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Cardiac rule out

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https://www.readbyqxmd.com/read/29138794/noninvasive-cardiac-testing-vs-clinical-evaluation-alone-in-acute-chest-pain-a-secondary-analysis-of-the-romicat-ii-randomized-clinical-trial
#1
Samuel W Reinhardt, Chien-Jung Lin, Eric Novak, David L Brown
Importance: The incremental benefit of noninvasive testing in addition to clinical evaluation (history, physical examination, an electrocardiogram [ECG], and biomarker assessment) vs clinical evaluation alone for patients who present to the emergency department (ED) with acute chest pain is unknown. Objective: To examine differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography [CCTA] or stress testing) vs clinical evaluation alone...
November 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29135622/troponin-limit-of-detection-plus-cardiac-risk-stratification-scores-to-rule-out-acute-myocardial-infarction-and-30-day-major-adverse-cardiac-events-in-ed-patients
#2
Mitchell D Datlow, Kelly M Gray, Adriel Watts, Deborah B Diercks, Bryn E Mumma
When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0-3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135620/safety-of-a-1-hour-rule-out-high-sensitive-troponin-t-protocol-in-patients-with-chest-pain-at-the-emergency-department
#3
E Röttger, S de Vries-Spithoven, J B Reitsma, A Limburg, C E E van Ofwegen-Hanekamp, A W Hoes, J M Poldervaart
BACKGROUND: The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice. METHODS: Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29133490/auscultation-while-standing-a-basic-and-reliable-method-to-rule-out-a-pathologic-heart-murmur-in-children
#4
Bruno Lefort, Elodie Cheyssac, Nathalie Soulé, Jacques Poinsot, Marie-Catherine Vaillant, Alaeddin Nassimi, Alain Chantepie
PURPOSE: The distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children. METHODS: From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#5
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29122104/the-diagnosis-of-chronic-coronary-heart-disease
#6
Christian Albus, Jörg Barkhausen, Eckart Fleck, Jörg Haasenritter, Oliver Lindner, Sigmund Silber
BACKGROUND: Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation...
October 20, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29121105/economic-evaluation-of-the-one-hour-rule-out-and-rule-in-algorithm-for-acute-myocardial-infarction-using-the-high-sensitivity-cardiac-troponin-t-assay-in-the-emergency-department
#7
Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller
BACKGROUND: The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. METHODS AND FINDINGS: We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists...
2017: PloS One
https://www.readbyqxmd.com/read/29118888/a-rare-cause-of-dyspnea-undifferentiated-pleomorphic-sarcoma-in-the-left-atrium
#8
Martin A Munin, Maria Silvia Goerner, Ignacio Raggio, Jorge Wisner, Alejandro Tettamanzi, Jose Godia, Maria Paula Penaloza, Javier Guetta
Primary cardiac tumors are a rare entity. The presence of a mass in the left atrium suggests myxoma as a first differential diagnosis. Here we present a rare case of a woman with exertional dyspnea with a large tumor in the left atrium. The patient was extensively studied with echocardiography, cardiac MRI, coronary angiography and computed tomography. Extracardiac neoplastic involvement was ruled out. The patient underwent surgery, the mass was removed, and the final diagnosis was an undifferentiated pleomorphic sarcoma...
October 2017: Cardiology Research
https://www.readbyqxmd.com/read/29116691/hyperbaric-oxygen-in-patients-with-ischemic-stroke-following-cardiac-surgery-a-retrospective-observational-trial
#9
Viktoria Heide-Marie Weixler, Ameli Elisabeth Yates, Markus Puchinger, Birgit Zirngast, Prisca Pondorfer, Beatrice Ratzenhofer-Komenda, Andrea Amegah-Sakotnik, Freyja-Maria Smolle-Juettner, Otto Dapunt
BACKGROUND: Hyperbaric oxygenation (HBO₂) involves breathing 100% oxygen under elevated ambient pressure in a hyperbaric chamber, thereby dissolving oxygen in the plasma. This results in an increase of arterial partial pressure of oxygen (pO₂). Though well established in experimental studies, HBO₂ treatment for ischemic stroke is still under discussion. METHODS: From 2002-2014 HBO₂ (2.2 bar, 90 minutes one/day; average number per patient: 4.7) was applied in 49 consecutive patients (32 males, 17 females, mean age: 68...
