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Chest pain assessment clinic

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https://www.readbyqxmd.com/read/28637780/sex-based-differences-in-the-performance-of-the-heart-score-in-patients-presenting-to-the-emergency-department-with-acute-chest-pain
#1
Ingrid E M Bank, Vince C de Hoog, Dominique P V de Kleijn, Gerard Pasterkamp, Pieter A Doevendans, Hester M den Ruijter, Geertje Dalmeijer, Thierry X Wildbergh, Arend Mosterd, Leo Timmers
BACKGROUND: Sex-based differences in clinical presentation, pathophysiology, and outcomes of patients with acute chest pain are increasingly being recognized, but are not implemented in guidelines and clinical prediction tools. We evaluated the performance of the HEART score in women versus men, because sex-based differences may exist among the algorithm's components: history, electrocardiogram, age, risk factors, and admission troponin level. METHODS AND RESULTS: The HEART score was retrospectively assessed in 831 women and 1084 men presenting to the emergency department with acute chest pain, assigning patients to the low-, intermediate-, or high-risk category for the occurrence of major adverse cardiac events (MACE) within 6 weeks...
June 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28630238/impact-of-sex-on-cardiac-troponin-concentrations-a-critical-appraisal
#2
REVIEW
Kai M Eggers, Bertil Lindahl
BACKGROUND: The use of sex-specific cutoffs for cardiac troponin (cTn) is currently debated. Although endorsed by scientific working groups, concerns have been raised that sex-specific cutoffs may have only a small clinical effect at the cost of increased complexity in decision-making. METHODS: We reviewed studies investigating the interrelations between high-sensitivity (hs) cTn results and sex, diagnoses, and outcome. Investigated populations included community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including those with acute coronary syndromes...
June 19, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28628525/assessing-sensitivity-and-specificity-of-the-manchester-triage-system-in-the-evaluation-of-acute-coronary-syndrome-in-adult-patients-in-emergency-care-a-systematic-review
#3
Fernanda Ayache Nishi, Flávia de Oliveira Motta Maia, Itamar de Souza Santos, Dina de Almeida Lopes Monteiro da Cruz
BACKGROUND: Triage is the first assessment and sorting process used to prioritize patients arriving in the emergency department (ED). As a triage tool, the Manchester Triage System (MTS) must have a high sensitivity to minimize the occurrence of under-triage, but must not compromise specificity to avoid the occurrence of overtriage. Sensitivity and specificity of the MTS can be calculated using the frequency of appropriately assigned clinical priority levels for patients presenting to the ED...
June 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28624401/the-external-validity-of-prediction-models-for-the-diagnosis-of-obstructive-coronary-artery-disease-in-patients-with-stable-chest-pain-insights-from-the-promise-trial
#4
Tessa S S Genders, Adrian Coles, Udo Hoffmann, Manesh R Patel, Daniel B Mark, Kerry L Lee, Ewout W Steyerberg, M G Myriam Hunink, Pamela S Douglas
OBJECTIVES: This study sought to externally validate prediction models for the presence of obstructive coronary artery disease (CAD). BACKGROUND: A better assessment of the probability of CAD may improve the identification of patients who benefit from noninvasive testing. METHODS: Stable chest pain patients from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial with computed tomography angiography (CTA) or invasive coronary angiography (ICA) were included...
June 9, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28621042/clinical-evaluation-of-anomalous-aortic-origin-of-a-coronary-artery-aaoca
#5
Silvana Molossi, Hitesh Agrawal
The clinical evaluation of patients with an anomalous aortic origin of a coronary artery (AAOCA), a congenital abnormality of the origin or course of a coronary artery that arises from the aorta, is challenging given its first presentation being sudden cardiac arrest in about half of the patients. Symptoms of chest pain, shortness of breath and syncope during exertion should be of concern in evaluating young athletes and nonathletes. The lack of abnormal signs on the physical exam and electrocardiogram further adds to the difficulty in establishing the diagnosis...
June 16, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28616562/coronary-calcification-compromises-myocardial-perfusion-irrespective-of-luminal-stenosis
#6
Michael Y Henein, Tarek Bengrid, Rachel Nicoll, Ying Zhao, Bengt Johansson, Axel Schmermund
AIM: The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients. METHOD: Retrospective analysis of 120 patients (age 65.1 ± 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography...
