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https://www.readbyqxmd.com/read/29455230/things-we-do-for-no-reason-hospitalization-for-the-evaluation-of-patients-with-low-risk-chest-pain
#1
Christopher A Caulfield, John R Stephens
No abstract text is available yet for this article.
February 13, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29452690/utility-of-physician-selection-of-cardiac-tests-in-a-chest-pain-unit-to-exclude-acute-coronary-syndrome-among-patients-without-a-history-of-coronary-artery-disease
#2
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
https://www.readbyqxmd.com/read/29450676/comorbid-obstructive-sleep-apnea-and-increased-risk-for-sickle-cell-disease-morbidity
#3
Tal Katz, Jeffrey Schatz, Carla W Roberts
PURPOSE: Sickle cell disease (SCD) imparts an increased risk for obstructive sleep apnea (OSA) in childhood. Studies of pediatric SCD have identified an increased risk for pain and neurologic complications with comorbid OSA. We determined the rate of a broad range of SCD-related medical complications to better characterize the spectrum of SCD complications related to OSA. METHODS: Retrospective chart review at a single hematology clinic identified 641 youth with SCD who received consistent screenings for OSA as part of routine hematological health maintenance visits over an 11-year period...
February 15, 2018: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/29436171/ischaemic-heart-disease-following-conventional-and-hypofractionated-radiation-treatment-in-a-contemporary-breast-cancer-series
#4
Melissa James, Sami Swadi, Ma Yi, Lisa Johansson, Bridget Robinson, Ashutosh Dixit
INTRODUCTION: We report the incidence of ischaemic cardiac toxicity in a contemporary cohort of patients receiving conventional (CFRT) or hypofractionated (HFRT) radiation after surgery for early breast cancer and investigate the interplay of cardiac risk factors and fractionation. METHODS: Included were patients receiving external beam radiation treatment from 2002 to 2006 at the Christchurch public hospital. Hospital coding databases, oncology databases and medical records were reviewed for baseline characteristics, treatment details and outcomes...
February 13, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29432369/implementation-of-an-early-discharge-protocol-and-chest-pain-clinic-for-low-risk-chest-pain-in-the-emergency-department
#5
Mohammad Amin Kashef, Jane Garb, Aaron Kugelmass, Amir Lotfi
BACKGROUND: Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive. METHODS: We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Also a chest pain clinic (CPC) was started for cardiology follow-up within 72 hours. In a retrospective cohort study, primary outcome of major adverse cardiac events (MACEs) of death, myocardial infarction, or revascularization was compared between CPC patients and those hospitalized for observation...
March 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29427301/prospective-validation-and-refinement-of-a-decision-rule-to-obtain-cxr-in-patients-with-non-traumatic-chest-pain-in-the-ed
#6
Case Newsom, Rebecca Jeanmonod, Wendy Woolley, Nirali Shah, Shellie Asher, Eric Bruno, Michael Silberman, Mark Reiter, Donald Jeanmonod
OBJECTIVES: To prospectively validate and refine previously published criteria to determine the potential utility of chest x-ray (CXR) in the evaluation and management of patients presenting to the emergency department (ED) with non-traumatic chest pain. METHODS: A prospective observational study was performed of patients presenting to three EDs in the US with a chief complaint of non-traumatic chest pain. Previously defined high-risk history and exam elements were combined into a refined decision rule and these elements were recorded for each patient by the ED physician...
February 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29420956/performance-of-coronary-risk-scores-among-patients-with-chest-pain-in-the-emergency-department
#7
Dustin G Mark, Jie Huang, Uli Chettipally, Mamata V Kene, Megan L Anderson, Erik P Hess, Dustin W Ballard, David R Vinson, Mary E Reed
BACKGROUND: Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES: The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates...
February 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29417415/provocative-testing-for-low-risk-chest-pain-patients-must-we-continue
#8
EDITORIAL
James Booth, J Jeremy Thomas
No abstract text is available yet for this article.
