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Chest pain assessment clinic

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https://www.readbyqxmd.com/read/28730895/incidence-treatment-strategies-and-outcomes-of-acute-coronary-syndrome-with-and-without-ongoing-myocardial-ischaemia-results-from-the-czech-3-registry
#1
Petr Tousek, Klara Staskova, Anna Mala, Martin Sluka, Alexandra Vodzinska, Radek Jancar, Denisa Maluskova, Jiri Jarkovsky, Petr Widimsky
BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28730842/comparison-of-distinctive-clinical-and-cardiac-magnetic-resonance-features-between-st-elevation-myocardial-infarction-patients-with-incomplete-myocardial-rupture-and-those-with-moderate-to-severe-pericardial-effusion
#2
Víctor Pineda, Jaume Figueras, Sergio Moral, Jordi Bañeras, José Rodríguez-Palomares, Artur Evangelista, David García-Dorado
BACKGROUND: Whether patients with incomplete myocardial rupture (IMR) present distinctive clinical and cardiac magnetic resonance features from those with moderate-severe pericardial effusion (⩾10 mm (PE)) remains unknown Methods: We compared the clinical, angiographic and cardiac magnetic resonance characteristics of nine patients with IMR (diagnosed angiographically and/or by cardiac magnetic resonance) with 29 with PE, and also with 38 without IMR or PE with evidence of transmural necrosis (reference group) matched for age, gender and year of admission...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28730686/high-resolution-manometry-assessment-of-the-lower-esophageal-sphincter-after-contraction-normative-values-and-clinical-correlation
#3
D A Carlson, P J Kahrilas, M Tye, Z Listernick, K Ritter, I Wong, Y Xiao, V Bul, J E Pandolfino
BACKGROUND: The Chicago Classification v3.0 proposed extending the distal contractile integral (DCI) measurement domain to include the lower esophageal sphincter (LES) to enhance the detection of esophageal hypercontractility. However, normative and clinical data for this approach are unreported. We aimed to describe the application of an extended DCI measurement in asymptomatic controls and patients. METHODS: High-resolution manometry (HRM) of 65 asymptomatic controls and 72 patients with normal motility were evaluated retrospectively...
July 21, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/28726114/sex-related-differences-in-serum-matrix-metalloproteinase-9-screening-non-calcified-and-mixed-coronary-atherosclerotic-plaques-in-outpatients-with-chest-pain
#4
Chun Gu, Fang Wang, Zhihui Hou, Bin Lv, Yang Wang, Xiangfeng Cong, Xi Chen
The objective of this study is to evaluate the clinical feasibility of serum matrix metalloproteinase-9 (MMP-9) for screening plaque composition as assessed by coronary computed tomography angiography (CCTA) in outpatients with chest pain,and the effects of sex on this feasibility. Eight hundred and sixty-two consecutive outpatients with chest pain were divided into three groups according to the results of CCTA: non-plaque (NP, n = 474), calcified plaques (CPs, n = 179), non-calcified and mixed plaques (NCPs and MPs, n = 209)...
July 19, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28716296/clinical-and-radiologic-predictive-factors-of-rib-fractures-in-outpatients-with-chest-pain
#5
REVIEW
Liang Zhang, Colm J McMahon, Samir Shah, Jim S Wu, Ronald L Eisenberg, Justin W Kung
PURPOSE: To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. METHOD AND MATERIALS: Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting...
May 30, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/28713853/factors-associated-with-acute-postoperative-pain-following-breast-reconstruction
#6
Anita R Kulkarni, Andrea L Pusic, Jennifer B Hamill, Hyungjin M Kim, Ji Qi, Edwin G Wilkins, Randy S Roth
INTRODUCTION: Post-mastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. In an attempt to identify at-risk patients, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. METHODS: Women (N = 2207; one-week 82...