March 2017: IJC Heart & Vasculature
https://www.readbyqxmd.com/read/28609191/understanding-frequent-emergency-department-use-among-primary-care-patients
#7
Morgan Hardy, Alex Cho, Alissa Stavig, Marigny Bratcher, Janice Dillard, Lawrence Greenblatt, Kevin Schulman
Patients with high emergency department (ED) utilization are an important focus in population health management. This retrospective cohort study analyzed patterns of frequent ED use for 4087 patients enrolled at an academically-affiliated primary care clinic. For all ED visits (n = 4776), the chief complaints, admission rates, number of complaints per patient, and median time between return visits were assessed. Chart reviews were conducted for the 10 highest utilizers from each of the 3 leading complaints to help explain repeated ED use for the same complaints...
June 13, 2017: Population Health Management
https://www.readbyqxmd.com/read/28605043/typical-angina-is-associated-with-greater-coronary-endothelial-dysfunction-but-not-abnormal-vasodilatory-reserve
#8
Ahmed AlBadri, Derek Leong, C Noel Bairey Merz, Janet Wei, Eileen M Handberg, Chrisandra L Shufelt, Puja K Mehta, Michael D Nelson, Louise E Thomson, Daniel S Berman, Leslee J Shaw, Galen Cook-Wiens, Carl J Pepine
BACKGROUND: Typical angina (TA) is defined as substernal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin. Women and elderly patients are usually have atypical symptoms both at rest and during stress, often in the setting of nonobstructive coronary artery disease (CAD). HYPOTHESIS: To further understand this, we performed subgroup analysis comparing subjects who presented with TA vs nontypical angina (NTA) using baseline data of patients with nonobstructive CAD and coronary microvascular dysfunction (CMD) enrolled in a clinical trial...
June 12, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28601817/the-organisational-value-of-diagnostic-strategies-using-high-sensitivity-troponin-for-patients-with-possible-acute-coronary-syndromes-a-trial-based-cost-effectiveness-analysis
#9
Paul Jülicher, Jaimi H Greenslade, William A Parsonage, Louise Cullen
OBJECTIVES: To evaluate hospital-specific health economic implications of different protocols using high-sensitivity troponin I for the assessment of patients with chest pain. DESIGN: A cost prediction model and an economic microsimulation were developed using a cohort from a single centre recruited as part of the (ADAPT) trial, a prospective observational trial conducted from 2008 to 2011. The model was populated with 40 000 bootstrapped samples in five high-sensitivity troponin I-enabled algorithms versus standard care...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28599831/alterations-in-cardiac-deformation-timing-of%C3%A2-contraction-and-relaxation-and-early-myocardial-fibrosis-accompany-the-apparent-recovery-of-acute-stress-induced-takotsubo-cardiomyopathy-an-end-to-the-concept-of%C3%A2-transience
#10
Konstantin Schwarz, Trevor Ahearn, Janaki Srinivasan, Christopher J Neil, Caroline Scally, Amelia Rudd, Baljit Jagpal, Michael P Frenneaux, Cristina Pislaru, John D Horowitz, Dana K Dawson
BACKGROUND: Takotsubo syndrome is an increasingly recognized cause of chest pain and occasionally of cardiogenic shock. Despite rapid improvement of the left ventricular (LV) ejection fraction, recent registry data raise concerns about long-term prognosis. The aim of this study was to test the hypothesis that restoration of normal ejection fraction after acute takotsubo syndrome is not equivalent to full functional recovery. METHODS: Fifty-two patients with takotsubo syndrome (according to the Mayo Clinic criteria plus cardiac magnetic resonance imaging to exclude myocardial infarction) and 44 healthy control subjects of the same age, gender, and cardiovascular comorbidity distribution were prospectively recruited...
June 6, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28591063/a-new-technique-for-lipid-core-plaque-detection-by-optical-coherence-tomography-for-prevention-of-peri-procedural-myocardial-infarction-a-case-report
#11
Yongcheol Kim, Muthukaruppan Gnanadesigan, Gijs van Soest, Thomas W Johnson
RATIONALE: Percutaneous coronary intervention (PCI) provides effective revascularization of atherosclerotic coronary arteries but the invasive nature of treatment can result in complications. PATIENT CONCERNS: A 53-year old man underwent coronary angiography due to chest pain with minimal ST-segment elevation in the inferior leads of the electrocardiogram. DIAGNOSIS: We proceeded directly to coronary angiography and delineated a moderate stenosis with haziness in the mid right coronary artery (RCA)...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28584311/takotsubo-cardiomyopathy-in-the-case-of-72-year-old-teacher-after-work-related-psychological-stress-evolution-of-left-ventricular-longitudinal-strain-delayed-but-complete-recovery-in-automated-function-imaging-afi
#12
Karina Wierzbowska-Drabik, Andrzej Marcinkiewicz, Piotr Hamala, Ewa Trzos, Piotr Lipiec, Małgorzata Kurpesa, Radosław Kręcki, Michał Plewka, Jarosław D Kasprzak
Takotsubo cardiomyopathy (TC) is related to a transient systolic dysfunction of left ventricle (LV), accompanied by clinical and electrocardiographic symptoms of myocardial ischemia in the absence of hemodynamically significant coronary artery disease. Takotsubo cardiomyopathy is usually provoked by a psychologically or/and physically stressful event which may be related to occupational activities. Although visually assessed evolution of LV function is well documented, the data concerning strain changes is sparse and various patterns of deformation abnormalities are suggested...
