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Emergency department chest pain

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https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#1
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28533990/anomalous-origin-of-right-coronary-artery-originating-from-the-pulmonary-trunk-arcapa-an-incidental-finding-in-a-patient-presenting-with-chest-pain
#2
Pragathi Balakrishna, Michael Illovsky, Youssef M Al-Saghir, Abdul M Minhas
Anomalous origin of the right coronary artery originating from the pulmonary trunk (ARCAPA) is a rare congenital coronary anomaly with an estimated prevalence of 0.002%. Most patients are asymptomatic and the anomaly is detected incidentally during evaluation for other problems. Occasionally, ARCAPA may lead to myocardial ischemia and/or sudden cardiac arrest. We present a case of a 55-year-old female with a history of hypertension who presented to the emergency department with intermittent chest discomfort for three days...
April 17, 2017: Curēus
https://www.readbyqxmd.com/read/28528430/risk-classification-of-highly-sensitive-troponin-i-predict-presence-of-vulnerable-plaque-assessed-by-dual-source-coronary-computed-tomography-angiography
#3
Ting Liu, Guan Wang, Peiling Li, Xu Dai
Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS...
May 20, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#4
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28511924/evaluation-of-the-effectiveness-of-a-phone-based-care-coordination-pilot-on-hospital-utilisation-and-costs-for-patients-with-chest-pain
#5
Peita Price, Ruth Vincent, Mark Tacey, Jane Gilchrist, Danny Liew, Leeanne Grigg, Lucio Naccarella
BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the Emergency Department (ED) after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28501386/atrioesophageal-fistula-after-ablation-for-atrial-fibrillation
#6
Trisha Mackle, Kevin Pistawka
BACKGROUND: Atrioesophageal fistula (AEF) is a rare and highly fatal complication of ablation procedures for atrial fibrillation. We report a diagnostically challenging case of AEF that highlights the unfortunate outcome that can be expected when this condition is not promptly diagnosed and managed accordingly. The varied clinical presentations are reviewed and recommended diagnostic and management approaches are presented. CASE REPORT: A 79-year-old female who was 5 weeks post-ablation presented to a community emergency department with chest pain and a transient episode of left-arm weakness...
May 10, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#7
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28500130/a-seizure-induced-t8-burst-fracture-re-presenting-as-an-acute-abdomen
#8
Radford Arran James Smith, Nigel Poland, Simon Cope
A male aged 44 years presented to the emergency department with a 1-week history of intermittent right-sided abdominal pain radiating to the midline. Examination demonstrated a tender right upper quadrant with voluntary guarding and a low grade fever. One week previously, he had been admitted to hospital after an isolated, self-terminating seizure secondary to an deliberate venlafaxine overdose. His upper abdominal symptoms started immediately postseizure but at the time were attributed to musculoskeletal chest pain by the discharging team...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28499728/push-alert-notification-of-troponin-results-to-physician-smartphones-reduces-the-time-to-discharge-emergency-department-patients-a%C3%A2-randomized-controlled-trial
#9
Aikta Verma, Angela S Wang, Michael J Feldman, Darren A Hefferon, Alex Kiss, Jacques S Lee
STUDY OBJECTIVE: For emergency department (ED) patients with chest pain, discharge decisions often hinge on troponin results. Push-alert notifications deliver results immediately to physician smartphones. Our objective is to determine whether troponin push alerts improve the time to discharge decisions for ED patients with chest pain. METHODS: In an academic ED, we assessed the effect of a quality improvement initiative using troponin push alerts to physician smartphones, with a cluster-randomized evaluation...
May 5, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28497506/left-ventricular-obstruction-caused-by-a-large-hiatal-hernia
#10
Kenji Harada, Ushio Tamura, Chiyo Ichimiya, Naho Terada, Yasuhiro Yokoyama, Norihito Kageyama, Akira Hirono, Yuya Hiroshima, Takeshi Omura, Hirofumi Yamamoto, Hiroyuki Fujinaga
A 76-year-old man was admitted to our emergency department owing to chest pain, which started immediately after lunch. Although electrocardiogram revealed ST-segment elevation with hyperacute T-wave changes in the anterior lead tracings, emergency coronary angiography revealed normal coronary arteries. Echocardiography revealed left ventricular (LV) compression with left ventricular obstruction (LVO) caused by an echogenic mass. Computed tomography clearly revealed compression of both left atrial (LA) and LV by a large hiatal hernia...
May 12, 2017: Echocardiography
https://www.readbyqxmd.com/read/28496513/dog-footprint-in-the-heart
#11
Hassan Aghajani, Shahrooz Yazdani, Seyed Khalil Forouzan Nia, Hamed Vahidi, Faezeh Aghajani
Cardiac manifestations of the hydatid cyst are relatively uncommon. Cardiac involvement may lead to the compression of vital organs, pulmonary hypertension, pericardial effusion, and even anaphylaxis. A 45-year-old woman presented to the Emergency Department of Tehran Heart Center with chest pain. Cardiac examination revealed relatively muffled heart sounds. Echocardiography demonstrated a round echolucent well-defined mass (47 × 25 mm) on the base and the mid lateral wall of the left ventricle (LV) without septation...
