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Emergency department chest pain

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https://www.readbyqxmd.com/read/27867441/the-role-of-computed-tomography-in-the-diagnostics-of-diaphragmatic-injury-after-blunt-thoraco-abdominal-trauma
#1
Agata Gmachowska, Ryszard Pacho, Agnieszka Anysz-Grodzicka, Leopold Bakoń, Maria Gorycka, Wawrzyniec Jakuczun, Waldemar Patkowski
BACKGROUND: Diaphragmatic injuries occur in 0.8-8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury. MATERIAL/METHODS: The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma...
2016: Polish Journal of Radiology
https://www.readbyqxmd.com/read/27865485/comparison-of-the-effectiveness-of-stress-echocardiography-versus-myocardial-perfusion-imaging-in-patients-presenting-to-the-emergency-department-with-low-risk-chest-pain
#2
Rhian Davies, Guodong Liu, Christopher Sciamanna, William R Davidson, Douglas L Leslie, Andrew J Foy
The aim of this study was to compare clinically relevant cardiovascular outcomes and downstream resource utilization associated with stress echocardiography (SE) and myocardial perfusion imaging (MPI) in emergency department patients with low-risk chest pain. This was a retrospective analysis of health insurance claims data for a national sample of privately insured patients over the period January 1 to December 31, 2011. Subjects were selected who presented to the emergency department with a primary or secondary diagnosis of chest pain and underwent either SE or MPI...
October 18, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27865194/high-sensitivity-cardiac-troponin-t-levels-in-the-emergency-department-in-patients-with-chest-pain-but-no-myocardial-infarction
#3
Axel C Carlsson, Nadia Bandstein, Andreas Roos, Ola Hammarsten, Martin J Holzmann
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department. METHODS: We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27863892/pericarditis-mimicking-brugada-syndrome-a-case-report
#4
Manuel Monti, Giulia Olivi, Francesca Francavilla, Francesco Borgognoni
INTRODUCTION: Brugada syndrome (BrS) is a genetic heart disorder due to alteration of the ion channels function that causes an impaired in the cardiac conduction system. It is characterized by an abnormal electrocardiogram pattern and may be complicated by malignant ventricular arrhythmias. Pericarditis is an inflammation of the pericardium and 90% of isolated cases of acute pericarditis are idiopathic or viral. Acute pericarditis may appears with chest pain, fever, pericardial friction rub, and cardiac tamponade...
November 9, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27862670/do-gender-and-race-make-a-difference-in-acute-coronary-syndrome-pretest-probabilities-in-the-emergency-department
#5
Paul I Musey, Jeffrey A Kline
STUDY OBJECTIVES: To test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90 day returns, cost, and chest radiation exposure after these stratifications. METHODS: This is a secondary analysis of a prospective outcomes study of ED patients with chest pain and shortness of breath...
November 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27847339/analytical-evaluation-of-a-new-point-of-care-system-for-measuring-cardiac-troponin-i
#6
Danielle Wm Kemper, Veronique Semjonow, Femke de Theije, Diederick Keizer, Lian van Lippen, Johannes Mair, Bernadette Wille, Michael Christ, Felicitas Geier, Pierre Hausfater, David Pariente, Volkher Scharnhorst, Joyce Curvers, Jeroen Nieuwenhuis
OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS: Li-heparin whole blood and plasma were used to perform analytical studies. The sample type comparison study was performed at 4 different hospitals. The 99th percentile upper reference limit (URL) study was performed using Li-heparin plasma, Li-heparin whole blood and capillary blood samples from 750 healthy adults, aging from 18 to 86years...
