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Cardiology. Pain management

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https://www.readbyqxmd.com/read/29922729/the-heart-score-a-guide-to-its-application-in-the-emergency-department
#1
REVIEW
William Brady, Katya de Souza
Chest pain is one of the most common, potentially serious presenting complaints for adult emergency department (ED) visits. The challenge of acute coronary syndrome (ACS) identification with appropriate disposition is quite significant. Many of these patients are low risk and can be managed non-urgently in the outpatient environment; other patients, however, are intermediate to high risk for ACS and should be managed more aggressively, likely with inpatient admission and cardiology consultation. The HEART score, a recently derived clinical decision rule aimed at the identification of risk in the undifferentiated chest pain patient, is potentially quite useful as an adjunct to physician medical decision-making...
June 2018: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29890282/the-importance-of-anginal-symptoms-characteristics-for-the-prediction-of-coronary-artery-disease-in-a-cohort-of-stable-patients-in-the-modern-era
#2
Georgios Nakas, Aris Bechlioulis, Aikaterini Marini, Konstantinos Vakalis, Mara Bougiakli, Sophia Giannitsi, Konstantina Nikolaou, Emorfili Ioanna Antoniadou, Αnna Kotsia, Konstantina Gartzonika, Georgios Chasiotis, Eleni Bairaktari, Christos S Katsouras, Georgios Triantis, Dimitrios Sionis, Lampros K Michalis, Katerina K Naka
BACKGROUND: Angina is an important clinical symptom indicating underlying coronary artery disease (CAD). Its characteristics are important for the diagnosis and risk-stratification of patients with CAD. Currently, we aimed to investigate the association of chest pain characteristics with the presence of obstructive CAD in a contemporary cohort of patients undergoing coronary angiography for suspected stable CAD. METHODS: Consecutive patients undergoing coronary angiography for suspected stable CAD (n=686) in a single University Hospital Cardiology Department were enrolled...
June 8, 2018: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/29850267/should-de-winter-t-wave-electrocardiography-pattern-be-treated-as-st-segment-elevation-myocardial-infarction-equivalent-with-consequent-reperfusion-a-dilemmatic-experience-in-rural-area-of-indonesia
#3
Raymond Pranata, Ian Huang, Vito Damay
Background: Although de Winter T-wave electrocardiography pattern is rare, it signifies proximal left anterior descending artery occlusion and is often unrecognized by physicians. The aim of this case report was to highlight the dilemma in the management of a patient with de Winter T-wave pattern in the hospital without interventional cardiology facility. Case Presentation: A 65-year-old male presented with typical chest pain since 2 hours before admission, and ECG showed sinus rhythm of 57 bpm and >1 mm upsloping ST depression with symmetric tall T in lead V2-3 characteristic of de Winter T-wave ECG pattern...
2018: Case Reports in Cardiology
https://www.readbyqxmd.com/read/29805407/comparing-the-efficacy-of-morphine-alone-with-morphine-and-mgso4-in-pain-management-after-coronary-artery-bypass-surgery
#4
Rana Altaf Ahmad, Syed Suhail Ahmad, Waqas Hamid, Aamir Furqan
Objective: To compare the effectiveness of Morphine alone and Morphine with MgSo4 in pain management after CABG surgery. Methods: This randomized control trial was conducted in the department of anesthesia and critical care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from November 2016 to June 2017. All collected data was entered and analyzed by using computer software SPSS version 23.1. Quantitative data like age, VAS score was analyzed and presented as mean and standard deviation...
March 2018: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29484044/interarterial-course-of-anomalous-right-coronary-artery-pathophysiology-diagnosis-and-treatment
#5
George Renchao Wu, Aman Saini, Imtiaz Ahmed, Charles Finch
Anomalous coronary artery from the opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, and sudden cardiac death. Management of anomalous coronary artery from the opposite sinus varies; however, current guidelines suggest surgery in symptomatic patients. Our patient is a middle-aged male with a history of coronary artery disease and status post coronary artery bypass graft. He presented with complaints of vague chest pain. After a positive stress test, he was sent to the catheterization suite...
December 2017: Radiology case reports
https://www.readbyqxmd.com/read/29476027/sex-differences-in-presenting-symptoms-of-acute-coronary-syndrome-the-epiheart-cohort-study
#6
Carla Araújo, Olga Laszczyńska, Marta Viana, Filipa Melão, Ana Henriques, Andreia Borges, Milton Severo, Maria Júlia Maciel, Ilídio Moreira, Ana Azevedo
OBJECTIVES: Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN: Data were collected within a prospective cohort study (EPIHeart). SETTING: Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014...
