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Chest pain assessment clinic

Fang Wang, Tiewei Li, Xiangfeng Cong, Zhihui Hou, Bin Lu, Zhou Zhou, Xi Chen
Progression of coronary artery calcification (CAC) was significantly associated with all-cause mortality, and high coronary artery calcium score (CACS) portends a particularly high risk of cardiovascular events. But how often one should rescan is still an unanswered question. Preliminary screening by testing circulating biomarker may be an alternative before repeat computed tomography (CT) scan. The aim of this study was to investigate the value of big endothelin-1 (bigET-1), the precursor of endothelin-1 (ET-1), in predicting the severity of CAC...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Robert Roehle, Viktoria Wieske, Georg M Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato, Juhani Knuuti, Matthijs F L Meijs, Harald Brodoefel, Shona M M Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp Kaufmann, Ronny Ralf Büchel, Bernhard Herzog, Melvin Clouse, David A Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean-Pierre Laissy, Roy Marcus, Simone Muraglia, Jean-Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)...
March 19, 2018: European Radiology
Masaki Izumo, Yoshihiro J Akashi
Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology. TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications...
February 2018: Cardiovascular Diagnosis and Therapy
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...
March 13, 2018: Nuclear Medicine Communications
Thomas Krysztofiak, John Byrne
High-sensitivity cardiac troponin assays have emerged as a powerful tool in the management of patients presenting acutely to hospital with suspected cardiac chest pain. Recent guidelines emphasize the reassurance offered by low troponin concentrations early after admission. We describe a patient with known coronary artery disease, who presented with a classical history of recurrent myocardial ischaemia. High-sensitivity cardiac Troponin-I concentrations remained in the low-normal sex-specific reference range, despite serial testing on the day of admission, and despite recurrent pain with dynamic ECG changes...
January 1, 2018: Scottish Medical Journal
Samuel L Sidharta, Timothy J Baillie, Stuart Howell, Stephen J Nicholls, Natalie Montarello, Satoshi Honda, Daisuke Shishikura, Sinny Delacroix, Susan Kim, John F Beltrame, Peter J Psaltis, Stephen G Worthley, Matthew I Worthley
OBJECTIVE: Coronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging...
March 1, 2018: Heart: Official Journal of the British Cardiac Society
Shabnam ShahAli, Amir Massoud Arab, Esmaeil Ebrahimi, Shiva ShahAli, Nahid Rahmani, Hossein Negahban, Anoshirvan Kazemnejad, Andia Bahmani
PURPOSE: The present study investigated group differences between the thickness changes of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, during performance of the isometric supine chest raise and the supine double leg-straight leg raise tests in women with and without low back pain (LBP). METHOD: Twenty women with LBP and 20 women without LBP participated in this case-control study. The thickness of the right TrA, IO, and EO muscles was measured using B-mode ultrasound (US) at rest, immediately at the beginning of performing the tests and when participants in both groups self-reported fatigue...
February 26, 2018: Physiotherapy Theory and Practice
Xia Lin, Yingming Xiang, Hongcan Shi, Fangbiao Zhang
Due to the extreme rarity of primary intrapulmonary solitary fibrous tumours (SFTs), their clinical course, imaging characteristics, diagnosis, treatment and prognosis are poorly understood. The present study therefore assessed the diagnosis and management of primary intrapulmonary SFTs and systematically reviewed previously reported cases in the literature. A total of 5 patients who underwent resection for primary intrapulmonary SFTs were enrolled in the present study and their clinical course, tumour characteristics, management and survival were assessed in this retrospective study...
March 2018: Oncology Letters
Akamin Raymond, Ettore Pedretti, Giuseppina Privitera, Cristina Cicero, Giacomo Biasucci
BACKGROUND: Unilateral absence of the pulmonary artery (UAPA) is a rare congenital malformation often associated with other cardiac anomalies; however it may occur as an isolated lesion. Isolated absence of the right pulmonary artery is twice more frequent than that of the left pulmonary artery. Patients with isolated UAPA are usually asymptomatic at birth; thereafter they may develop a progression of symptoms such as exercise intolerance, dyspnea, chest pain, hemoptysis and recurrent pulmonary infections...
February 20, 2018: Italian Journal of Pediatrics
Feng Hai, Chen Xueming, Zhang Zhiwen, Li Chenyu, Fang Jie, Zhang Zhe, Lian Lishan, Zhu Renming, Yu Hongzhi, Liu Bin
OBJECTIVE: To evaluate the safety and efficacy of selective catheter-directed thrombolysis in treating acute massive pulmonary thromboembolism (AMPTE). MATERIALS AND METHODS: Twenty-six AMPTE patients were enrolled between March 2010 and March 2013. A Uni*Fuse infusion system was inserted into the main pulmonary artery thrombus. The thrombolytic regimen included an intraoperative bolus injection of 250,000 IU urokinase, followed by continuous thrombolytic infusion of 5,000IU/kg...
