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Emergency department chest pain

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https://www.readbyqxmd.com/read/28087181/challenging-the-99th-percentile-a-lower-troponin-cutoff-leads-to-low-mortality-of-chest-pain-patients
#1
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
https://www.readbyqxmd.com/read/28081310/a-simple-risk-score-in-acute-st-elevation-myocardial-infarction-modified-acef-age-creatinine-and-ejection-fraction-score
#2
Arzu Kalaycı, Vecih Oduncu, Çetin Geçmen, Selim Topcu, Can Yücel Karabay, İbrahim Akın İzgi, Cevat Kırma
BACKGROUND/AIM: The aim of this study was to evaluate if the modified ACEF (age, creatinine, and ejection fraction) score is a predictor of major adverse cardiac and cerebrovascular events during 1 year of follow-up in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: We retrospectively enrolled 1632 consecutive patients who were admitted to our emergency department diagnosed with STEMI within 12 h of chest pain and treated with primary PCI...
December 20, 2016: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28077467/gut-microbiota-dependent-trimethylamine-n-oxide-in-acute-coronary-syndromes-a-prognostic-marker-for-incident-cardiovascular-events-beyond-traditional-risk-factors
#3
Xinmin S Li, Slayman Obeid, Roland Klingenberg, Baris Gencer, François Mach, Lorenz Räber, Stephan Windecker, Nicolas Rodondi, David Nanchen, Olivier Muller, Melroy X Miranda, Christian M Matter, Yuping Wu, Lin Li, Zeneng Wang, Hassan S Alamri, Valentin Gogonea, Yoon-Mi Chung, W H Wilson Tang, Stanley L Hazen, Thomas F Lüscher
AIMS: Systemic levels of trimethylamine N-oxide (TMAO), a pro-atherogenic and pro-thrombotic metabolite produced from gut microbiota metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine, predict incident cardiovascular event risks in stable primary and secondary prevention subjects. However, the prognostic value of TMAO in the setting of acute coronary syndromes (ACS) remains unknown. METHODS AND RESULTS: We investigated the relationship of TMAO levels with incident cardiovascular risks among sequential patients presenting with ACS in two independent cohorts...
January 11, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28063812/left-main-occlusion-secondary-to-infective-endocarditis-vegetation-the-unusual-suspect
#4
Marco Pavani, Federico Conrotto, Fabrizio D'Ascenzo, Maurizio D'Amico, Paolo Centofanti, Fiorenzo Gaita
Treatment of acute coronary syndrome secondary to septic coronary embolism during valvular endocarditis is controversial. Urgent coronary angiography and stent implantation or surgical intervention have been proposed. We present the case of a patient presented at the emergency department with chest pain and cardiogenic shock. The coronary angiography showed a large filling defect in the left main due to a septic coronary embolism.
November 30, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28041756/trauma-induced-acute-myocardial-infarction-due-to-delayed-dissection-of-the-left-anterior-descending-coronary-artery
#5
Magdalena Wilczynska-Golonka, Pawel Rostoff, Aleksander Siniarski, Agnieszka Skrzypek, Andrzej Gackowski, Ewa Konduracka, Jadwiga Nessler
Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4...
December 27, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28033243/prognostic-values-of-4-risk-scores-in-chinese-patients-with-chest-pain-prospective-2-centre-cohort-study
#6
Xiao-Hui Chen, Hui-Lin Jiang, Yun-Mei Li, Cangel Pui Yee Chan, Jun-Rong Mo, Chao-Wei Tian, Pei-Yi Lin, Colin A Graham, Timothy H Rainer
Four risk scores for stratifying patients with chest pain presenting to emergency departments (EDs) (namely Thrombolysis in myocardial infarction [TIMI], Global registry for acute coronary events [GRACE], Banach and HEART) have been developed in Western settings but have never been compared and validated in Chinese patients. We aimed to find out to the number of MACE within 7 days, 30 days, and 6 months after initial ED presentation, and also to compare the prognostic performance of these scores in Chinese patients with suspected cardiac chest pain (CCP) to predict 7-day, 30-day, and 6-month major adverse cardiac events (MACE)...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28029000/comparison-between-soluble-st2-and-high-sensitivity-troponin-i-in-predicting-short-term-mortality-for-patients-presenting-to-the-emergency-department-with-chest-pain
#7
Rossella Marino, Laura Magrini, Francesca Orsini, Veronica Russo, Patrizia Cardelli, Gerardo Salerno, Mina Hur, Salvatore Di Somma
BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. METHODS: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed...
March 2017: Annals of Laboratory Medicine
https://www.readbyqxmd.com/read/28025351/immediate-adverse-events-in-interventional-pain-procedures-a-multi-institutional-study
#8
Carrie M Carr, Christopher T Plastaras, Matthew J Pingree, Matthew Smuck, Timothy P Maus, Jennifer R Geske, Christine A El-Yahchouchi, Zachary L McCormick, David J Kennedy
SETTING: Interventional procedures directed toward sources of pain in the axial and appendicular musculoskeletal system are performed with increasing frequency. Despite the presence of evidence-based guidelines for such procedures, there are wide variations in practice. Case reports of serious complications such as spinal cord infarction or infection from spine injections lack appropriate context and create a misleading view of the risks of appropriately performed interventional pain procedures...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28007272/pulmonary-artery-dissection-a-case-treated-by-homograft-replacement
#9
Didier K Adodo, Martin Kloeckner, Eric Bergoend, Jean-Paul Couëtil
Pulmonary artery dissection was diagnosed in a 32-year-old man who was admitted to the emergency department with intense chest pain. He had a history of pulmonary balloon valvuloplasty for congenital pulmonary stenosis at the age of 7 and no pulmonary hypertension. The operation was performed with cardiopulmonary bypass. The dissected pulmonary arterial trunk was removed with the distorted valve, and replaced with a pulmonary artery homograft. The postoperative course was uneventful. Histologic examination revealed medionecrosis...
