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Chest pain assessment clinic

Agnieszka Wsol, Wioletta Wydra, Marek Chmielewski, Andrzej Swiatowiec, Marek Kuch
BACKGROUND: A retrospective study was designed to investigate P-wave duration changes in exercise stress (EST) test for the prediction of angiographically documented substantial coronary artery disease (CAD). METHODS: We analyzed 265 cases of patients, who underwent EST and subsequently coronary angiography. Analysis of P-wave duration was performed in leads II, V5 at rest, and in the recovery period. RESULTS: The sensitivity and specificity for the isolated ST-segment depression were only 31% and 76%, respectively...
October 17, 2016: Cardiology Journal
Dario Gulin, Jozica Sikic, Jasna Cerkez Habek, Sandra Jerkovic Gulin, Edvard Galic
Eosinophilic myocarditis (EM) is a rare and potentially fatal disease if left untreated. Because the disease can have a delayed presentation and can appear even after 2 years, its underlying causes often remain unknown. We report the case of a 63-year-old man with an atypical clinical presentation of hypersensitive EM and significant coronary artery disease, which was confirmed through coronary angiography. The patient was treated with hydrochlorothiazide (12.5 mg once daily for 2 years) and budesonide/formoterol (160/4...
December 2016: Drug Saf Case Rep
Christos Panayi, Nagui Antoun, Richard Sandford
A 44-year-old woman with a history of von Hippel-Lindau (VHL) disease, a rare inherited neoplasia syndrome, presented acutely to hospital with a productive cough, symptoms of respiratory tract infection and odynophagia (painful swallowing). A chest X-ray confirmed right-sided pneumonia. Investigation of the persistent odynophagia using barium swallow revealed aspiration of the contrast into the lungs and suggested a neurological cause for her chest infection. Clinical assessment and speech and language therapy confirmed a pseudobulbar palsy...
October 13, 2016: BMJ Case Reports
Jacob Zeitani, Marco Russo, Eugenio Pompeo, Gian Luigi Sergiacomi, Luigi Chiariello
BACKGROUND: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. METHODS: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2)...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Martina Scharitzer, Peter Pokieser, Michaela Wagner-Menghin, Ferdinand Otto, Olle Ekberg
PURPOSE: Clinical assessment of swallowing disorders (dysphagia) requires accurate and comprehensive medical history-taking to further tailor the diagnostic work-up, but functional health care questionnaires show a large variability and various limitations. The aim of this study was to assess the way in which international swallowing experts from various disciplines asses swallowing problems in order to improve the radiologist´s ability to take a thorough medical history in this specific patient group...
October 11, 2016: Abdominal Radiology
Giovanni Teruzzi, Giuseppe Calligaris, Paolo Ravagnani, Daniela Trabattoni, Luca Grancini, Giovanni Monizzi, Alessandro Lualdi, Antonio L Bartorelli
Spontaneous coronary artery dissection (SCAD) accounts approximately for 0.2% of cases of acute coronary syndrome. It is defined "spontaneous" in absence of any coronary wall damage. This disease affects primarily young women in good health, with no risk factors for coronary artery disease, especially during the postpartum period. Since the clinical presentation varies widely from no symptoms to typical angina and sudden cardiac death, SCAD incidence is underestimated.A 40-year-old woman, in the 8th week after delivery, was admitted to our emergency department because of acute chest pain, and a diagnosis of inferior and posterior non-ST-elevation myocardial infarction was made...
October 2016: Giornale Italiano di Cardiologia
Katherine Lambe, Judy Currey, Julie Considine
BACKGROUND: Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care. METHODS: A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia...
October 7, 2016: Australasian Emergency Nursing Journal: AENJ
Jesper J Linde, Mathias Sørgaard, Jørgen T Kühl, Jens D Hove, Henning Kelbæk, Walter B Nielsen, Klaus F Kofoed
The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations)...
October 7, 2016: International Journal of Cardiovascular Imaging
Chung-Lieh Hung, Ding-Kuo Chien, Shou-Chuan Shih, Wen-Han Chang
BACKGROUND: Accurate diagnosis of acute coronary syndrome (ACS) in a timely fashion is challenging in the elderly population, especially elderly women, who usually exhibit atypical clinical symptoms. A multiple cardiac biomarker (MCB) based approach has been shown to improve diagnostic efficacy of ACS. However, data in various age groups and sex differences remain largely unexplored. METHODS: Point-of-care testing (POCT) was performed on 290 patients (aged ≥18 years) who were admitted to the emergency department (ED) with symptoms of acute chest pain under suspicion of acute coronary syndrome (ACS)...
October 7, 2016: BMC Cardiovascular Disorders
Houda Snène, Anissa Berraies, Besma Hamdi, Jamel Ammar, Hanadi Ouali, Agnes Hamzaoui
Objective to assess the different localizations of tuberculosis (TB) in children in a pneumopediatric department in Tunisia and to describe its diagnosis tools since clinical investigations of childhood TB are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. Methods Forty-six cases of TB in children were studied between 2008 and 2013. Clinical history, examination and chest radiography were reported. Several investigations have been conducted to confirm the diagnosis of TB such as: tuberculin skin test (TST), bacteriological and histological investigations...