March 23, 2017: International Journal of Occupational Medicine and Environmental Health
https://www.readbyqxmd.com/read/28576799/audit-analysing-the-outcome-of-patients-referred-to-the-rapid-access-chest-pain-clinic-and-assessing-the-positive-predictive-value-of-the-rapid-access-chest-pain-clinic-of-patients-with-coronary-artery-disease
#13
Khizar Khan-Mahmood, Viraj Patel, Mark Scoote
No abstract text is available yet for this article.
June 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28576606/difference-of-achalasia-subtypes-based-on-clinical-symptoms-radiographic-findings-and-stasis-scores
#14
A Meillier, D Midani, D Caroline, M Saadi, H Parkman, R Schey
INTRODUCTION: Three subtypes of achalasia have been defined through high-resolution esophageal manometry: subtype i shows no pressurization with swallows, subtype ii has increased isobaric panesophageal pressure, and subtype iii has distal esophageal spastic non-isobaric contractions. Studies describing the subtypes based on radiographic findings, clinical symptoms, and stasis scores are limited. AIM: To determine the differences in clinical symptoms, radiographic findings, and stasis scores for the 3 achalasia subtypes...
May 30, 2017: Revista de Gastroenterología de México
https://www.readbyqxmd.com/read/28566132/early-diagnostic-performance-of-heart-type-fatty-acid-binding-protein-in-suspected-acute-myocardial-infarction-evidence-from-a-meta-analysis-of-contemporary-studies
#15
Li-Qian Xu, Yun-Mei Yang, Hong Tong, Chang-Fu Xu
BACKGROUND: Although cardiac troponin is the cornerstone in diagnosis of acute myocardial infarction (AMI), the accuracy is still suboptimal in the early hours after chest pain onset. Due to its small size, heart-type fatty acid-binding protein (H-FABP) has been reported accurate in diagnosis of AMI, however, this remains undetermined. The aim is to investigate the diagnostic performance of H-FABP alone and in conjunction with high-sensitivity troponin (hs-Tn) within six hours of symptom onset...
May 4, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28562541/preoperative-flap-site-injection-with-ropivacaine-and-epinephrine-in-baba-robotic-and-endoscopic-thyroidectomy-safely-reduces-postoperative-pain-a-consort-compliant-double-blinded-randomized-controlled-study-pain-brekor-trial
#16
Joon-Hyop Lee, Yong Joon Suh, Ra-Yeong Song, Jin Wook Yi, Hyeong Won Yu, Hyungju Kwon, June Young Choi, Kyu Eun Lee
BACKGROUND: Clinical trials on bilateral axillo-breast approach (BABA) thyroidectomy show that levobupivacaine and ropivacaine significantly reduce postoperative pain, but they focused on BABA robotic thyroidectomy only and did not identify specific sites of significant pain relief. Our objective was to assess the pain reduction at various sites and safety of ropivacaine-epinephrine flap injection in BABA thyroidectomy. METHODS: This prospective double-blinded randomized controlled trial was conducted in compliance with the revised CONSORT statement (ClinicalTrials...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#17
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28512745/implementation-of-multi-disciplinary-care-reduces-maternal-mortality-in-women-with-sickle-cell-disease-living-in-low-resource-setting
#18
Eugenia Vicky Asare, Edeghonghon Olayemi, Theodore Boafor, Yvonne Dei-Adomakoh, Enoch Mensah, Harriet Ghansah, Yvonne Osei-Bonsu, Selina Crabbe, Latif Musah, Charles Hayfron-Benjamin, Brittany Covert, Adetola A Kassim, Andra James, Mark Rodeghier, Michael R DeBaun, Samuel A Oppong
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic...
May 16, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28500860/interventions-for-preventing-silent-cerebral-infarcts-in-people-with-sickle-cell-disease
#19
REVIEW
Lise J Estcourt, Patricia M Fortin, Sally Hopewell, Marialena Trivella, Carolyn Doree, Miguel R Abboud
BACKGROUND: Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Silent cerebral infarcts are the commonest neurological complication in children and probably adults with SCD. Silent cerebral infarcts also affect academic performance, increase cognitive deficits and may lower intelligence quotient...
May 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#20
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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