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https://www.readbyqxmd.com/read/29240719/pericardial-effusion-as-a-presenting-symptom-of-hashimoto-thyroiditis-a-case-report
#1
Alberto Leonardi, Laura Penta, Marta Cofini, Lucia Lanciotti, Nicola Principi, Susanna Esposito
Background: Hashimoto thyroiditis (HT) is the most frequent cause of acquired hypothyroidism in paediatrics. HT is usually diagnosed in older children and adolescents, mainly in females and is rare in infants and toddlers with cardiac involvement, including pericardial effusion, that can be found in 10% to 30% of adult HT cases. In this paper, a child with HT and pericardial effusion as the most important sign of HT is described. Case presentation: A four-year-old male child suffering for a few months from recurrent abdominal pain sometimes associated with vomiting underwent an abdominal ultrasound scan outside the hospital...
December 14, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-healthcare-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#2
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome (ACS) are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the healthcare system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice decision aid (CPC) on overall healthcare utilization as well as utilization of specific services both during the index emergency department visit and in the subsequent 45 days...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29191566/usefulness-of-achieving-%C3%A2-10-mets-with-a-negative-stress-electrocardiogram-to-screen-for-high-risk-obstructive-coronary-artery-disease-in-patients-referred-for-coronary-angiography-after-exercise-stress-testing
#3
Adrián I Löffler, Margarita V Perez, Emmanuel O Nketiah, Jamieson M Bourque, Ellen C Keeley
Functional capacity in exercise stress testing is an independent predictor of cardiac events. Routine use of nuclear perfusion imaging increases radiation burden and cost. Our goal was to assess the clinical utility of exercise functional capacity with stress electrocardiogram (ECG) as an adjunct in predicting the presence of high-risk obstructive coronary artery disease (CAD) on diagnostic coronary angiography. We performed a retrospective study of patients who underwent exercise stress testing for the evaluation of chest pain and underwent diagnostic coronary angiography within the subsequent 3 months...
October 31, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29170329/32%C3%A2-do-low-risk-patients-with-non-cardiac-chest-pain-prefer-early-discharge-after-rapid-rule-out-in-the-emergency-department
#4
Isabelle Hancock, Edward Carlton
BACKGROUND: There has been a recent drive to implement rapid rule-out strategies which allow the early discharge of low-risk patients with suspected cardiac chest pain directly from the Emergency Department (ED). Previously, such patients would have been admitted to a hospital bed for observation and delayed biomarker testing. While the drive to implement rapid rule-out strategies comes from healthcare providers, there has been little assessment of patient perspectives on early discharge, in what is known to be a high-anxiety presentation...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170297/bet-2-sharing-decisions-for-patients-with-suspected-cardiac-chest-pain-in-the-emergency-department
#5
Abigail Ward, Richard Body
A short-cut review was carried out to establish whether shared decision making used alongside a decision aid can lead to greater patient satisfaction, lower healthcare resource use and non-inferior clinical outcomes in patients with suspected acute coronary syndromes. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of shared decision-making tools in the ED for management of patients with low-risk chest pain appears to be beneficial to the patient and the physician...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#6
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
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
#7
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/29135619/the-heart-pathway-and-hospital-cost-savings
#8
Amy A Yau, Long T Nguyendo, LaKeesha L Lockett, Edward Michaud
Chest pain is a common complaint in emergency departments. Several guidelines and tools exist to help the clinician determine need for hospitalization. For low-risk patients, clinical judgment can underestimate a patient's risk of major adverse cardiac event. Implementation of an advanced diagnostic protocol with the HEART Pathway can reduce hospital cost. For our academic institution, we saw an approximate $1 million in total savings during the initial implementation year along with increased outpatient visits...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29131477/a-risk-assessment-score-and-initial-high-sensitivity-troponin-combine-to-identify-low-risk-of-acute-myocardial-infarction-in-the-emergency-department
#9
John W Pickering, Dylan Flaws, Stephen W Smith, Jaimi Greenslade, Louise Cullen, William Parsonage, Edward Carlton, A Mark Richards, Richard Troughton, Christopher Pemberton, Peter M George, Martin P Than
OBJECTIVES: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. METHODS: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS...
November 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29131324/advanced-imaging-reduces-cost-compared-to-standard-of-care-in-emergency-department-of-triage-of-acute-chest-pain
#10
Pamela S Noack, Jhanna A Moore, Michael Poon
OBJECTIVE: To evaluate medical costs of novel therapies in complex medical settings using registry data. DATA SOURCE/STUDY SETTING: Primary data, from 2008 to 2010. We used patient registry data to evaluate cost and quality performance of coronary computed tomography angiography (CCTA) in triaging chest pain patients in our tertiary care emergency department and to model financial performance under Medicare's two midnight rule. STUDY DESIGN: Using generalized linear modeling, we retrospectively compared estimated expenditures for evaluation of low-to-intermediate-risk chest pain for demographic and medically risk matched samples of 894 patients each, triaged with CCTA or local standard of care (SOC) using Medicare reimbursement as a proxy...
November 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/29121752/identification-of-coronary-artery-calcification-can-optimize-risk-stratification-in-patients-with-acute-chest-pain
#11
Daniel O Bittner, Richard A P Takx, Pedro V Staziaki, Sumbal Janjua, Tomas G Neilan, Nandini M Meyersohn, Michael T Lu, Anand M Prabhakar, John T Nagurney, Udo Hoffmann, Brian B Ghoshhajra
BACKGROUND: The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. METHODS AND RESULTS: We included 826 consecutive patients (mean age: 53±11years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis...
