss, or recent trauma...
February 2017: Radiology
https://www.readbyqxmd.com/read/28087181/challenging-the-99th-percentile-a-lower-troponin-cutoff-leads-to-low-mortality-of-chest-pain-patients
#20
Nils Arne Sörensen, Johannes Tobias Neumann, Francisco Ojeda, Tjark Schwemer, Thomas Renné, Renate B Schnabel, Tanja Zeller, Mahir Karakas, Stefan Blankenberg, Dirk Westermann
BACKGROUND: Rule-out of non-ST-elevation myocardial infarction is based on consecutive measurements of cardiac troponins using the 99th percentile of the respective assay as cutoff. The new ESC guidelines alternatively offer rapid 1h algorithms with lower cutoffs than the 99th percentile for rule-out of non-ST-elevation myocardial infarction. We aimed to compare a recently introduced 1h algorithm based on a high-sensitivity cardiac troponin I (hs-TnI) cutoff of 6ng/L at 0h and 1h to the current standard of care using the 99th percentile (27ng/L) as cutoff with reference to follow-up events in a large chest pain cohort...
December 27, 2016: International Journal of Cardiology
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