February 7, 2018: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29407013/contemporary-emergency-department-management-of-patients-with-chest-pain-a-concise-review-and-guide-for-the-high-sensitivity-troponin-era
#9
REVIEW
James E Andruchow, Peter A Kavsak, Andrew D McRae
This article synthesizes current best evidence for the evaluation of patients with suspected acute coronary syndrome (ACS) using high-sensitivity troponin assays, enabling physicians to effectively incorporate them into practice. Unlike conventional assays, high-sensitivity assays can precisely measure blood cardiac troponin concentrations in the vast majority of healthy individuals, facilitating the creation of rapid diagnostic algorithms. Very low troponin concentrations on presentation accurately rule out acute myocardial infarction (AMI) and enable the discharge of approximately 20% of patients after a single test, whereas an additional 30%-40% of patients can be safely discharged after short-interval serial sampling in as little as 1 or 2 hours...
February 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29384941/concomitant-coronary-and-pulmonary-embolism-associated-with-patent-foramen-ovale-a-case-report
#10
Zhongxiu Chen, Chen Li, Yajiao Li, Hong Tang, Li Rao, Mian Wang
RATIONALE: The differential diagnosis of acute chest pain is very important, and can sometimes be challenging. Related diseases share a number of risk factors, and occasionally, 1 condition causes another disease to develop. PATIENT CONCERNS: We described a 59-year-old man who presented to emergency department complaining of chest pain. DIAGNOSES: He was suffered acute myocardial infarction (MI) and pulmonary embolism (PE) simultaneously. INTERVENTIONS: Dual antiplatelet therapy, statin, and low molecular weight heparin were administrated during his stay...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29374373/utilization-of-stress-testing-for-low-risk-patients-with-chest-discomfort-in-the-emergency-department
#11
Sheela Krishnan, Rachael Venn, Daniel M Blumenthal, Vijeta Bhambhani, Henry Gewirtz, Rory B Weiner, John T Nagurney, Jason H Wasfy
BACKGROUND: The management of patients presenting to an emergency department with chest discomfort at low-risk for acute coronary syndrome represents a common clinical challenge. Such patients are often triaged to chest pain units for monitoring and cardiac stress testing for further risk stratification. METHODS: We conducted a retrospective study of 292 low-risk patients who presented to an emergency department with chest discomfort. We performed physician-adjudicated chart reviews of all patients with positive stress tests to assess downstream testing, subsequent coronary revascularization, and outcomes...
January 26, 2018: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29365611/role-of-the-cycle-ergometer-stress-test-in-chest-pain-with-low-intermediate-risk
#12
Paolo Scarinzi, Marta Biolo, Chiara Panzavolta, Lisa Benvegnù, Alois Saller, Sandra Bertocco, Sabina Zambon, Fabrizio Fabris, Enzo Manzato, Alberto Zambon, Lorenzo Previato
No abstract text is available yet for this article.
August 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29336989/are-geriatric-patients-placed-in-an-emergency-department-observation-unit-on-a-chest-pain-pathway-more-likely-than-non-geriatric-patients-to-re-present-to-the-hospital-within-30%C3%A2-days
#13
Christopher C Gruenberg, Alan H Breaud, James H Liu, Patricia M Mitchell, James A Feldman, Kerrie P Nelson, Joseph H Kahn
BACKGROUND: Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations. OBJECTIVE: The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing. METHODS: We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015...
January 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29322167/use-of-high-risk-coronary-atherosclerotic-plaque-detection-for-risk-stratification-of-patients-with-stable-chest-pain-a-secondary-analysis-of-the-promise-randomized-clinical-trial
#14
Maros Ferencik, Thomas Mayrhofer, Daniel O Bittner, Hamed Emami, Stefan B Puchner, Michael T Lu, Nandini M Meyersohn, Alexander V Ivanov, Elizabeth C Adami, Manesh R Patel, Daniel B Mark, James E Udelson, Kerry L Lee, Pamela S Douglas, Udo Hoffmann
Importance: Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. Objective: To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors...
