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Emergency department chest pain

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https://www.readbyqxmd.com/read/28723703/management-of-chest-pain-in-the-french-emergency-healthcare-system-the-prospective-observational-epidoultho-study
#1
Sandrine Charpentier, Sebastien Beaune, Luc Marie Joly, Abdo Khoury, François-Xavier Duchateau, Raphael Briot, Bertrand Renaud, François-Xavier Ageron
OBJECTIVE: The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). PATIENTS AND METHODS: All patients with chest pain who contacted a SAMU and/or were managed by a MICU and/or were admitted into an ED were included in a 1-day multicentre prospective study carried out in January 2013...
July 18, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28719089/development-and-implementation-of-an-emergency-department-telephone-follow-up-system
#2
O John Ma, Mary Tanski, Beech Burns, Elizabeth F Spizman, James A Heilman
Implementing a telephone follow-up system after a patient's emergency department (ED) visit is challenging, but it may improve patient safety and care. This study's objective was to describe the development and implementation of a comprehensive ED telephone follow-up system over a 9-year period. Discharged patients who received a follow-up telephone call within 48 hours of their ED visit included all pediatric patients, those who left without being seen by a provider, and any adult patient with a "high-risk chief complaint," which was defined as a headache, visual problem, chest pain, dyspnea, abdominal pain, syncope, trauma, and neurological-related problems...
July 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/28715835/correction-effect-of-using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department
#3
(no author information available yet)
No abstract text is available yet for this article.
July 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28712187/utility-of-heart-type-fatty-acid-binding-protein-h-fabp-point-of-care-test-in-the-early-hours-of-stemi-compared-with-troponin-i-in-pakistani-population
#4
Walid Ahmad Abbasi, Muhammad Saleem, Shahid Rasheed, Azhar Mahmood Kiyani
BACKGROUND: Acute coronary syndrome remains a dominant cause of high morbidity and mortality despite advancements in treatment This study was conducted to examine the utility of point-of-care test of heart-type fatty-acid binding protein (h-FABP) and compare it with the point-of-care test of cardiac troponin I (cTnI) in the first 06 hours of STEMI. METHODS: This cross-sectional, comparative study which was conducted in Rawalpindi institute of cardiology, Rawalpindi, Pakistan, from January to June 2015...
January 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28711124/cardiovascular-conditions-in-the-observation-unit-beyond-chest-pain
#5
REVIEW
Jeremiah D Gaddy, Kathleen T P Davenport, Brian C Hiestand
The first emergency department observation units (EDOUs) focused on chest pain and potential acute coronary syndromes. However, most EDOUs now cover multiple other conditions that lend themselves to protocolized, aggressive diagnostic and therapeutic regimens. In this article, the authors discuss the management of 4 cardiovascular conditions that have been successfully deployed in EDOUs around the country.
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711123/care-of-the-patient-with-chest-pain-in-the-observation-unit
#6
REVIEW
Joseph B Borawski, Louis G Graff, Alexander T Limkakeng
Care of the patient presenting to an emergency department (ED) with chest pain remains a common yet challenging aspect of emergency medicine. Acute coronary syndrome presents in nonspecific fashion. The development and evolution of the ED-based observation unit has helped to safely assess and diagnose those most at risk for an adverse cardiac event. Furthermore, there are several provocative testing modalities to help assess for coronary artery disease. This article serves to describe and discuss the modern ED-based observation unit approach to patients with chest pain and/or angina equivalents presenting to an ED...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28700484/cardiac-metastasis-of-tongue-squamous-cell-carcinoma-complicated-by-pulmonary-embolism-a-case-report
#7
Sonaz Malekzadeh, Alexandra Platon, Pierre-Alexandre Poletti
RATIONALE: Cardiac metastasis is known as a rare complication of head and neck malignancy. PATIENT CONCERNS: We present a 58-year-old woman patient with a history of tongue carcinoma who was admitted in emergency department for sudden chest pain. Imaging work-up by computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) diagnosed a cardiac metastasis complicated by intraventricular thrombus and pulmonary embolism. DIAGNOSIS: Cardiac metastasis from tongue carcinoma complicated by pulmonary embolism...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28697726/successful-percutaneous-coronary-intervention-in-the-setting-of-an-aberrant-left-coronary-artery-arising-from-the-right-coronary-cusp-in-a-patient-with-acute-coronary-syndrome-a-case-report
#8
Jung-Hee Lee, Jong-Seon Park
BACKGROUND: An aberrant origin of the left coronary artery (LCA) from the right coronary cusp (RCC) is an extremely rare congenital anomaly. We here report on successful percutaneous coronary intervention (PCI) in a patient presenting with acute coronary syndrome and an aberrant origin of the LCA from the RCC. CASE PRESENTATION: A 50-year-old man presented at our emergency department with recurrent resting chest pain. Following unsuccessful attempts at visualizing the left coronary artery using Judkins left and Amplatz catheters, an aortogram using a pigtail catheter suggested anomalous left coronary artery origin and showed a significant occlusive lesion at proximal left anterior descending artery...
