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https://www.readbyqxmd.com/read/29655571/a-rapid-access-chest-pain-clinic-racpc-initial-australian-experience
#1
C Yu, M J Sheriff, A C C Ng, S Brazete, J Gullick, D B Brieger, L Kritharides, H C Lowe
Chest pain is the second most common presenting symptom to emergency departments (ED) in Australia, although up to 85% of these patients do not have an acute coronary syndrome (ACS). Cardiologist-led rapid access chest pain clinics (RACPC) have been proposed overseas to assist in the management of such patients, with prompt outpatient assessment if patients are deemed low risk and discharged from the ED. The use of RACPCs in Australia has been only recently proposed; we therefore sought to examine one such RACPC in an Australian context...
December 11, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29622596/risk-stratifying-chest-pain-patients-in-the-emergency-department-using-heart-grace-and-timi-scores-with-a-single-contemporary-troponin-result-to-predict-major-adverse-cardiac-events
#2
Peter D W Reaney, Hamish I Elliot, Awsan Noman, Jamie G Cooper
BACKGROUND: The majority of patients presenting to the ED with cardiac sounding chest pain have a non-diagnostic ECG and the problem of differentiating those suffering an acute coronary syndrome from those without is familiar to all ED clinical staff. To stratify risk in these patients, specific scores have been developed. Recent work has focused on incorporating newer high-sensitivity cardiac troponin (hs-cTn) assays; however, issues regarding performance and availability of these assays remain...
April 5, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29620793/antidepressants-versus-placebo-for-panic-disorder-in-adults
#3
REVIEW
Irene Bighelli, Mariasole Castellazzi, Andrea Cipriani, Francesca Girlanda, Giuseppe Guaiana, Markus Koesters, Giulia Turrini, Toshi A Furukawa, Corrado Barbui
BACKGROUND: Panic disorder is characterised by repeated, unexpected panic attacks, which represent a discrete period of fear or anxiety that has a rapid onset, reaches a peak within 10 minutes, and in which at least four of 13 characteristic symptoms are experienced, including racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness and breathlessness. It is common in the general population with a lifetime prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions...
April 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29614585/-coronary-microvascular-resistance-and-its-relevant-factors-in-patients-with-moderate-coronary-stenosis-and-chest-pain
#4
D F He, M Y Liu, L J Zhang, C J Guo, Y P Chi, L Zhao, X J Zhang
Objective: To evaluate the impact of cardiovascular risk factors on index of microvascular resistance (IMR) and coronary flow reserve (CFR) and to explore the characteristics of IMR and CFR and the relationship between IMR and angiographic features in patients with intermediate coronary stenosis and chest pain. Methods: Fractional flow reserve (FFR), CFR, and IMR were measured in patients who underwent invasive coronary angiography with 40%-70% stenosis by visual assessment. All patients with FFR>0.75 were enrolled and grouped with the cut-off points of IMR≥25 and CFR≤2...
April 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29574581/new-algorithm-for-the-prediction-of-cardiovascular-risk-in-symptomatic-adults-with-stable-chest-pain
#5
REVIEW
Muralidhar R Papireddy, Carl J Lavie, Abhizith Deoker, Hadii Mamudu, Timir K Paul
PURPOSE OF REVIEW: To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing. RECENT FINDINGS: There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models...
March 24, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29570722/thoracic-dysfunction-in-whiplash-associated-disorders-a-systematic-review
#6
Nicola R Heneghan, Richard Smith, Isaak Tyros, Deborah Falla, Alison Rushton
BACKGROUND: Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine's contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research...
2018: PloS One
https://www.readbyqxmd.com/read/29566887/defer-urgent-noninvasive-testing-in-low-risk-chest-pain-patients
#7
Benjamin C Sun
No abstract text is available yet for this article.