January 10, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#15
Jason P Stopyra, William S Harper, Tyson J Higgins, Julia V Prokesova, James E Winslow, Robert D Nelson, Roy L Alson, Christopher A Davis, Gregory B Russell, Chadwick D Miller, Simon A Mahler
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted...
February 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29306269/sealone-safety-and-efficacy-of-coronary-computed-tomography-angiography-with-low-dose-in-patients-visiting-emergency-room-trial-study-protocol-for-a-randomized-controlled-trial
#16
Joonghee Kim, Joon-Won Kang, Kyuseok Kim, Sang Il Choi, Eun Ju Chun, Yeo Goon Kim, Won Young Kim, Dong Woo Seo, Jonghwan Shin, Huijai Lee, Kwang-Nam Jin, Soyeon Ahn, Seung Sik Hwang, Kwang Pyo Kim, Ru-Bi Jeong, Sang Ook Ha, Byungho Choi, Chang-Hwan Yoon, Jung-Won Suh, Hack-Lyoung Kim, Ju Kyoung Kim, Sujin Jang, Ji Seon Seo
OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29297745/exercise-electrocardiogram-neither-predicts-nor-excludes-coronary-artery-disease-in-women-with-low-to-intermediate-risk
#17
Remco J J Knol, Huub Kan, Maurits Wondergem, Jan H Cornel, Victor A W M Umans, Tjeerd van der Ploeg, Friso M van der Zant
AIM: The value of exercise electrocardiogram (ExECG) in symptomatic female patients with low to intermediate risk for significant coronary artery disease (CAD) has been under debate for many years, and nondiagnostic or even erroneous test results are frequently encountered. Cardiac-CT may be more appropriate to exclude CAD in women. This study compares the results of ExECGs with those of cardiac-CTs, performed within a time frame of 1 month in an all-comers female chest pain population...
January 3, 2018: Journal of Women's Health
https://www.readbyqxmd.com/read/29289400/shared-decision-making-as-the-future-of-emergency-cardiology
#18
REVIEW
Marc A Probst, Peter A Noseworthy, Juan P Brito, Erik P Hess
Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions...
February 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29282539/the-global-spine-care-initiative-a-systematic-review-of-individual-and-community-based-burden-of-spinal-disorders-in-rural-populations-in-low-and-middle-income-communities
#19
REVIEW
Eric L Hurwitz, Kristi Randhawa, Paola Torres, Hainan Yu, Leslie Verville, Jan Hartvigsen, Pierre Côté, Scott Haldeman
PURPOSE: The purpose of this review was to synthesize literature on the burden of spinal disorders in rural communities to inform the Global Spine Care Initiative care pathway and model of care for their application in medically underserved areas and low- and middle-income countries. METHODS: A systematic review was conducted. Inclusion criteria included all age groups with nonspecific low back pain, neck pain, and associated disorders, nonspecific thoracic spinal pain, musculoskeletal chest pain, radiculopathy, or spinal stenosis...
December 27, 2017: European Spine Journal
https://www.readbyqxmd.com/read/29277845/subacute-right-ventricular-perforation-by-pacemaker-lead-causing-left-sided-hemothorax-and-epicardial-hematoma
#20
Abdelrahman Ahmed, Mohamed Shokr, Randy Lieberman
We report a case of right ventricular wall perforation by a pacemaker lead in a 78-year-old female 18 days after a permanent pacemaker insertion. This injury necessitated explant of the perforating lead and implantation of a new one with surgical backup. We review the literature and discuss the possible risk and protective factors including lead models that were associated with higher incidence of perforation. We review the traditional pacing parameters and their lack of reliability to diagnose perforation and the need for low threshold to utilize imaging in appropriate clinical scenarios...
2017: Case Reports in Cardiology
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