December 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29108799/corrigendum-to-remote-management-of-low-to-intermediate-risk-chest-pain-a-case-series-am-j-emerg-med-2017
#12
Alexander Chiu, Kathleen Shumaker, Christopher Del Corral, Blessy George, Michael Kasper, Marie-Carmelle Elie-Turenne, Preeti Jois, Daniel Dipsia, Meaghan Donnelly, Lauren Sidow, Caroline Chau, Adam Ash
No abstract text is available yet for this article.
November 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29096836/association-of-lipoprotein-a-level-with-short-and-long-term-outcomes-after-cabg-the-role-of-lipoprotein-apheresis
#13
Marat V Ezhov, Olga I Afanasieva, Larisa N Il'ina, Maya S Safarova, Irina Yu Adamova, Yuri G Matchin, Gennady A Konovalov, Renat S Akchurin, Sergei N Pokrovsky
OBJECTIVE: To evaluate the association of lipoprotein(a) [Lp(a)] level with short- and long-term outcomes after coronary artery bypass grafting (CABG) and to assess the effect of a 12 month course of weekly lipoprotein apheresis on vein graft patency and coronary atherosclerosis course in post-CABG patients with hyperlipidemia. METHODS: This study was performed in patients after successful CABG and consisted of three parts: a) a retrospective part with computed tomography assessment of vein graft patency in patients with first-year recurrence of chest pain after CABG (n = 102); b) a prospective trial with evaluation of cardiovascular outcomes during follow up time up to 15 years in relation to baseline Lp(a) levels (n = 356); c) an 12-months interventional controlled study in 50 patients with low-density lipoprotein cholesterol (LDL-C) levels >2...
November 2017: Atherosclerosis. Supplements
https://www.readbyqxmd.com/read/29089344/impact-of-diabetes-mellitus-on-the-evaluation-of-stable-chest-pain-patients-insights-from-the-promise-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain-trial
#14
Abhinav Sharma, Nishant K Sekaran, Adrian Coles, Neha J Pagidipati, Udo Hoffmann, Daniel B Mark, Kerry L Lee, Hussein R Al-Khalidi, Michael T Lu, Patricia A Pellikka, Quynh A Trong, Pamela S Douglas
BACKGROUND: The impact of diabetes mellitus on the clinical presentation and noninvasive test (NIT) results among stable outpatients presenting with symptoms suggestive of coronary artery disease (CAD) has not been well described. METHODS AND RESULTS: The PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial enrolled 10 003 patients with known diabetic status, of whom 8966 were tested as randomized and had interpretable NIT results (1908 with diabetes mellitus, 21%)...
October 31, 2017: Journal of the American Heart Association
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/29061617/secondary-analysis-of-frequency-circumstances-and-consequences-of-calculation-errors-of-the-heart-history-ecg-age-risk-factors-and-troponin-score-at-the-emergency-departments-of-nine-hospitals-in-the-netherlands
#16
Marten Ras, Johannes B Reitsma, Arno W Hoes, Alfred Jacob Six, Judith M Poldervaart
OBJECTIVE: The HEART score can accurately stratify the risk of major adverse cardiac events (MACE) in patients with chest pain. We investigated the frequency, circumstances and potential consequences of errors in its calculation. METHODS: We performed a secondary analysis of a stepped wedge trial of patients with chest pain presenting to nine Dutch emergency departments. We recalculated HEART scores for all patients by re-evaluating the elements age (A), risk factors (R) and troponin (T) and compared these new scores with those given by physicians in daily practice...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29056118/validity-of-grace-risk-score-as-a-prognostic-marker-of-in-hospital-mortality-after-acute-coronary-syndrome
#17
Samar Firdous, Muhammad Amir Mehmood, Uzma Malik
OBJECTIVE: To determine validity of GRACE risk score as a determinant of immediate death during hospitalization for Acute Coronary Syndrome (ACS) and analyze the percentage of cardiac deaths among high, intermediate and low risk groups. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Coronary Care Unit of Mayo Hospital, Lahore, from April to July 2015. METHODOLOGY: Patients with acute chest pain were selected according to inclusion and exclusion criteria...
October 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
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/29046004/-coronary-computed-tomography-angiography-in-patients-with-stable-coronary-artery-disease
#19
Helen Ullrich, Tommaso Gori
The guidelines on the management of stable coronary artery disease (SCAD) recommend the use of coronary computed tomography angiography (CTA) in the process of diagnosing coronary artery disease in patients with low intermediate pre-test probability for SCAD. Particularly in cases where stress electrocardiogram or stress imaging provides unclear results, a computed tomographic examination can be considered as a reliable alternative to invasive coronary angiography. Due to its high negative predictive value, coronary CTA can provide accurate information on the presence of coronary artery stenosis and thus coronary artery disease can be reliably excluded without the risks associated with invasive procedures...
October 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28992867/early-exclusion-of-major-adverse-cardiac-events-in-emergency-department-chest-pain-patients-a-prospective-observational-study
#20
Yuk-Ki Leung, Nga-Man Cheng, Cangel Pui-Yee Chan, Anna Lee, Jeffrey Ka-Tak Wong, Bryan Ping-Yen Yan, Anil Tejbhan Ahuja, Colin Alexander Graham, Timothy Hudson Rainer
BACKGROUND: The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. OBJECTIVE: We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for early rule out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART (history, electrocardiogram, age, risk factors, troponin) score...
September 2017: Journal of Emergency Medicine
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