November 12, 2016: Clinical Biochemistry
https://www.readbyqxmd.com/read/27846010/does-uric-acid-level-provide-additional-risk-stratification-information-in-emergency-patients-with-symptoms-of-possible-acute-coronary-syndrome
#7
Harry Jin, Jaimi H Greenslade, William A Parsonage, Tracey Hawkins, Martin Than, Louise Cullen
OBJECTIVE: Elevated uric acid levels have been associated with the presence and severity of coronary artery disease (CAD). This study aimed to assess the clinical utility of serum uric acid levels to identify patients at high risk of acute coronary syndrome (ACS) in those who presented to the emergency department (ED) with chest pain. METHODS: This was a prospective observational study of 951 adult patients who were being evaluated for ACS in a single ED. Serum uric acid was taken on presentation...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846006/chest-pain-risk-scores-can-reduce-emergent-cardiac-imaging-test-needs-with-low-major-adverse-cardiac-events-occurrence-in-an-emergency-department-observation-unit
#8
Hao Wang, Katherine Watson, Richard D Robinson, Kristina H Domanski, Johnbosco Umejiego, Layton Hamblin, Sterling E Overstreet, Amanda M Akin, Steven Hoang, Meena Shrivastav, Michael Collyer, Ryan N Krech, Chet D Schrader, Nestor R Zenarosa
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography. METHODS: A prospective observational single center study was conducted from January 2014 through June 2015...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846005/novel-emergency-department-risk-score-discriminates-acute-coronary-syndrome-among-chest-pain-patients-with-known-coronary-artery-disease
#9
Matthew T Crim, Scott A Berkowitz, Mustapha Saheed, Jason Miller, Amy Deutschendorf, Gary Gerstenblith, Peter Hill, Frederick K Korley
BACKGROUND: Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS: We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846004/implementation-of-a-risk-stratification-and-management-pathway-for-acute-chest-pain-in-the-emergency-department
#10
Christopher W Baugh, Jeffrey O Greenberg, Simon A Mahler, Joshua M Kosowsky, Jeremiah D Schuur, Siddharth Parmar, George R Ciociolo, Christina W Carr, Roya Ghazinouri, Benjamin M Scirica
OBJECTIVES: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources. METHODS: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27845754/secondhand-smoke-is-an-important-modifiable-risk-factor-in-sickle-cell-disease-a-review-of-the-current-literature-and-areas-for-future-research
#11
REVIEW
S Christy Sadreameli, Benjamin T Kopp, Susan E Creary, Michelle N Eakin, Sharon McGrath-Morrow, John J Strouse
Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy that causes significant morbidity and mortality related to chronic hemolytic anemia, vaso-occlusion, and resultant end-organ damage. Tobacco smoke exposure (TSE) through secondhand smoke exposure in people with SCD of all ages and through primary smoking in adolescents and adults is associated with significantly increased morbidity, with increased rates of emergency department visits and hospitalizations for painful vaso-occlusive crises and acute chest syndrome (ACS)...
November 12, 2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27843762/dangers-of-flying-high-and-diving-low-an-unusual-case-of-dyspnea
#12
Poornima Ramadas, Rumon Chakravarty, Prathik Krishnan, Anupa Nadkarni
Giant bullae are bullae that occupy at least 30 percent of a hemi thorax. This condition can rarely be idiopathic and not usually suspected in young patients with no risk factors. We describe a case of a giant solitary pulmonary bulla in a healthy young female with no known risk factors. 23-year-old female presented to the Emergency department with dyspnea and pleuritic right sided chest pain. She started experiencing these symptoms when she was on a 7-h flight and later experienced similar symptoms when she went scuba diving...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27843372/wissler-fanconi-syndrome-and-related-diagnoses-a-case-report
#13
Mustafa Q Albustani, Robert F Howard
INTRODUCTION: Wissler-Fanconi syndrome is a rare rheumatic syndrome that was first described during the 1940s in Europe. Since then, many papers have been written that cover all aspects of this syndrome, most of which are in French and German language, with only a very few in English (none of them recent). We report here a case that fulfils the criteria for Wissler-Fanconi syndrome. Under the more general descriptive umbrella of Wissler-Fanconi syndrome, our patient also fulfils the Modified Jones criteria, and the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis, and was interpreted by other internists and another rheumatologist as fulfilling the Yamaguchi criteria for adult onset Still's disease...
2016: Open Access Rheumatol
https://www.readbyqxmd.com/read/27842923/mean-heart-scores-for-hospitalized-chest-pain-patients-are-higher-in-more-experienced-providers
#14
Jeff Dubin, Eric Kiechle, Matt Wilson, Christian Timbol, Rahul Bhat, Dave Milzman
BACKGROUND: The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience. METHODS: We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE...
October 18, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27825694/does-gender-bias-in-cardiac-stress-testing-still-exist-a-videographic-analysis-nested-in-a-randomized-controlled-trial
#15
David M Nestler, Waqas I Gilani, Ryan T Anderson, M Fernanda Bellolio, Megan E Branda, Annie LeBlanc, Sean Phelan, Ronna L Campbell, Erik P Hess
OBJECTIVES: Despite a high prevalence of coronary heart disease in both genders, studies show a gender disparity in evaluation whereby women are less likely than men to undergo timely or comprehensive cardiac investigation. Using videographic analysis, we sought to quantify gender differences in provider recommendations and patient evaluations. METHODS: We analyzed video recordings from our Chest Pain Choice trial, a single center patient-level randomized trial in which emergency department patients with chest pain being considered for cardiac stress testing were randomized to shared decision-making or usual care...
