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Cardiac rule out

Mohamed A Mohamed, Rohit Abraham, Tareq I Maraqa, Samir Elian
Aortic dissection is a rare and fatal complication of cocaine-induced hypertension. The injury mechanism is through shear stress that penetrates the intimal vessel layer, allowing blood flow to separate intimal and medial layers. Due to its scarcity and the paucity of related literature, our knowledge of this condition is limited. We present a rare case of a cocaine-induced aortic dissection, which extended continuously from the aortic root to the common iliacs, along with a literature review of similar cases...
January 12, 2018: Curēus
Basmah Safdar, Gail D'Onofrio, James Dziura, Raymond R Russell, Caitlin Johnson, Albert J Sinusas
AIMS: Coronary microvascular dysfunction (CMD) is common in patients with non-obstructive coronary arteries but has not been described in low-risk symptomatic patients. We therefore assessed the prevalence and characteristics of CMD in low to moderate risk patients with chest pain in an emergency department. METHODS AND RESULTS: We used three-dimensional Rb82 cardiac positron emission tomography/computed tomography to diagnose coronary artery disease (known or new regional defect, any coronary calcification) and CMD (low coronary flow reserve without coronary artery disease) in chest pain patients after being ruled out for acute myocardial infarction...
March 1, 2018: European Heart Journal. Acute Cardiovascular Care
Marcus Eng Hock Ong, Gavin D Perkins, Alain Cariou
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff...
March 10, 2018: Lancet
Aaron Lear, Merritt Huber, Amy Canada, Jessica Robertson, Evan Bosman, Stephen Zyzanski
OBJECTIVE: To determine whether admission, and provocative stress testing of patients who have ruled out for acute coronary syndrome put patients with low-risk category for coronary artery disease (CAD) at risk for false-positive provocative stress testing and unnecessary coronary angiogram/imaging. METHODS: A retrospective chart review was performed on patients between 30 and 70 years old, with no pre-existing diagnosis of CAD, admitted to observation or inpatient status chest pain or related complaints...
March 2018: Journal of the American Board of Family Medicine: JABFM
Neslihan Arzu Akgün, Orçun Çiftci, Kerem Can Yılmaz, Emir Karaçağlar, Alp Aydınalp, Atilla Sezgin, I Haldun Müderrisoğlu, Mehmet Haberal
OBJECTIVES: Coronary vasospasm in heart transplant recipients occurs through various mechanisms. It has been linked to allograft rejection and coronary vasculopathy, which can result in mortality during follow-up. Here, we investigated the prevalence of coronary vasospasm among heart transplant recipients undergoing surveillance coronary angiography procedures. MATERIALS AND METHODS: This study was prospectively performed at Başkent University Faculty of Medicine by retrospectively analyzing medical information of patients who underwent bicaval heart transplant between 2003 and 2016 and subsequently had coronary angiography to rule out allograft vasculopathy...
March 2018: Experimental and Clinical Transplantation
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 12, 2018: International Heart Journal
Iacopo Olivotto, Gherardo Finocchiaro, Niccolò Maurizi, Lia Crotti
Ventricular or supraventricular ectopic beats or atrial fibrillation may be the first presentation of uncommon cardiac disease, both acquired and genetically determined. In some patients, these manifestations can be the first sign of the underlying cardiac disorder. In others, however, they are also important as prognostic indicators, reflecting electrical instability and risk. Most cardiology clinics are busy environments where the implementation of complex diagnostic algorithms is not feasible. However, it is equally impossible to reach a final diagnosis, among the thousands of rare diseases that involve the heart, moving from a first line clinical and instrumental examination...
April 15, 2018: International Journal of Cardiology
Sushil Azad, Nilanjan Dutta, Kuntal Roy Chowdhuri, Tarun Raina Ramman, Nishit Chandra, Sitaraman Radhakrishnan, Krishna Subramony Iyer
Cardiac myxomas are the most common primary cardiac tumors and are typically attached to the interatrial septum. Left ventricular myxomas are exceedingly rare and presentation in children is all the more uncommon. We report a case of left ventricular myxoma with very atypical cystic appearance raising an initial suspicion of a hydatid cyst. Subsequently, cardiac magnetic resonance imaging was done, which ruled out the diagnosis of hydatid cyst. Complete surgical excision was done through transaortic and transmitral route...