January 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28005512/cardiac-mr-imaging-in-acute-coronary-syndrome-application-and-image-interpretation
#10
Farhood Saremi
Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations...
January 2017: Radiology
https://www.readbyqxmd.com/read/28002152/comorbid-conditions-are-associated-with-emergency-department-visits-hospitalizations-and-medical-charges-of-patients-with-systemic-lupus-erythematosus
#11
Guang-Ming Han, Xiao-Feng Han
BACKGROUND/OBJECTIVES: In addition to increase mortality, comorbidities can increase medical costs for systemic lupus erythematosus (SLE). Healthcare utilization can dramatically increase medical costs. It is essential to better understand the comorbidities that can lead to healthcare utilization, such as emergency department visit and/or hospitalization, for SLE patients. Therefore, the objective of this study was to examine the associations between comorbidities and healthcare utilization and medical charges of patients with SLE...
January 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/27998631/emergency-department-cardiopulmonary-evaluation-of-low-risk-chest-pain-patients-with-self-reported-stress-and-anxiety
#12
Paul I Musey, Jeffrey A Kline
BACKGROUND: Chest pain is a high-risk emergency department (ED) chief complaint; the majority of clinical resources are directed toward detecting and treating cardiopulmonary emergencies. However, at follow-up, 80%-95% of these patients have only a symptom-based diagnosis; a large number have undiagnosed anxiety disorders. OBJECTIVE: Our aim was to measure the frequency of self-identified stress or anxiety among chest pain patients, and compare their pretest probabilities, care processes, and outcomes...
December 17, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27989538/clinical-profile-of-patients-of-acute-aortic-dissection-presenting-to-an-emergency-department-without-chest-pain
#13
Kit Ling Fan, Ling Pong Leung
No abstract text is available yet for this article.
December 15, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27989256/junctional-tachycardia-in-a-child-with-non-rheumatic-fever-streptococcal-pharyngitis
#14
Neha Bansal, Peter P Karpawich, Chenni S Sriram
Accelerated junctional rhythm has been reported in children in the setting of acute rheumatic fever; however, we describe a hitherto unreported case of isolated junctional tachycardia in a child with streptococcal pharyngitis, not meeting revised Jones criteria for rheumatic fever. A previously healthy, 9-year-old girl presented to the emergency department with complaints of sore throat, low-grade fever, and intermittent chest pain. She was found to have a positive rapid streptococcal antigen test. The initial electrocardiogram showed junctional tachycardia with atrioventricular dissociation in addition to prolonged and aberrant atrioventricular conduction...
December 19, 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/27987314/risk-benefit-and-cost-thresholds-for-emergency-department-testing-a-cross-sectional-scenario-based-study
#15
Arjun Prasad Meka, Jonathan Douglas Porath, Rahul Iyengar, Chelsea Morrow, Angela Fagerlin, William J Meurer
INTRODUCTION: While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. METHODS: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0...
December 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27987279/falsely-elevated-troponin-rare-occurrence-or-future-problem
#16
James Nguyen, Rosy Thachil, Neil Vyas, Thomas Marino
INTRODUCTION: Troponins are known to be released in response to cardiac damage and therefore are the biomarkers of choice for the early diagnosis of acute myocardial infarction (AMI), improving outcome in patients presenting with chest pain. However, false results can occur due to interference from other substances in the blood. CASE: A 52-year-old male with a past medical history of alcohol abuse, hypertension, and coronary artery bypass graft at age 34 with normal stress test 2 years before presented to the emergency department (ED) complaining of 1 day of non-exertional chest pain with radiation to the neck and left arm...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27986980/-chest-pain-in-the-emergency-department-differential-diagnosis-and-diagnostic-strategy
#17
T Köhnlein
Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.
December 16, 2016: Der Internist
https://www.readbyqxmd.com/read/27976544/post-pci-angina-painful-in-many-ways
#18
EDITORIAL
Ahmed Al Badri, Timothy D Henry
Based on a multi-payer claims database, post-PCI angina (or chest pain) was frequent, occurring in 28% of patients at 1-year and 40% at 3 years. Patients with post-PCI angina had more physician and emergency department visits, diagnostic testing, (including repeat cardiac catheterization 29 vs. 4%) and hospitalizations at 1-year leading to markedly higher total direct medical costs. These results should stimulate further research into the etiology of post-PCI angina and strategies to decrease both the frequency and the significant economic burden associated with the challenging problem...
December 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27970272/tct-109-predictive-performance-of-high-sensitivity-cardiac-troponin-i-for-all-cause-death-is-affected-by-cut-off-value-in-patients-enrolled-in-chest-pain-center-at-emergency-department
#19
Il Park, Jin-Ho Choi, Namjoon Kim, Young-Do Jeon, Ji-Sun Choi, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Sang Hoon Lee
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27958691/triple-rule-out-cardiac-ct-is-it-finally-a-reality
#20
Regina DE LA Mora Cervantes, Carole Dennie
Acute coronary syndrome (ACS), pulmonary embolism and acute aortic syndrome are the most common causes of life threatening chest pain. The triple rule-out CT (TRO CT) has emerged as a technology that can simultaneously visualize the coronary arteries, aorta and pulmonary arteries as well as other intrathoracic structures. It has been proposed as a one-stop imaging modality in patients who present to the emergency department with low to intermediate risk of ACS in whom pulmonary embolism and/or acute aortic syndrome are also considered...
December 13, 2016: Minerva Cardioangiologica
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