September 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27823689/safety-and-efficacy-of-the-0-h-3-h-protocol-for-rapid-rule-out-of-myocardial-infarction
#16
Karin Wildi, Berit Nelles, Raphael Twerenbold, Maria Rubini Giménez, Tobias Reichlin, Hélène Singeisen, Sophie Druey, Philip Haaf, Zaid Sabti, Petra Hillinger, Cedric Jaeger, Isabel Campodarve, Philip Kreutzinger, Christian Puelacher, Zoraida Moreno Weidmann, Mathias Gugala, Gilles Pretre, Stephanie Doerflinger, Max Wagener, Fabio Stallone, Michael Freese, Claudia Stelzig, Katharina Rentsch, Stefano Bassetti, Roland Bingisser, Stefan Osswald, Christian Mueller
BACKGROUND: The early and accurate diagnosis of acute myocardial infarction (AMI) is an important medical and economic challenge. We aimed to prospectively evaluate the performance of the new European Society of Cardiology rapid 0-hour/3-hour (0 h/3 h) rule out protocol for AMI. METHODS: We enrolled 2,727 consecutive patients presenting with suspected AMI without persistent ST-segment elevation to the emergency department in a prospective international multicenter study...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27821831/-delayed-diagnosis-of-aortic-dissection-following-thrombolytic-therapy-in-a-patient-with-acute-ischemic-stroke-report-of-a-case
#17
Yosuke Miyamoto, Zenichi Masuda, Yasuhiro Kotani, Suguru Tarui, Yosuke Kuroko, Yasuhiro Fujii, Susumu Ozawa, Shunji Sano
Diagnosis of aortic dissection complicating cerebral ischemic stroke is difficult. A 60-year-old patient presented at an emergency department of a hospital with a sudden development of left-sided weakness, but without chest pain. During administration of recombinant tissue plasminogen activator with diagnosis of cerebral infarction, he developed symptomatic hypotension and was transferred to our hospital. His chest computed tomography revealed Stanford type A aortic dissection. Replacement of the ascending aorta and aortic arch was successfully performed on the 4th day...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27819965/computed-tomography-diagnosis-of-nonspecific-acute-chest-pain-in-the-emergency-department-from-typical-acute-coronary-syndrome-to-various-unusual-mimics
#18
Seung Min Yoo, Eun Ju Chun, Hwa Yeon Lee, Daniel Min, Charles S White
It is a challenging task for emergency department physicians to establish a precise and rapid diagnosis based only on clinical and laboratory findings in patients who present with nonspecific acute chest pain. In this circumstance, CT angiography can provide important clues to the diagnosis. To provide a rapid diagnosis of acute coronary syndrome (ACS) and its various mimics, the physician should enumerate each possible cause of acute chest pain on the basis of an objective assessment of pretest probability...
November 4, 2016: Journal of Thoracic Imaging
https://www.readbyqxmd.com/read/27814441/a-study-of-the-patients-admitted-to-the-clinical-decision-unit-over-one-year
#19
E O'Shea, S Cusack, I O'Sullivan
Clinical decision units (CDUs) are areas within an emergency department (ED) providing care for the patient who may benefit from an extended observation period, usually for a maximum of twenty-four hours. A retrospective patient record audit was performed to determine the characteristics of patients admitted to the Cork University Hospital (CUH) CDU over 12 months. The average length of stay of a patient in the CDU was 29 hours. The most common diagnoses admitted to the CDU were chest pain (9.5%) and headache (7...
June 10, 2016: Irish Medical Journal
https://www.readbyqxmd.com/read/27811203/rapid-rule-out-of-acute-myocardial-injury-using-a-single-high-sensitivity-cardiac-troponin-i-measurement
#20
Yader Sandoval, Stephen W Smith, Anoop S V Shah, Atul Anand, Andrew R Chapman, Sara A Love, Karen Schulz, Jing Cao, Nicholas L Mills, Fred S Apple
BACKGROUND: Rapid rule-out strategies using high-sensitivity cardiac troponin assays are largely supported by studies performed outside the US in selected cohorts of patients with chest pain that are atypical of US practice, and focused exclusively on ruling out acute myocardial infarction (AMI), rather than acute myocardial injury, which is more common and associated with a poor prognosis. METHODS: Prospective, observational study of consecutive patients presenting to emergency departments [derivation (n = 1647) and validation (n = 2198) cohorts], where high-sensitivity cardiac troponin I (hs-cTnI) was measured on clinical indication...
November 3, 2016: Clinical Chemistry
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