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Emergency department chest pain

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https://www.readbyqxmd.com/read/29773479/emergency-department-diagnosis-of-septic-pulmonary-embolism-due-to-infectious-endocarditis-using-bedside-ultrasound
#1
Jason Arthur, Juvenal Havyarimana, Ashley Booth Norse
BACKGROUND: Septic pulmonary embolism (SPE) is a rare disorder caused by metastasis of infectious thrombi to the lungs. Most commonly, this occurs as a result of infectious endocarditis. This clinical entity may easily be confused for more common and less mortal diagnoses such as pneumonia, bronchitis, or pulmonary embolism. CASE REPORT: A 47-year-old woman presented in respiratory distress with a complaint of cough productive of rusty sputum, shortness of breath, and pleuritic chest pain...
May 14, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29769019/comparison-of-outcomes-in-emergency-department-patients-with-suspected-cardiac-chest-pain-two-centre-prospective-observational-study-in-southern-china
#2
Huilin Jiang, Yunmei Li, Junrong Mo, Xiaohui Chen, Min Li, Peiyi Lin, Kevin K C Hung, Timothy H Rainer, Colin A Graham
BACKGROUND: Hong Kong (HK) and Guangzhou (GZ) are cities in China with different healthcare systems. This study aimed to compare 30-day and 6-month mortality and characteristics of patients with suspected cardiac chest pain admitted to two emergency departments (ED) in HK and GZ. METHODS: A prospective observational study enrolled patients with suspected cardiac chest pain presenting to EDs in the Prince of Wales Hospital (PWH), HK and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU),GZ...
May 16, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29768320/monocyte-chemoattractant-protein-1-as-a-predictor-of-coronary-atherosclerosis-in-patients-receiving-coronary-angiography
#3
Simon A Mahler, Thomas C Register, Robert F Riley, Ralph B D'Agostino, Jason P Stopyra, Chadwick D Miller
BACKGROUND: Animal studies suggest that monocyte chemoattractant protein-1 (MCP-1) is a promising biomarker for coronary artery atherosclerosis (CAA), but human studies have been inconclusive. OBJECTIVE: To determine potential relationships between plasma MCP-1 and CAA in patients with acute chest pain. METHODS: A secondary analysis of 150 patients enrolled in emergency department chest pain risk stratification clinical investigations was conducted...
June 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29753793/short-term-prognosis-of-myocardial-injury-type-1-and-type-2-myocardial-infarction-in-the-emergency-unit
#4
Alain Putot, Sophie Buet Derrida, Marianne Zeller, Aurélie Avondo, Patrick Ray, Patrick Manckoundia, Yves Cottin
BACKGROUND: Type 2 myocardial infarction and non-ischemic myocardial injury, corresponding to troponin elevation without atherothrombosis, are emerging concepts suspected of being common in emergency departments (ED). However, their respective frequencies, risk profiles and short-term prognoses remain to be investigated. METHODS: Among all the patients admitted from January 2014 to December 2016 in a university hospital ED (n=33,669), those with elevated conventional troponin Ic (≥0...
May 10, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29749756/sensitivity-and-specificity-of-the-manchester-triage-system-in-risk-prioritization-of-patients-with-acute-myocardial-infarction-who-present-with-chest-pain
#5
Fernanda A Nishi, Catarina Polak, Diná de Almeida Lopes Monteiro da Cruz
BACKGROUND: The purpose of the Manchester Triage System is to clinically prioritize each patient seeking care in an emergency department. Patients with suspected acute myocardial infarction who have typical symptoms including chest pain should be classified in the highest priority groups, requiring immediate medical assistance or care within 10 min. As such, the Manchester Triage System should present adequate sensitivity and specificity. AIMS: This study estimated the sensitivity and specificity of the Manchester Triage System in the triage of patients with chest pain related to the diagnosis of acute myocardial infarction, and the associations between the performance of the Manchester Triage System and selected variables...
May 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29743472/a-case-of-perforated-jejunal-diverticulum-an-unexpected-cause-of-pneumoperitoneum-in-a-patient-presenting-with-an-acute-abdomen
#6
Bruno Augusto Alves Martins, Rosana Rodrigues Galletti, Júlio Marinho Dos Santos Neto, Caroline Neiva Mendes
BACKGROUND Jejunal diverticulosis is a rare clinical condition, and the majority of patients are asymptomatic. However, some patients can develop serious complications, including perforation. We report the case of a 74-year-old female patient with a perforated jejunal diverticulum who presented with an 'acute abdomen' and with pneumoperitoneum on X-ray radiography. CASE REPORT A 74-year-old female patient presented to the emergency department with a 24-hour history of acute onset of diffuse abdominal pain associated with nausea and vomiting...