2017: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/29111419/diagnosis-of-multiple-system-atrophy
#10
REVIEW
Jose-Alberto Palma, Lucy Norcliffe-Kaufmann, Horacio Kaufmann
Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias...
October 23, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29102451/autonomic-dysfunction-in-cardiology-pathophysiology-investigation-and-management
#11
REVIEW
Amy C Arnold, Jessica Ng, Lucy Lei, Satish R Raj
Presyncope and syncope are common medical findings, with a > 40% estimated lifetime prevalence. These conditions are often elicited by postural stress and can be recurrent and accompanied by debilitating symptoms of cerebral hypoperfusion. Therefore, it is critical for physicians to become familiar with the diagnosis and treatment of common underlying causes of presyncope and syncope. In some patients, altered postural hemodynamic responses result from a failure of compensatory autonomic nervous system reflex mechanisms...
September 14, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29101287/0-1-hour-triage-algorithm-for-myocardial-infarction-in-patients-with-renal-dysfunction
#12
Raphael Twerenbold, Patrick Badertscher, Jasper Boeddinghaus, Thomas Nestelberger, Karin Wildi, Christian Puelacher, Zaid Sabti, Maria Rubini Gimenez, Sandra Tschirky, Jeanne du Fay de Lavallaz, Nikola Kozhuharov, Lorraine Sazgary, Deborah Mueller, Tobias Breidthardt, Ivo Strebel, Dayana Flores Widmer, Samyut Shrestha, Òscar Miró, F Javier Martín-Sánchez, Beata Morawiec, Jiri Parenica, Nicolas Geigy, Dagmar I Keller, Katharina Rentsch, Arnold von Eckardstein, Stefan Osswald, Tobias Reichlin, Christian Mueller
Background -The European Society of Cardiology (ESC) recommends a 0/1h-algorithm for rapid rule-out and rule-in of Non-ST-Segment-Elevation Myocardial Infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) concentrations irrespective of renal function. As patients with renal dysfunction (RD) frequently present with increased hs-cTn concentrations even in absence of NSTEMI, concern has been raised regarding the performance of the 0/1h-algorithm in RD. Methods -In a prospective multicenter diagnostic study enrolling unselected patients presenting with suspected NSTEMI to the emergency department, we assessed the diagnostic performance of the ESC 0/1h-algorithm using hs-cTnT and hs-cTnI in patients with RD, defined as an estimated glomerular filtration rate below 60mL/min/1...
November 3, 2017: Circulation
https://www.readbyqxmd.com/read/29096902/-paradoxical-embolism-myth-or-reality
#13
P Aubry, H Demian, E Brochet, J-M Juliard
Paradoxical embolism should be suspected in front of a clinical phenomenon of thromboembolism associated with an anatomical right-to-left shunt. Others potential cardiac sources of thromboembolism must be ruled out. Strokes constitute the most frequent clinical manifestations of paradoxical embolism. Right-to-left left shunts are in connection with intracardiac defects (atrial septal defect and patent foramen ovale) or pulmonary arteriovenous malformations. The probability that a discovered PFO is stroke-related can be evaluated by a score...
October 30, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29079658/renal-dysfunction-influences-the-diagnostic-and-prognostic-performance-of-high-sensitivity-cardiac-troponin-i
#14
Ian Gunsolus, Yader Sandoval, Stephen W Smith, Anne Sexter, Karen Schulz, Charles A Herzog, Fred S Apple
Measures of cardiac troponin (cTn) may have lower specificity for myocardial infarction in patients with CKD. We examined the diagnostic accuracy of baseline and serial high-sensitivity cTnI (hs-cTnI) measurements for myocardial infarction and 30- and 180-day mortality according to renal function. hs-cTnI was measured (Abbott assay) using sex-specific 99th percentiles (women, 16 ng/L; men, 34 ng/L) in 1555 adults presenting to the emergency department with symptoms suggesting ischemia (NCT02060760). Myocardial infarction was adjudicated along universal definition classification...
October 27, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29079376/validation-of-the-troponin-only-manchester-acute-coronary-syndromes-decision-aid-with-a-contemporary-cardiac-troponin-i-assay
#15
Patricia Va Den Berg, Gillian Burrows, Philip Lewis, Simon Carley, Richard Body
OBJECTIVES: The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity...