April 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29561447/situs-inversus-totalis-with-solid-pseudopapillary-pancreatic-tumor-a-case-report-and-review-of-literature
#8
Deng Xiang, Jiannan He, Zimeng Fan, Fangfang Xiong, Gang Liu, Sufen Chen, Wu Wen, Jianfeng Li, Junhua Ai, Renhua Wan, Gongxian Wang, Jun Shi
RATIONALE: Situs inversus totalis (SIT) is a rare anatomical variation of the internal organs, and solid pseudopapillary tumor of the pancreas (SPTP) is a rare tissue type of pancreatic tumors, classified as benign or low-grade malignancy. However, to our knowledge, a patient with SIT and SPTP is extremely rare and has never been reported. PATIENT CONCERNS: We retrospectively analyzed a case of SIT with SPTP in a 45-year-old woman. The main complaints were abdominal pain and sensation of heaviness for 2 weeks...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29549371/triaging-primary-care-patients-referred-for-chest-pain-to-specialist-cardiology-centres-efficacy-of-an-optimised-protocol
#9
Francine Cl Tan, Jonathan Yap, John C Allen, Olivia Tan, Swee Yaw Tan, David B Matchar, Terrance Sj Chua
INTRODUCTION: Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology consultation. MATERIALS AND METHODS: Under the 'Triage Protocol', patients referred for chest pain were pretriaged using a standardised algorithm and subsequently referred for relevant functional diagnostic cardiology tests before their initial cardiology consultation...
February 2018: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/29546068/outcomes-of-patients-with-newly-diagnosed-cardiac-myxoma-a-retrospective-multicentric-study
#10
Frantisek Nehaj, Juraj Sokol, Michal Mokan, Veronika Jankovicova, Frantisek Kovar, Marianna Kubaskova, Stanislav Mizera, Marian Mokan
The patient database at the First Department of Internal Medicine in Martin, the Central Slovak Institute for Cardiac and Vascular Diseases in Banska Bystrica, and the National Slovak Institute of Cardiovascular Diseases in Bratislava was searched to identify patients with benign tumors of the heart seen during the 5-year period between 2011 and 2016. Forty-one patients with primary cardiac myxomas were identified and their medical records were reviewed for details pertaining to presenting symptoms, staging modalities, treatment approaches, and outcomes...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29543037/prevalence-and-characteristics-of-coronary-microvascular-dysfunction-among-chest-pain-patients-in-the-emergency-department
#11
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
https://www.readbyqxmd.com/read/29540151/anxiety-about-anxiety-a-survey-of-emergency-department-provider-beliefs-and-practices-regarding-anxiety-associated-low-risk-chest-pain
#12
Paul I Musey, John A Lee, Cassandra A Hall, Jeffrey A Kline
BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique...
March 14, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29538096/clinical-role-of-bone-scintigraphy-in-low-to-intermediate-framingham-risk-patients-with-atypical-chest-pain
#13
Jeong Won Lee, Se-Whan Lee, Sung-Hae Chang, Sang Mi Lee
OBJECTIVE: The purpose of the study is to evaluate the clinical usefulness of bone scintigraphy for etiological diagnosis of patients with atypical chest pain. PATIENTS AND METHODS: We retrospectively enrolled 225 patients with atypical chest pain who underwent bone scintigraphy for etiological diagnosis. No patients showed any symptoms or signs other than chest pain and had low-to-intermediate Framingham risk with insignificant findings on initial cardiac evaluation...
May 2018: Nuclear Medicine Communications
https://www.readbyqxmd.com/read/29535238/retrospective-comparison-of-cardiac-testing-and-results-on-inpatients-with-low-pretest-probability-compared-with-moderate-high-pretest-probability-for-coronary-artery-disease
#14
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
https://www.readbyqxmd.com/read/29525894/surgical-correction-of-pectus-excavatum-by-the-nuss-procedure-a-15-year-experience-study
#15
Piotr Cierpikowski, Adam Rzechonek, Piotr Błasiak, Hanna Lisowska, Grzegorz Pniewski, Patric Le Pivert
Pectus excavatum is the most common congenital deformity of the chest. The Nuss procedure is minimally invasive surgical correction of this defect, using retrosternal metal bars. The purpose of the present study was to describe a 15-year experience with the Nuss surgery, and to evaluate the long-term clinical results of the procedure. We retrospectively evaluated 239 patients, aged 14-34, who underwent the Nuss surgery in the years 2002-2016. Postoperative complications were observed in 40/236 (16.9%) patients...