May 10, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29742603/progression-of-multiple-myeloma-detected-on-cardiac-scintigraphy-with-99mtc-sestamibi
#7
Jonathan Bulzan, Jonathan Revels, Kathy Byun
It is important to understand normal and abnormal radiotracer biodistribution patterns in patients who undergo cardiac Tc-2-methoxyisobutyl-isonitrile (Tc-sestamibi) scans to provide important clinical guidance. Our case describes a 75-year-old man with a history of multiple myeloma in remission, who presented to the emergency department for unrelated chest pain and shortness of breath. The patient underwent a nuclear cardiac stress test with Tc-sestamibi scintigraphy as part of his cardiac workup. The images demonstrated diffuse radiotracer uptake in the skeletal structures raising concern for progression of multiple myeloma, of which, subsequent biopsy confirmed the presence of recurrent disease...
May 7, 2018: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/29739630/extracorporeal-life-support-as-salvage-therapy-for-massive-pulmonary-embolus-and-cardiac-arrest-in-pregnancy
#8
Michael E Takacs, Kristina E Damisch
BACKGROUND: Massive pulmonary embolus (PE) with prolonged cardiac arrest in the setting of pregnancy has few treatment options. Selections are further restricted if there are contraindications to the standard therapies of embolectomy and thrombolysis. We report a case of extracorporeal life support (ECLS) used as salvage therapy for a critically ill pregnant patient. CASE REPORT: A 21-year-old woman presented to a small rural hospital with chest pain, dyspnea, hypoxia, and syncope...
May 5, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29737180/copeptin-to-rule-out-myocardial-infarction-in-blacks-versus-caucasians
#9
Neil Beri, Lori B Daniels, Allan Jaffe, Christian Mueller, Inder Anand, W Frank Peacock, Judd E Hollander, Christopher DeFilippi, Donald Schreiber, James McCord, Alexander T Limkakeng, Alan H B Wu, Fred S Apple, Deborah B Diercks, John T Nagurney, Richard M Nowak, Chad M Cannon, Paul Clopton, Sean-Xavier Neath, Robert H Christenson, Christopher Hogan, Gary Vilke, Alan Maisel
BACKGROUND: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. METHODS: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn...
May 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29736199/emergency-department-increased-use-of-observation-care-for-elderly-medicare-patients
#10
Gelareh Z Gabayan, Li-Jung Liang, Brian Doyle, David Yu-Chuang Huang, Catherine A Sarkisian
Background: Over the past decade, a growing number of older Medicare beneficiaries visit the Emergency Department (ED) and have been placed in observation care. We investigated and compared the prevalence and factors associated with patients age ≥ 65 years with Medicare insurance who are placed in the hospital, observation care, or discharged following an ED visit. Methods: We conducted a retrospective cohort study using data from a nationally representative 5% sample of Medicare patients age ≥ 65 years during the year 2013...
June 2018: Journal of Hospital Administration
https://www.readbyqxmd.com/read/29716823/apical-hypertrophic-cardiomyopathy-a-concerning-electrocardiogram-in-the-emergency-department
#11
Patrick J Rogers, Ann-Jeannette Geib, Darren Cuthbert, Grant Wei
BACKGROUND: Apical hypertrophic cardiomyopathy is a rare, complex phenotypic variant of the classically taught hypertrophic cardiomyopathy. It is highly variable in its pathophysiology as well as its clinical course, spanning the spectrum from a healthy asymptomatic lifestyle to sudden cardiac death and severe diastolic dysfunction. The hallmark electrocardiographic findings of unusually large T-wave inversions, in conjunction with the most common presenting symptom being chest pain, makes this disease entity concerning in the emergency department (ED) setting...
April 28, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29714434/a-statistical-approach-to-evaluate-the-performance-of-cardiac-biomarkers-in-predicting-death-due-to-acute-myocardial-infarction-time-dependent-roc-curve
#12
Eda Karaismailoğlu, Zeliha Günnur Dikmen, Filiz Akbıyık, Ahmet Ergun Karaağaoğlu
Background/aim: Myoglobin, cardiac troponin T, B-type natriuretic peptide (BNP), and creatine kinase isoenzyme MB (CK-MB) are frequently used biomarkers for evaluating risk of patients admitted to an emergency department with chest pain. Recently, time- dependent receiver operating characteristic (ROC) analysis has been used to evaluate the predictive power of biomarkers where disease status can change over time. We aimed to determine the best set of biomarkers that estimate cardiac death during follow-up time...
April 30, 2018: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29709318/allergic-myocardial-infarction-following-recombinant-human-insulin
#13
Bülent Özlek, Eda Özlek, Oğuzhan Çelik, Cem Çil, Volkan Doğan, Murat Biteker
BACKGROUND: Allergic myocardial infarction is a rare clinical entity. OBJECTIVES: Although a few number of case reports with severe anaphylactic reactions to recombinant human insulin have been reported, allergic myocardial infarction, known as Kounis Syndrome, has not been reported before. METHODS: Herein, we report a 57-year-old woman with myocardial infarction, referred for urticarial rash, chest pain, and palpitations developed after the first subcutaneous dose of recombinant human insulin...