February 23, 2018: BMJ Open
https://www.readbyqxmd.com/read/29421014/use-of-echocardiography-in-outpatients-with-chest-pain-and-normal-resting-electrocardiograms-referred-to-mayo-clinic-rochester
#7
Raymond J Gibbons, Damita Carryer, Hongfang Liu, Peter A Brady, John Wells Askew, David Hodge, Naser Ammash, Jon O Ebbert, Veronique L Roger
OBJECTIVES: To determine how often unnecessary resting echocardiograms that are "not recommended" by clinical practice guidelines are performed in patients with stable chest pain and normal resting electrocardiograms (ECGs). BACKGROUND: There are scant data to indicate how often Class III recommendations are ignored in clinical practice. PATIENTS AND METHODS: We searched electronically all medical records of referral outpatients seen at Mayo Clinic Rochester from January 1, 2010, through December 31, 2013, to identify patients with stable chest pain and known or suspected coronary artery disease who underwent resting echocardiography and had normal resting ECGs and no other indication for echocardiography...
February 2018: American Heart Journal
https://www.readbyqxmd.com/read/29406940/heart-disease-in-children
#8
REVIEW
Richard U Garcia, Stacie B Peddy
The pediatric cardiology field has developed rapidly over the past few decades. More children than ever born with congenital heart disease (CHD) are growing into adulthood. Primary care providers play a key role in diagnosis, management, and referral of children with CHD because many common cardiac complaints (eg, feeding intolerance, cyanosis, chest pain, palpitations, and syncope) are first addressed in the primary care setting. The spectrum of heart disease in children ranges from common complaints to complex single-ventricle physiology, acute myocarditis, and heart transplantation...
March 2018: Primary Care
https://www.readbyqxmd.com/read/29345690/clozapine-induced-myocarditis
#9
COMMENT
Tanuka Datta, Allen J Solomon
Approved in 1989 for the management of treatment-resistant schizophrenia, Clozapine is a last-line atypical antipsychotic drug used with increasing frequency. In addition to its well-known side effect of agranulocytosis, this drug also carries with it rare but serious adverse cardiovascular risk of myocarditis. We present a patient on Clozapine who was admitted to the cardiology service with chest pain, ST segment elevations and elevated troponin concerning for acute myocardial infarction. Evaluation with imaging revealed decreased left ventricular function, however, no coronary artery disease was present on catheterization; findings consistent with a diagnosis of myocarditis...
January 2018: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/29324936/the-impact-of-lung-perfusion-scintigraphy-in-the-emergency-management-of-patients-with-suspected-pulmonary-embolism
#10
Cristina Ferrari, Alessandra Cimino, Giacomo Bianco, Francesca Iuele, Alessandra Di Palo, Margherita Fanelli, Artor Niccoli-Asabella, Giuseppe Rubini
OBJECTIVE: Pulmonary Embolism (PE) is an emergency condition that requires immediate treatment. As the symptoms and the risk factors are nonspecific, PE differential diagnosis is often required. Even if angio-CT is considered the gold standard for PE diagnosis, the frequent allergic condition and/or chronic renal failure of patients make, in most cases, not possible the use of contrast enhancement in emergency with even more increasing use of Lung Perfusion Scintigraphy (LPS), as a simple and fast examination with no preparation/contraindication...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29030806/palliative-care-in-the-management-of-patients-with-advanced-heart-failure
#11
Susan E Lowey
Globally, there are 18-million individuals living with heart failure, a disease that is responsible for 12-15 million office visits and 6.5 million inpatient hospitalizations each year. As HF becomes advanced or end-stage, patients often live in a cycle of frequent transitions between care settings, and with unmet needs, including distress from inadequately managed symptoms. Prognostication in patients with heart failure can be challenging due to the unpredictable exacerbating-remitting illness trajectory that is associated with this progressive disease...
October 14, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29029775/-management-of-nstemi-in-a-hospital-without-interventional-cardiology-and-without-use-of-grace-score-does-the-clinician-appreciation-match-the-grace-score-calculated-retrospectively-for-the-coronarography-delay
#12
F Bouriche, S Yvorra, A Hassan, F Paganelli, L Bonello, S Luigi, F Attia
PURPOSE: The management of non-ST segment elevation acute coronary syndromes (NSTEACS) remains an issue for mobidity, mortality, and an economic stake. The first aim of the study was to evaluate the additional value of the GRACE score for the compliance with the recommended times to coronary angiography in an hospital without interventional cardiology. We also analysed the in-hospital and 6-month mortality and the predictive factors of compliance for the coronarography delays. METHODS: Retrospective monocenter cross-sectional study including consecutive patients with chest pain suggestive of a NSTEACS during 1 year...