March 11, 2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29520449/cardiac-ct-in-the-emergency-department-contrasting-evidence-from-registries-and-randomized-controlled-trials
#16
REVIEW
Nam Ju Lee, Harold Litt
PURPOSE OF REVIEW: To compare outcomes between registries and randomized controlled trials of coronary computed tomographic angiography (CCTA)-based versus standard of care approaches to the initial evaluation of patients with acute chest pain. RECENT FINDINGS: Randomized trials have demonstrated CCTA to be a safe and efficient tool for triage of low- to intermediate-risk patients presenting to the emergency department with chest pain. Recent studies demonstrate heterogeneous result using different standard of care approaches for evaluation of hard endpoints in comparison with standard evaluation...
March 8, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29519347/10-year-resource-utilization-and-costs-for-cardiovascular-care
#17
Leslee J Shaw, Abhinav Goyal, Christina Mehta, Joe Xie, Lawrence Phillips, Anita Kelkar, Joseph Knapper, Daniel S Berman, Khurram Nasir, Emir Veledar, Michael J Blaha, Roger Blumenthal, James K Min, Reza Fazel, Peter W F Wilson, Matthew J Budoff
BACKGROUND: Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. OBJECTIVES: This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. METHODS: Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data...
March 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29512019/an-external-validation-of-the-heart-pathway-among-emergency-department-patients-with-chest-pain
#18
Joshua James Oliver, Matthew Jay Streitz, Jessica Marie Hyams, Richard Michael Wood, Yevgeniy Mikhaylovich Maksimenko, Brit Long, Robert Michael Barnwell, Michael David April
The impact of an outpatient disposition strategy for patients with HEART score 0-3 (HEART pathway) on HEART score prognostic accuracy is unclear. Our objective is to perform an external validation the HEART score in the setting of recent implementation of the HEART pathway. We conducted an external validation study of the HEART pathway among patients presenting to our ED with chest pain 6 weeks after institutional implementation of a HEART pathway outpatient disposition pathway. We reviewed the charts of 625 consecutive patients with chest pain...
March 6, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29507795/endoscopic-diagnosis-and-management-of-pleural-effusion-in-malignant-pleural-mesothelioma
#19
REVIEW
Paolo Ceruti, Sara Lonni, Francesca Baglivo, Giampietro Marchetti
Malignant pleural mesothelioma (MPM) is an asbestos-related aggressive tumor, that requires proper diagnosis and management. Symptoms are nonspecific and chest computed tomography (CT) and chest ultrasound (US) are important radiological tools in the initial workup to identify early pathological signs. Performing a medical thoracoscopy (MT) is essential for a definitive diagnosis of MPM. The procedure, integrated with a prior US, allows a global evaluation of the pleural cavity and the execution of multiple targeted biopsies, with low risk of complications...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29502085/prevalence-of-coronary-artery-calcification-in-a-non-specific-chest-pain-population-in-emergency-and-cardiology-departments-compared-with-the-background-population-a-prospective-cohort-study-in-southern-denmark-with-12-month-follow-up-of-cardiac-endpoints
#20
Nivethitha Ilangkovan, Christian Backer Mogensen, Hans Mickley, Annmarie Touborg Lassen, Jess Lambrechtsen, Niels Peter Ronnow Sand, Rasmus Albiniussen, Jørgen Byg, Flemming Hald Steffensen, Mette Hjortdal Grønhøj, Axel Diederichsen
OBJECTIVES: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. DESIGN: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up...
March 3, 2018: BMJ Open
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