January 1, 2018: World Journal for Pediatric & Congenital Heart Surgery
Zulfiqar Qutrio Baloch, Muhammad Hussain, Shabber Agha Abbas, Jorge L Perez, Muhammad Ayyaz
The development of methamphetamine-associated cardiomyopathy (MACM) represents a severe complication of chronic methamphetamine abuse. MACM-induced irreversible structural and functional changes in the heart can eventually lead to decompensated heart failure, ultimately requiring heart transplantation. In this case report we present a 47-year old male with a previous history of chronic amphetamine abuse who presented to the emergency room with severe dyspnea at rest associated with mild substernal non-radiating chest pain...
2018: Emergency (Tehran, Iran)
Thomas Moumneh, Vanessa Richard-Jourjon, Emilie Friou, Fabrice Prunier, Caroline Soulie-Chavignon, Jacques Choukroun, Betty Mazet-Guilaumé, Jérémie Riou, Andréa Penaloza, Pierre-Marie Roy
In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study...
March 2, 2018: Internal and Emergency Medicine
Syed Rafay Ali Sabzwari, Zoltan Varga, Khurram Butt, Nimra Khan
Vasospastic angina (VSA), also known as variant or Prinzmetal's angina, is a relatively uncommon cause of retrosternal chest pain with transient ST segment elevation, mainly due to vasospasm in the coronary arteries. This is a case of 37-year-old female who presented with chest pain and syncope. Her initial workup, including echocardiogram, was negative. Subsequently, she was sent home with an event monitor. During the next two weeks, she continued to have recurrent episodes of similar chest pains and presented to her cardiology appointment with a heart rate of 45 bpm and blood pressure of 100/60 mmHg and was taken to hospital emergency department...
December 16, 2017: Curēus
Alfred Burger, Chad Miller, Bradley A Sharpe, Rachel E Thompson
BACKGROUND: Hospital Medicine has a widening scope of practice. This article provides a summary of recent highimpact publications for busy clinicians who provide care to hospitalized adults. METHODS: The authors reviewed articles published between March 2016 and March 2017 for the Update in Hospital Medicine presentations at the 2017 Society of Hospital Medicine and Society of General Internal Medicine annual meetings. Nine of the 20 articles presented were selected for this review based on the article quality and potential to influence practice...
February 27, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Wouter C Meijers, Manuel Maglione, Stephan J L Bakker, Rupert Oberhuber, Lyanne M Kieneker, Steven de Jong, Bernhard J Haubner, Wouter B Nagengast, Alexander R Lyon, Bert van der Vegt, Dirk J van Veldhuisen, B Daan Westenbrink, Peter van der Meer, Herman H W Silljé, Rudolf A de Boer
Background -Heart failure (HF) survival has improved and nowadays many patients with HF die from non-cardiac causes, including cancer. Our aim was to investigate whether a causal relationship exists between HF and the development of cancer. Methods -HF was induced by inflicting large anterior myocardial infarction (MI) in APCmin mice, which are prone to develop precancerous intestinal tumors, and tumor growth was measured. In addition, to rule out hemodynamic impairment, a heterotopic heart transplantation model was employed, where an infarcted or sham-operated heart was transplanted into a recipient mouse, while the native heart was left in situ...
February 19, 2018: Circulation
Stacey J Howell, Jonathan Bui, Balasingam Thevakumar, Ezra A Amsterdam
There are few data on the utility of physician selection of cardiac tests, including no-test, in a chest pain unit (CPU) to rule out acute coronary syndrome in low-risk patients without a history of coronary artery disease. We analyzed consecutive low-risk patients admitted to our CPU between 2012 and 2014 and determined the proportion of patients selected for testing, the type of initial cardiac test selected, and the incidence of major adverse cardiac events (MACEs) at 30 days and 6 months. The study group comprised 619 patients: mean age 57 years (27 to 92), 332 women (54%), and 360 (58%) with multiple cardiac risk factors...