November 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28934404/organizational-and-managerial-factors-associated-with-clinical-practice-guideline-adherence-a-simulation-based-study-in-36-french-hospital-wards
#13
Florence Saillour-Glénisson, Marion Kret, Sandrine Domecq, Matthieu Sibé, Valentin Daucourt, Virginie Migeot, David Veillard, Philippe Michel
Objectives: To identify managerial and organizational characteristics of multi-specialty medicine wards and individual characteristics of health professionals that are most strongly associated with clinical practice guidelines (CPG) adherence. Design: Cross-sectional stratified cluster sample design. Setting: Data were gathered from 36 randomly selected multi-specialty medicine wards. Participants: The study population included all health professionals involved in patient care working in the participating wards...
August 1, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28882941/anomalous-left-anterior-descending-artery-arising-from-the-pulmonary-trunk-a-rare-cause-of-angina
#14
Abdalla Ibrahim, Stephen P Power, Peter Kelly
A 60-year-old man with a medical history of hypertension and dyslipidaemia presented to our rapid access chest pain clinic with a 2-month history of chest pain on exertion. An exercise stress test was arranged, which showed electrical evidence of inducible ischaemia. Subsequently, a coronary angiogram revealed an anomalous left anterior descending artery arising from the main pulmonary artery that received grade 3 collaterals from a large right coronary artery arising from the aorta. The circumflex arises from the right coronary sinus with a retroaortic course and provided collaterals to the anomalous left anterior descending artery...
September 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28875731/outpatient-palliative-cardiology-service-embedded-within-a-heart-failure-clinic-experiences-with-an-emerging-model-of-care
#15
Benjamin Gandesbery, Krista Dobbie, Eiran Z Gorodeski
BACKGROUND: The role of palliative care consultation in the outpatient treatment of patients with symptomatic heart failure (HF) is poorly studied. In August 2015, we created an outpatient palliative care service embedded within the HF clinic at Cleveland Clinic main campus. AIM: To characterize patients cared for by our novel outpatient palliative cardiology service, including their degree of HF, symptoms, comorbidities, topics addressed in clinic, palliative treatments prescribed, advanced directives status, and mortality...
April 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28828019/chronic-pain-in-chronic-heart-failure-a-review-article
#16
REVIEW
Mohammad Javad Alemzadeh-Ansari, Mohammad Mostafa Ansari-Ramandi, Nasim Naderi
Heart failure (HF) is one of the main causes of death and disability in the world. The prevalence of HF in developed countries is between 1% and 2% of the adult population and approximately between 6% and 10% in the elderly, giving rise to high costs of care and treatment. Indeed, in the United States, the direct and indirect costs exceeded 23 billion dollars in 2002. HF is typically characterized by periods of acute symptoms followed by returns to nearly asymptomatic periods. As dyspnea and fatigue are considered the signature symptoms of HF, other symptoms such as pain go unnoticed...
April 2017: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/28821988/presentation-and-management-of-symptomatic-central-bone-cement-embolization
#17
Ahmed Samir Barakat, Tamer Owais, Mohamed Alhashash, Mootaz Shousha, Hesham El Saghir, Bernward Lauer, Heinrich Boehm
BACKGROUND CONTEXT: With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial. PURPOSE: In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization...
August 18, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28722339/structured-pain-management-reduces-patient-discomfort-after-catheter-ablation-and-rhythm-device-surgery
#18
M Dörschner, A Bollmann, B Dinov, S Richter, M Döring, A Arya, A Müssigbrodt, S Kircher, N Dagres, P Sommer, G Hindricks, K Bode
BACKGROUND: The goal was to test the effectiveness of a structured pain management programme after invasive electrophysiological interventions in cardiology including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT) and implantation, or explantation, of pacemakers or implantable cardioverter defibrillators. METHODS: This was a prospective study with a pre-/post-design where a post-intervention group (116 consecutive patients) was compared to a pre-intervention group (102 consecutive patients) after implementation of a structured pain-management programme using the numeric rating scale (NRS 0-10) and classified as moderate-to-severe if NRS > 3...
November 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/28607778/saphenovenous-graft-aneurysm-a-rare-complication-of-cabg
#19
James Thomas Connell
Saphenovenous graft aneurysm is a rare complication of coronary artery bypass grafts that is likely underdiagnosed. It is typically asymptomatic, slow growing, and often diagnosed incidentally on angiography or following catastrophic rupture. There is no consensus on best management but PCI and surgery appear to have more favourable mortality outcomes relative to conservative management. We present the case of a 48-year-old male with a cardiovascular risk profile hallmarked by diabetes mellitus, end stage renal failure, recalcitrant hyperlipidaemia, and IHD previously treated with CABG...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28414682/a-left-main-coronary-artery-thrombus-presenting-as-a-non-st-elevation-mi
#20
U Ezema, D Daberkow, T Delord, L Guidry, N R Sells
INTRODUCTION: Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. CASE: A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
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