September 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29076887/the-use-of-levosimendan-in-cardiac-surgery-an-update-after-the-levo-cts-cheetah-and-licorn-trials-in-the-light-of-clinical-practice
#16
Fabio Guarracino, Matthias Heringlake, Bernard Cholley, Dominique Bettex, Stefaan Bouchez, Vladimir V Lomivorotov, Angela Rajek, Matti Kivikko, Piero Pollesello
Levosimendan is a calcium sensitizer and ATP-dependent potassium channel opener which exerts sustained hemodynamic, symptomatic and organ-protective effects. It is registered for the treatment of acute heart failure, and when inotropic support is considered appropriate. In the past fifteen years, levosimendan has been widely used in clinical practice, and has also been tested in clinical trials to stabilize at-risk patients undergoing cardiac surgery. Recently, three randomized, placebo-controlled, multicenter studies (LICORN, CHEETAH and LEVO-CTS) have been published reporting on the peri-operative use of levosimendan in patients with compromised cardiac ventricular function...
October 30, 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/29076052/assessment-of-acute-myocarditis-by-cardiac-magnetic-resonance-imaging-comparison-of-qualitative-and-quantitative-analysis-methods
#17
Massimo Imbriaco, Carmela Nappi, Marta Puglia, Marco De Giorgi, Serena Dell'Aversana, Renato Cuocolo, Andrea Ponsiglione, Igino De Giorgi, Maria Vincenza Polito, Michele Klain, Federico Piscione, Leonardo Pace, Alberto Cuocolo
BACKGROUND: To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM). METHODS: A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE)...
October 26, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29054440/external-validation-of-heart-type-fatty-acid-binding-protein-high-sensitivity-cardiac-troponin-and-electrocardiography-as-rule-out-for-acute-myocardial-infarction
#18
Christopher B Van Hise, Jaimi H Greenslade, William Parsonage, Martin Than, Joanna Young, Louise Cullen
OBJECTIVE: To externally validate a clinical decision rule incorporating heart fatty acid binding protein (h-FABP), high-sensitivity troponin (hs-cTn) and electrocardiogram (ECG) for the detection of acute myocardial infarction (AMI) on presentation to the Emergency Department. We also investigated whether this clinical decision rule improved identification of AMI over algorithms incorporating hs-cTn and ECG only. DESIGN AND METHODS: This study included data from 789 patients from the Brisbane ADAPT cohort and 441 patients from the Christchurch TIMI RCT cohort...
October 18, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/29046747/ventricular-fibrillation-due-to-overdose-of-loperamide-the-poor-man-s-methadone
#19
Amr Salama, Yana Levin, Pramod Jha, Richard Alweis
Loperamide is an over-the-counter antidiarrheal agent that is considered by many patients to be safe, but has been used as a drug of abuse due to its opioid properties. However, cardiotoxicity has been reported, prompting the FDA to release a warning regarding the arrhythmogenic potential of loperamide. We present a case of a 38-year-old female presenting with cardiac arrest thought to be secondary to abuse of the loperamide that she was using to alleviate the heroin withdrawal symptoms. Cardiac ischemia and other drug toxicities were ruled out...
October 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29038153/prospective-validation-of-a-biomarker-based-rule-out-strategy-for-functionally-relevant-coronary-artery-disease
#20
Joan E Walter, Ursina Honegger, Christian Puelacher, Deborah Mueller, Max Wagener, Nicolas Schaerli, Ivo Strebel, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Lorraine Sazgary, Stella Marbot, Jeanne du Fay de Lavallaz, Christoph Kaiser, Stefan Osswald, Damian Wild, Katharina Rentsch, Michael Zellweger, Tobias Reichlin, Christian Mueller
BACKGROUND: This study aimed to prospectively advance a rule-out strategy for functionally significant coronary artery disease (CAD) by use of high-sensitivity cardiac troponin I (hs-cTnI) from bench to bedside, by application of a 3-step approach: validation in serum, correlation in plasma, and application on a clinical platform. METHODS: Patients without known CAD referred for rest/stress myocardial perfusion single-photon emission tomography/computer tomography (MPI-SPECT/CT) were assigned to 3 consecutive cohorts: validation, correlation, and application...
October 16, 2017: Clinical Chemistry
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