October 3, 2016: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/28493646/validation-of-the-no-objective-testing-rule-and-comparison-to-the-heart-pathway
#12
Jason P Stopyra, Chadwick D Miller, Brian C Hiestand, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Robert F Riley, Gregory B Russell, James W Hoekstra, Simon A Mahler
BACKGROUND: The No Objective Testing Rule (NOTR) is a decision aid designed to safely identify Emergency Department (ED) patients with chest pain who do not require objective testing for coronary artery disease. OBJECTIVES: To validate the NOTR in a cohort of US ED patients with acute chest pain and compare its performance to the HEART Pathway. METHODS: A secondary analysis of 282 participants enrolled in the HEART Pathway Randomized Controlled Trial was conducted...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28493596/overcoming-the-tower-of-babel-in-medical-science-by-finding-the-equator-research-reporting-guidelines
#13
Christopher R Carpenter, Zachary F Meisel
You are hosting a journal club on chest pain management in the emergency department (ED) for colleagues and trainees in your department. Interested in understanding the history of cardiac biomarkers to evaluate ED patients with chest pain, you search PubMed using the combination of terms "cardiac biomarker", "chest pain", and "emergency department". Your search nets no studies prior to 2002 which you doubt is accurate, so you take the old-fashioned approach and start flipping through the oldest issues of emergency medicine journals at your local medical school library...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28483037/effect-of-the-4-h-target-on-time-to-ecg
#14
James A Hughes, C J Cabilan, Caitlin Young, Andrew Staib
Objectives The aim of this study was to assess the relationship between compliance with time-based Emergency Department (ED) targets (known as NEAT) and the time taken to collect an electrocardiogram (TTE) in patients presenting with chest pain.Methods This was a pilot descriptive retrospective cohort study completed in a large inner city tertiary ED. Patients who presented with active or recent chest pain between July 2014 and June 2015 were eligible for inclusion. Pregnant patients, inter-hospital transfers, and traumatic chest pain were excluded...
May 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28473422/cardioversion-of-a-supraventricular-tachycardia-svt-in-a-7-year-old-using-a-postural-modification-of-the-valsalva-manoeuvre
#15
Edward John Morley-Smith, James Gagg, Andrew Appelboam
A boy aged 7 years presented with his parents to the emergency department (ED). He had a known diagnosis of paroxysmal supraventricular tachycardia (SVT) and was under the care of paediatricians. He had been suffering episodes of palpitations and chest pain for over a year and had been prescribed atenolol 25 mg ON, though the side effects meant he had not taken it for a month prior to presentation. He had 2 previous confirmed episodes of SVT, one that reverted with Valsalva manoeuvres, and the other with intravenous adenosine...
May 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28471148/clinical-imaging-in-patients-experiencing-chest-pain
#16
Angelo Silverio, Rodolfo Citro
Non-invasive imaging modalities integrate the clinical and laboratory diagnostic work-up of patients admitted in emergency department for chest pain. Transthoracic echocardiography is the first-line imaging tool because it is rapidly and widely available, bedside feasible and cost-effective. Even when a comprensive exam is not feasible, a fast focused ultrasound exam should be performed. Contrast enhanced computed tomography is an easily accessible tool with specific application in patients suspected for pulmonary embolism (PE) and acute coronary syndrome (ACS) according to the pre-test risk assessment and to the clinical status...
May 3, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28460856/longterm-prognosis-of-low-risk-women-presenting-to-the-emergency-department-with-chest-pain
#17
Moneer Eddin, Sandhya Venugopal, Brittany Chatterton, Angela Thinda, Ezra A Amsterdam
BACKGROUND: Prognosis of low risk women presenting to the emergency department with chest pain has not been clarified. We assessed early and longterm outcomes of such patients and determined the need for predischarge testing METHODS: Retrospective assessment of consecutive low risk women presenting to the ED with chest pain evaluated in a chest pain unit (CPU). Criteria of low risk: age ≤51 yr, no history of cardiovascular disease, diabetes or smoking, negative initial electrocardiogram (ECG), and cardiac troponin...
April 28, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28460689/a-new-4-variable-formula-to-differentiate-normal-variant-st-segment-elevation-in-v2-v4-early-repolarization-from-subtle-left-anterior-descending-coronary-occlusion-adding-qrs-amplitude-of-v2-improves-the-model
#18
Brian E Driver, Ayesha Khalil, Timothy Henry, Faraz Kazmi, Amina Adil, Stephen W Smith
INTRODUCTION: Precordial normal variant ST elevation (NV-STE), previously often called "early repolarization," may be difficult to differentiate from subtle ischemic STE due to left anterior descending (LAD) occlusion. We previously derived and validated a logistic regression formula that was far superior to STE alone for differentiating the two entities on the ECG. The tool uses R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B)...
April 19, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28451050/-tubulopapillary-carcinoma-in-a-17-year-old-female-patient-a-case-report-and-review-of-the-literature
#19
Adil Kallat, Hicham Ouazize, Otheman Fahsi, Hani Abousaleh, Hachem El Sayegh, Ali Iken, Lounis Benslimane, Yassine Nouini
Tubulopapillary carcinomas account for 10% of renal cell carcinomas. They are more frequent in men than in women (sex ratio:8/1). The average period is the sixth decade. There are two anatomopathological types:the 1 corresponding to a proliferation of basophilic cells and type 2 corresponding to a proliferation of eosinophilic cells. We report the case of a 17-year old female patient with no particular past medical history presenting to the emergency department with pain in the right lumbar fossa and in the right flank associated with hematuria evolving for two days before admission, with loss of body weight and deterioration of the general status...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28447144/-standardized-collection-of-presenting-complaints-in-the-emergency-room-integration-of-coded-presenting-complaints-into-the-electronic-medical-record-system-of-an-emergency-department-and-their-value-for-health-care-research
#20
F Greiner, D Brammen, M Kulla, F Walcher, B Erdmann
BACKGROUND: The point of entry of a patient in emergency care is a symptom or a complaint. To evaluate subsequent processes in an emergency department until a diagnosis is made, this information has to be taken into account. OBJECTIVES: We report the introduction of coded presenting complaints into the electronic medical record system of an emergency department and describe the patients based on these data. METHODS: The CEDIS presenting complaint list was integrated into the emergency department information system of an emergency department (38,000 patients/year)...
April 26, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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