March 2017: JPRAS Open
https://www.readbyqxmd.com/read/28698323/performance-of-highly-sensitive-cardiac-troponin-t-assay-to-detect-ischaemia-at-pet-ct-in-low-risk-patients-with-acute-coronary-syndrome-a-prospective-observational-study
#7
Beata Morawiec, Stephane Fournier, Maxime Tapponnier, John O Prior, Pierre Monney, Vincent Dunet, Nathalie Lauriers, Frederique Recordon, Catalina Trana, Juan-Fernando Iglesias, Damian Kawecki, Olivier Boulat, Daniel Bardy, Sabine Lamsidri, Eric Eeckhout, Olivier Hugli, Olivier Muller
BACKGROUND: Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. PURPOSE: To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. METHODS: Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28684906/hospital-admissions-and-mortality-in-patients-with-copd-exacerbations-and-vertebral-body-compression-fractures
#8
Sergi Pascual-Guardia, Diana Badenes-Bonet, Clara Martin-Ontiyuelo, Flavio Zuccarino, Judith Marín-Corral, Alejandro Rodríguez, Esther Barreiro, Joaquim Gea
BACKGROUND: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known. OBJECTIVE: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28684218/the-relationship-between-s-adenosylhomocysteine-and-coronary-artery-lesions-a-case-control-study
#9
Xinrui Huang, Xin Lv, Hui Song, Qing Yang, Yuemin Sun, Wenjuan Zhang, Xiangdong Yu, Shaozhuang Dong, Wei Yao, Yongle Li, Qing Wang, Bei Wang, Liya Ma, Guowei Huang, Yuxia Gao
The role of homocysteine (Hcy) in the pathogenesis of coronary artery disease (CAD) is controversial, as decreased Hcy levels have not demonstrated consistent clinical benefits. Recent studies propose that S-adenosylhomocysteine (SAH), and not Hcy, plays a role in cardiovascular disease (CVD). We aimed to assess the relationship between plasma SAH and coronary artery lesions. Participants (n=160; aged 40-80years) with chest pain and suspected CAD underwent coronary angiography (CAG) for assessment of coronary artery stenosis, and were assigned to either the atherosclerosis (AS) or CAD group...
August 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/28683951/diagnosis-and-exclusion-of-pulmonary-embolism
#10
Jeffrey A Kline
BACKGROUND: Failure to test for pulmonary embolism (PE) can be a lethal mistake, but PE and produces symptoms similar to many other diseases. Overtesting for PE has negative consequences. OBJECTIVES: Use published evidence to create a rationale and safe diagnostic approach for ambulatory and emergency patients with suspected PE in 2017. FINDINGS: Pulmonary embolism need not be pursued in patients with no symptoms of PE in the present or recent history (dyspnea, chest pain, cough or syncope), and always normal vital signs...
June 7, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28674630/a-specialty-specific-multimodality-educational-quality-improvement-initiative-to-deimplement-rarely-appropriate-myocardial-perfusion-imaging
#11
David E Winchester, Carsten Schmalfuss, Christian D Helfrich, Rebecca J Beyth
OBJECTIVE: Investigations of Appropriate Use Criteria (AUC) education have shown a mixed effect on changing provider behaviour. At our facility, rarely appropriate myocardial perfusion imaging (MPI) differs by specialty; awareness of AUC is low. Our objective is to investigate if specialty-specific, multimodality education could reduce rarely appropriate MPI. METHODS: We designed education focused on the rarely appropriate MPI ordered most often by each specialty...
2017: Open Heart
https://www.readbyqxmd.com/read/28674627/clinical-and-cost-effectiveness-of-adapted-cognitive-behaviour-therapy-for-non-cardiac-chest-pain-a-multicentre-randomised-controlled-trial
#12
Peter Tyrer, Helen Tyrer, Richard Morriss, Michael Crawford, Sylvia Cooper, Min Yang, Boliang Guo, Roger T Mulder, Samuel Kemp, Barbara Barrett
OBJECTIVE: To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. METHODS: We tested the effectiveness and cost-effectiveness of a modified form of CBT for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months...
2017: Open Heart
https://www.readbyqxmd.com/read/28657113/high-burden-of-coronary-atherosclerosis-in-patients-with-cirrhosis
#13
Konstantin Kazankov, Kim Munk, Kristian Altern Øvrehus, Jesper Møller Jensen, Cecilie Brøckner Siggaard, Henning Grønbaek, Bjarne Linde Nørgaard, Hendrik Vilstrup
BACKGROUND: Population studies report increased cardiovascular mortality in patients with cirrhosis. Coronary artery disease may be a trait of end-stage liver disease, but whether it is frequent or extensive in cirrhosis in general is unknown. Thus, we aimed to assess the prevalence and extent of coronary artery disease in unselected cirrhosis patients. MATERIALS AND METHODS: Using coronary computed tomography angiography, we investigated 52 patients from all Child-Pugh classes and etiologies of cirrhosis without known cardiac disease for presence and severity of coronary artery disease in a cross-sectional design...
June 28, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28653131/novel-risk-stratification-assays-for-acute-coronary-syndrome
#14
REVIEW
Haitham M Ahmed, Stanley L Hazen
PURPOSE OF REVIEW: Since identification of aspartate aminotransferase as the first cardiac biomarker in the 1950s, there have been a number of new markers used for myocardial damage detection over the decades. There have also been several generations of troponin assays, each with progressively increasing sensitivity for troponin detection. Accordingly, the "standard of care" for myocardial damage detection continues to change. The purpose of this paper is to review the clinical utility, biological mechanisms, and predictive value of these various biomarkers in contemporary clinical studies...
August 2017: Current Cardiology Reports
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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