April 27, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29707374/successful-surgical-treatment-of-massive-spontaneous-hemothorax-due-to-intrathoracic-secondary-degeneration-of-a-neurofibroma-from-mediastinal-involvement-of-type-1-neurofibromatosis
#14
Seong Cheol Jeong, Jae Jun Kim, Si Young Choi, Yong Hwan Kim, In Sub Kim
Massive hemothorax caused by a mediastinal mass is extremely rare. Herein, we present a case of successful surgery for a massive hemothorax caused by intrathoracic cystic hemorrhagic degeneration of a neurofibroma in a patient with neurofibromatosis type 1 (NF1). A 44-year-old man with NF1 was admitted to our emergency department for chest pain and dyspnea. Image studies revealed a massive hemothorax caused by a posterior mediastinal mass adjacent to the descending aorta and the spinal canal. The tumor, located at the fourth to the sixth thoracic vertebra, had diffusely and extensively infiltrated around proliferative vessels...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29701428/anaesthetic-management-in-a-duchennne-muscle-dystrophy-patient-for-treatment-of-recurrent-pneumothorax
#15
Sara Mota, Liuba Germanova, Joana Cortesão, Teresa Paiva
INTRODUCTION: Duchenne muscular dystrophy (DMD) is an x linked recessive disorder. Long term prognosis is ominous, with development of respiratory distress and cardiomyopathy in advanced stage of the disease and expected death in the teens-to-mid 20s due to respiratory or cardiac failure. Peri-operative management of this patients is challenging due to difficult airway anatomy (macroglossia, limited neck and mandibular mobility). Additionally, they are at risk of developing malignant hyperthermia, rhabdomyolysis and hyperkalemic cardiac arrest when exposed to halogenated inhalational anaesthetics and depolarizing muscle relaxants...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701374/bilateral-recurrent-spontaneous-pneumothorax-as-a-late-consequence-of-oesophageal-surgery-case-report
#16
Cristina Rodrigues, Daniel Cabral, Leonor Mota, António Bettencourt
INTRODUCTION: We report a case of a patient with recurrent bilateral spontaneous pneumothorax presumably originating in a left bulla. METHODS: A 68 year old male, was admitted to the emergency department with shortness of breath and bilateral chest pain. He had had oesophageal cancer resection 2 years before, with a posterior mediastinal reconstruction using a gastric tube. Afterwards he had to be operated twice for hiatal hernia. RESULTS: Bilateral chest tubes were inserted, with complete resolution in 72 hours...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29698345/presenting-signs-and-symptoms-of-pericardial-effusions-in-the-pediatric-emergency-department
#17
Matthew Cully, Jason R Buckley, Elysha Pifko, Olivia M Titus
OBJECTIVES: The primary objective of this study was to describe the frequency of the most common presenting signs and symptoms of pericardial effusions, particularly with relation to the size of the effusion. The secondary objective was to review the final etiology of the pericardial effusion in those patients who had presented to a tertiary care pediatric emergency department. METHODS: This was a retrospective chart review of patients younger than 17 years who presented and were evaluated at the pediatric emergency department and subsequently diagnosed with a pericardial effusion during a period of 10 years...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29696452/computer-aided-analysis-of-64-and-320-slice-coronary-computed-tomography-angiography-a-comparison-with-expert-human-interpretation
#18
Moshrik Abd Alamir, Pamela Noack, Kristine H Jang, Jhanna A Moore, Roman Goldberg, Michael Poon
Routine use of CCTA to triage Emergency Department (ED) chest pain can reduce ED length of stay while providing accurate diagnoses. We evaluated the effectiveness of using Computer Aided Diagnosis in the triage of low to intermediate risk emergency chest pain patients with Coronary Computed Tomographic Angiography (CCTA). Using 64 and 320 slice CT scanners, we compared the diagnostic capability of computer aided diagnosis to human readers in 923 ED patients with chest pain. We calculated sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for cases performed on each scanner...
April 25, 2018: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29693788/-what-the-hell-is-water-how-to-use-deliberate-clinical-inertia-in-common-emergency-department-situations
#19
Diana Egerton-Warburton, Louise Cullen, Gerben Keijzers, Daniel M Fatovich
Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures...
April 25, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29685465/concurrent-spontaneous-pneumomediastinum-and-pneumorrhachis
#20
Alexander J Heckman, Michael Mohseni, Armando Villanueva, Jennifer B Cowart, Charles G Graham
BACKGROUND: Spontaneous pneumomediastinum with concurrent pneumorrhachis (air in the spinal canal) and subcutaneous emphysema can be an alarming presentation, both clinically and radiographically. These clinical entities often require only conservative measures after ruling out any worrisome underlying causes. Management often involves appropriate imaging, hospital admission, and sub-specialty consultation as needed to help determine any potential causes for the presentation that may require anything more than a period of medical observation...
April 20, 2018: Journal of Emergency Medicine
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