February 15, 2018: Annals of Vascular Surgery
Mostafa Elguindy, Rod Stables, Zoe Nicholas, Ian Kemp, Nick Curzen
BACKGROUND: Investigation of anginal chest pain has traditionally involved either assessment of the coronary anatomy by angiography or noninvasive testing for reversible ischemia. Invasive pressure wire assessment at the time of angiography offers information on both anatomy and physiology. Fractional flow reserve-guided percutaneous coronary intervention is associated with lower resource utilization and improved clinical outcome compared with angiographic guidance alone. However, the value of routine fractional flow reserve of all major coronary vessels at the time of diagnostic angiography has not been established in a randomized trial despite persuasive observational data...
February 2018: Circulation. Cardiovascular Quality and Outcomes
Andreas Roos, Martin J Holzmann
BACKGROUND: Recent studies have suggested that there may be large diurnal variation in cardiac troponin T (cTnT) concentrations measured with a high sensitive assay. OBJECTIVE: To investigate if clinically relevant diurnal variation in cTnT concentrations is present in patients with chest pain in the emergency department (ED). METHODS: We included all patients with chest pain, but no myocardial infarction (MI), and no other acute condition that may affect troponin concentrations in the ED at Karolinska University Hospital, Stockholm, Sweden, 2011-2014...
February 12, 2018: Clinical Biochemistry
Anna Pettersson, Lina Ljung, Caroline Johansson, Umut Heilborn, Tomas Jernberg, Mats Frick, Kai M Eggers, Bertil Lindahl, Rikard Linder, Arne Martinsson, Per Svensson
BACKGROUND: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome. METHODS: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death...
March 2018: Critical Pathways in Cardiology
Natalia Stoeva, Galina Kirova, Milena Staneva, Diana Lekova, Anton Penev, Rumiana Bakalova
BACKGROUND: The assessment of the clinical symptoms is the weakest link of the pulmonary embolism (PE) diagnostic algorithm. Despite the presence of highly sensitive and specific imaging methods, verifying PE remains difficult due to nonspecific clinical symptoms and frequently its subclinical course. OBJECTIVE: The aim of this study is to improve the recognition of PE by investigating the clinical presentation and short-term prognosis of unprovoked PE in comparison to provoked PE...
February 2018: Respiratory Medicine
Daniel M Siegel, Stephen Tyring, Walter K Nahm, Marie Louise Østerdal, Astrid H Petersen, Brian Berman
OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of ingenol disoxate gel using a once-daily, three-day field treatment regimen in patients with actinic keratosis. DESIGN: This was a Phase II, multicenter, open-label trial ( NCT02305888). SETTING: The study was conducted in 20 trial sites in the United States. PARTICIPANTS: Participants included patients with 5 to 20 clinically typical actinic keratosis lesions on the full face/chest (250cm2), scalp (25-250cm2), or the trunk/extremities (250cm2)...
December 2017: Journal of Clinical and Aesthetic Dermatology
Alireza Jahangirifard, Mohammadreza Razavi, Zargham Hosein Ahmadi, Mohammad Forozeshfard
The aim of this study was to determine the effect of electrical nerve stimulation on pain intensity and pulmonary function in patients undergoing coronary artery bypass surgery. In a randomized clinical trial, a total of 100 patients undergoing coronary artery bypass surgery at Masih Daneshvari Hospital, Tehran, Iran, from February to May 2014, were divided into two groups. In the intervention group (n = 50), patients received routine care along with transcutaneous electrical nerve stimulation (TENS) immediately after admission to the intensive care unit (ICU)...
January 21, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
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
Sun Zongwen, Kong Song, Zhao Cong, Fu Tian, Zhang Yan
Some clinical investigations have assessed the efficacy and safety of bevacizumab combined with platinum anti-cancer drugs versus platinum drugs alone in treating malignant pleural effusion (MPE) caused by lung cancer through intrapleural injection. This report is a meta-analysis of independent research conclusions. Eleven controlled trials with 769 MPE patients were included in this report. Pooled odds ratios and standardized mean difference with 95% confidence intervals were estimated using the fixed or random effects model of meta-analysis...
December 26, 2017: Oncotarget
Wen Zheng, Jiali Wang, Feng Xu, Jiaqi Zheng, He Zhang, Jingjing Ma, Guangmei Wang, Hao Wang, Derek P Chew, Yuguo Chen
INTRODUCTION: Acute chest pain represents a major healthcare burden in emergency departments (ED) throughout the world. Among these patients, rapidly determining whether an acute coronary syndrome (ACS) is evolving remains difficult. In China, there are limited data correlating the baseline characteristics, evaluation and management of ED patients with acute chest pain and ACS-related symptoms with clinical outcomes. Nor has there been an evaluation of outcomes at different levels of hospitals...
January 23, 2018: BMJ Open
Shima Ghasemi-Roudsari, Abbas Al-Shimary, Benjamin Varcoe, Rowena Byrom, Lorraine Kearney, Mark Kearney
BACKGROUND: Magnetocardiography (MCG) is a non-invasive technique used to measure and map cardiac magnetic fields. We describe the predictive performance of a portable prototype magnetometer designed for use in acute and routine clinical settings. We assessed the predictive ability of the measurements derived from the magnetometer for the ruling-out of healthy subjects and patients whose chest pain has a non-ischemic origin from those with ischemic heart disease (IHD). METHODS: MCG data were analyzed from a technical performance study, a pilot clinical study, and a young healthy reference group...
2018: PloS One
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