July 11, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28695975/decreased-admissions-and-hospital-costs-with-a-neutral-effect-on-mortality-following-lowering-of-the-troponin-t-cutoff-point-to-the-99th-percentile
#9
Christian Bjurman, Matteus Zywczyk, Bertil Lindahl, Tobias Carlsson, Per Johanson, Max Petzold, Martin Holzmann, Michael Lx Fu, Ola Hammarsten
BACKGROUND: The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources. METHODS: Clinical and laboratory data from patients with chest pain or dyspnea at the emergency department (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012...
July 11, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28685795/the-risk-of-acute-coronary-syndrome-in-ramadan
#10
Asma Sriha Belguith, Houda Baccouche, Mohamed Habib Grissa, Hamdi Boubaker, Wahid Bouida, Kaouthar Beltaief, Adel Sekma, Nizar Fredj, Nasri Bzeouiche, Zied Zina, Riadh Boukef, Mohamed Soltani, Semir Nouira
BACKGROUND: Data on the effect of fasting on coronary disease are rare and controversial. The aim of our study was to investigate the influence of Ramadan on the prevalence of acute coronary syndrome among chest pain patients in the emergency department of Monastir. METHODS: It was a prospective study, performed in the emergency department of Fattouma Bourguiba University Hospital of Monastir, during the 3 months before, during and after Ramadan from 2012 to 2014...
October 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28679878/characteristics-of-the-highest-users-of-emergency-services-in-veterans-affairs-hospitals-homeless-and-non-homeless
#11
Adi V Gundlapalli, Audrey L Jones, Andrew Redd, Ying Suo, Warren B P Pettey, April Mohanty, Emily Brignone, Lori Gawron, Megan Vanneman, Matthew H Samore, Jamison D Fargo
Efforts are underway to understand recent increases in emergency department (ED) use and to offer case management to those patients identified as high utilizers. Homeless Veterans are thought to use EDs for non-emergent conditions. This study identifies the highest users of ED services in the Department of Veterans Affairs and provides descriptive analyses of these Veterans, the diagnoses for which they were seen in the ED, and differences based on their homeless status. Homeless Veterans were more likely than non-homeless Veterans to have >10 visits in the 2014 calendar year (12% vs...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28679305/iatrogenic-aortic-dissection-during-percutaneous-coronary-intervention-a-case-report-and-review-of-the-literature
#12
Jia-Chen Li, Xin-Liang Guan, Ming Gong, Hong-Jia Zhang
A 64-year-old female complaining of unrelieved chest pain for 2 days was admitted to the Emergency Room of the Beijing Anzhen Hospital, Beijing, China. After definitive diagnosis, a percutaneous coronary intervention was implemented, but immediately after embedding the stent in the distal area of the right coronary artery, an acute coronary and aortic dissection was found. Cardiologists immediately gave the patient conservative management. At the same time, another smaller stent was immediately embedded in the proximal area of the right coronary artery and plunged into the ascending aorta by 2 mm, with the intention of covering the tear of the dissection...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28669701/comparative-evaluation-of-2-hour-rapid-diagnostic-algorithms-for-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-t
#13
Andrew D McRae, Grant Innes, Michelle Graham, Eddy Lang, James E Andruchow, Hong Yang, Yunqi Ji, Shabnam Vatanpour, Danielle A Southern, Dongmei Wang, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
BACKGROUND: Symptoms of acute coronary syndrome account for a large proportion of emergency department (ED) visits and hospitalizations. High-sensitivity troponin can rapidly rule out or rule in acute myocardial infarction (AMI) within a short time of ED arrival. We sought to validate test characteristics and classification performance of 2-hour high-sensitivity troponin T (hsTnT) algorithms for the rapid diagnosis of AMI. METHODS: We included consecutive patients from 4 academic EDs with suspected cardiac chest pain who had hsTnT assays performed 2 hours apart (± 30 minutes) as part of routine care...