January 10, 2018: American Journal of Cardiology
Kenichiro Suzuki, Kimiaki Komukai, Kotaro Nakata, Renshi Kan, Yuhei Oi, Eri Muto, Yusuke Kashiwagi, Mitsutoshi Tominaga, Satoru Miyanaga, Tetsuya Ishikawa, Kenji Okuno, Masahiko Uzura, Michihiro Yoshimura
Objective This study was carried out to examine the usefulness of point-of-care (POC) cardiac troponin in diagnosing acute coronary syndrome (ACS) and to understand the limitations of a POC cardiac troponin I/T-based diagnoses. Methods Patients whose cardiac troponin levels were measured in the emergency department using a POC system (AQT System; Radiometer, Tokyo, Japan) between January and December 2016 were retrospectively examined (N=1449). Patients who were < 20 years of age or who were admitted with cardiopulmonary arrest were excluded...
February 9, 2018: Internal Medicine
Anna Pettersson, Lina Ljung, Caroline Johansson, Umut Heilborn, Tomas Jernberg, Mats Frick, Kai M Eggers, Bertil Lindahl, Rikard Linder, Arne Martinsson, Per Svensson
BACKGROUND: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome. METHODS: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death...
March 2018: Critical Pathways in Cardiology
Naureen Farook, L Cochon, A D Bode, B P Langer, A A Baez
BACKGROUND: Accurate identification of patients at risk of major adverse cardiac events (MACE) places a substantial burden on emergency physicians (EPs). Bayesian nomogram for risk stratification in low- to intermediate-risk cardiovascular patients has not been investigated previously. OBJECTIVE: The objective of this study was to develop a comparative diagnostic model using Bayesian statistics for exercise treadmill test (ETT) and stress echocardiogram (ECHO) to calculate post-test diagnostic risk of MACE using HEART (history, electrocardiogram, age, risk factors, and troponin) risk score as predictor of pretest probability...
February 2018: Journal of Emergency Medicine
Patrick Badertscher, Thomas Nestelberger, Jeanne du Fay de Lavallaz, Martin Than, Beata Morawiec, Damian Kawecki, Òscar Miró, Beatriz López, F Javier Martin-Sanchez, José Bustamante, Nicolas Geigy, Michael Christ, Salvatore Di Somma, W Frank Peacock, Louise Cullen, François Sarasin, Dayana Flores, Michael Tschuck, Jasper Boeddinghaus, Raphael Twerenbold, Karin Wildi, Zaid Sabti, Christian Puelacher, Maria Rubini Giménez, Nikola Kozhuharov, Samyut Shrestha, Ivo Strebel, Katharina Rentsch, Dagmar I Keller, Imke Poepping, Andreas Buser, Wanda Kloos, Jens Lohrmann, Michael Kuehne, Stefan Osswald, Tobias Reichlin, Christian Mueller
BACKGROUND: The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin. METHODS AND RESULTS: We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study...
December 14, 2017: Journal of the American Heart Association
Alex Robertson, Tain-Yen Hsia
Neurologic deficit subsequent to cardiac surgery remains a cause of postoperative morbidity and mortality. Although myriad risk factors for postoperative cognitive decline have been identified, their individual influence remains undefined. Although less emphasis is now placed on the heart lung machine as the major source of postoperative cognitive decline, the conduct of cardiopulmonary bypass and, in particular, the management of the bypass circuit remain key to patient safety. We present a case of inadvertent intraoperative exsanguination of a patient following open heart surgery for implantation of a left ventricular assist device...
March 2018: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
Jaimi Greenslade, Elizabeth Cho, Christopher Van Hise, Tracey Hawkins, William Parsonage, Jacobus Ungerer, Jillian Tate, Carel Pretorius, Martin Than, Louise Cullen
BACKGROUND: Low concentrations of cardiac troponin (cTn) have been recommended for rapid rule-out of acute myocardial infarction (AMI). We examined the Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay to identify a single test threshold that can safely rule out AMI. METHODS: This analysis used stored samples collected in 2 prospective observational studies. In all, 1871 patients presenting to a tertiary emergency department with symptoms of acute coronary syndrome had blood taken for measurement of cTnI on presentation...
February 1, 2018: Clinical Chemistry
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