April 2016: La Tunisie Médicale
O Nallet, N Ketata, N Ferrier, X Marcaggi
Acute chest pain is a common reason of consultation in the emergency department. The difficulty lies in discriminating patients with acute coronary syndrome or other life-threatening conditions from those non-cardiovascular, non-life-threatening chest pain. Only 15 to 25 % of patients with acute chest pain actually have acute coronary syndrome. Algorithms using high sensitivity troponin at admission and a second assessment 1 or 3hours later are validated to "rule in" or "rule out" the diagnosis of non ST-elevation myocardial infarction...
September 29, 2016: Annales de Cardiologie et D'angéiologie
Sung-Ji Park, Seungmin Chung, Sung-A Chang, Jin-Oh Choi, Jin-Ho Choi, Sang-Chol Lee, Seung Woo Park
BACKGROUND: Exercise stress echocardiography (ESEcho) is sufficiently sensitive and has high enough specificity for the clinical detection of coronary artery disease (CAD) in women. However, there was little data about the ability of ESEcho to detect CAD and predict clinical outcomes in female patients with chest pain and low global cardiovascular (CV) risks. The purposes of this study were (1) to determine the diagnostic accuracy of ESEcho, (2) to evaluate the clinical outcomes of major cardiovascular outcome (MACE), and (3) to assess the incremental prognostic value of ESEcho for the prediction of MACE in Korean female patients with low CV risks...
September 30, 2016: Echocardiography
Roxanne Pelletier, Jin Choi, Nicholas Winters, Mark J Eisenberg, Simon L Bacon, Jafna Cox, Stella S Daskalopoulou, Kim L Lavoie, Igor Karp, Avi Shimony, Derek So, George Thanassoulis, Louise Pilote
BACKGROUND: Over past decades, the incidence of acute coronary syndrome (ACS) has increased in young women, and greater mortality rates after discharge were observed among young women vs men. We revisited this issue with contemporary data from the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study. METHODS: One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY from 26 centres across Canada, the United States, and Switzerland between January 2009 and April 2013...
September 21, 2016: Canadian Journal of Cardiology
Patricia Ribinik, Ahcene Aimar, Antoinette Ngonde Njoh
OBJECTIVE: To evaluate the interest of social insurance preliminary agreement to enter PRM ward for patients after orthopedic surgery in Gonesse hospital. MATERIAL/PATIENTS AND METHODS: From 01/01/15 to 06/30/15 went to PRM ward (inpatient or day hospital rehabilitation) 16 patients after TKA, 20 patients including 3 femoral neck fracture after THA, 3 patients after anterior cruciate knee ligamentoplasty and 3 patients with cuff tear surgery. At entrance, we assess patient's pain, mobility, personal and environmental factors upon Sofmer-Fedmer, MSAP and HAS standards...
September 2016: Annals of Physical and Rehabilitation Medicine
Daniel Waltho, Gloria Rockwell
BACKGROUND: Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements...
September 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Juan Sanchis, Sergio García-Blas, Arturo Carratalá, Ernesto Valero, Anna Mollar, Gema Miñana, Vicente Ruiz, Jose Vicente Balaguer, Mercé Roqué, Xavier Bosch, Julio Núñez
Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (<14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE...
August 31, 2016: American Journal of Cardiology
Mazen El Sayed, Hani Tamim, Ahel Al-Hajj Chehadeh, Amin A Kazzi
BACKGROUND: Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction...
September 19, 2016: Prehospital and Disaster Medicine
Alastair J Moss, Marc R Dweck, Andrew D Flapan
CLINICAL INTRODUCTION: A 33-year-old man with no history of coronary artery disease presented to the rapid access cardiology clinic with an episode of atypical anginal chest pain. He had a 15 pack-year history of smoking and a family history of myocardial infarction under the age of 55. Physical examination and exercise ECG testing were unremarkable. On assessment in the cardiology clinic, blood sampling was notable for an elevated high-sensitivity troponin I of 61 ng/L (99% upper reference level, 34 ng/L)...
September 15, 2016: Heart: Official Journal of the British Cardiac Society
Arshad Javaid, Mazhar Ali Khan, Mir Azam Khan, Sumaira Mehreen, Anila Basit, Raza Ali Khan, Muhammad Ihtesham, Irfan Ullah, Afsar Khan, Ubaid Ullah
OBJECTIVE: To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. METHODS: Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. RESULTS: Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases...
September 2016: Asian Pacific Journal of Tropical Medicine
Alberto Sandri, Francesco Guerrera, Matteo Roffinella, Stefania Olivetti, Lorena Costardi, Alberto Oliaro, Pier Luigi Filosso, Paolo Olivo Lausi, Enrico Ruffini
BACKGROUND: To assess the trend of our surgical patients affected by malignant pleural mesothelioma (MPM) and submitted to diagnostic/palliative or curative surgical procedures and to validate the European Organisation for Research and Treatment of Cancer (EORTC) prognostic score in our patient population. METHODS: This is a cohort study of patients submitted to surgery for MPM from January 2007 to December 2013. Primary outcome was overall survival (OS). Univariate and multivariate-adjusted comparisons by EORTC prognostic score for OS were accomplished using Cox method...
August 2016: Journal of Thoracic Disease
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