May 3, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28666458/risk-score-to-predict-false-positive-st-segment-elevation-myocardial-infarction-in-the-emergency-department-a-retrospective-analysis
#14
Ji Hoon Kim, Yun Ho Roh, Yoo Seok Park, Joon Min Park, Bo Young Joung, In Cheol Park, Sung Phil Chung, Min Joung Kim
BACKGROUND: The best treatment approach for ST-segment elevation myocardial infarction (STEMI) is prompt primary percutaneous coronary intervention (PCI). However, some patients show ST elevation on electrocardiography (ECG), but do not have myocardial infarction. We sought to identify the frequency of and to develop a prediction model for false-positive STEMI. METHODS: This study was conducted in the emergency departments (EDs) of two hospitals using the same critical pathway (CP) protocol to treat STEMI patients with primary PCI...
June 30, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28665102/identifying-emergency-department-patients-with-chest-pain-who-are-at-low-risk-for-acute-coronary-syndromes
#15
David Markel
Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes, identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing...
July 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28659571/chest-pain-and-sudden-onset-paraplegia-at-the-emergency-department-an-uncommon-presentation
#16
Feng Han Chiu, Shih Hung Tsai, Cheng Hsuan Ho
BACKGROUND Coarctation of the aorta is characterized by narrowing of the descending aorta. The narrowing typically is at the isthmus, the segment just distal to the left subclavian artery. Adults with undiagnosed aortic coarctation are asymptomatic or may present with nonspecific hypertension. We present a case that highlights the uncommon complication of aortic coarctation with spinal compression syndrome. CASE REPORT A 45-year-old male presented to the emergency department (ED) with acute-onset chest pain; he experienced urinary incontinence and bilateral lower limb weakness during his ED visit...
June 29, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28655309/the-effectiveness-of-emergency-nurse-practitioner-service-in-the-management-of-patients-presenting-to-rural-hospitals-with-chest-pain-a-multisite-prospective-longitudinal-nested-cohort-study
#17
Tina E Roche, Glenn Gardner, Leanne Jack
BACKGROUND: Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities...
June 27, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28654978/cardiac-testing-after-emergency-department-evaluation-for-chest-pain-time-for-a-paradigm-shift
#18
Benjamin C Sun, Rita F Redberg
No abstract text is available yet for this article.
June 26, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28654959/cardiovascular-testing-and-clinical-outcomes-in-emergency-department-patients-with-chest-pain
#19
Alexander T Sandhu, Paul A Heidenreich, Jay Bhattacharya, M Kate Bundorf
Importance: Noninvasive testing and coronary angiography are used to evaluate patients who present to the emergency department (ED) with chest pain, but their effects on outcomes are uncertain. Objective: To determine whether cardiovascular testing-noninvasive imaging or coronary angiography-is associated with changes in the rates of coronary revascularization or acute myocardial infarction (AMI) admission in patients who present to the ED with chest pain without initial findings of ischemia...
June 26, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28653131/novel-risk-stratification-assays-for-acute-coronary-syndrome
#20
REVIEW
Haitham M Ahmed, Stanley L Hazen
PURPOSE OF REVIEW: Since identification of aspartate aminotransferase as the first cardiac biomarker in the 1950s, there have been a number of new markers used for myocardial damage detection over the decades. There have also been several generations of troponin assays, each with progressively increasing sensitivity for troponin detection. Accordingly, the "standard of care" for myocardial damage detection continues to change. The purpose of this paper is to review the clinical utility, biological mechanisms, and predictive value of these various biomarkers in contemporary clinical studies...
August 2017: Current Cardiology Reports
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