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Chest pain assessment clinic

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https://www.readbyqxmd.com/read/28107211/type-2-myocardial-infarction-incidence-presentation-treatment-and-outcome-in-routine-clinical-practice
#1
Dragana Radovanovic, Thomas Pilgrim, Burkhardt Seifert, Philip Urban, Giovanni Pedrazzini, Paul Erne
AIMS: The clinical definition and optimal treatment for myocardial infarction (MI) type 2 (T2MI) are not well established. We assessed differences in presentation, treatment and outcomes of patients with MI type 1 (T1MI) and T2MI. METHODS: The data of MI patients enrolled in the AMIS Plus cohort with T2MI were compared with T1MI using propensity score matching. RESULTS: A total of 13 829 patients had T1MI and 1091 (7.3%) T2MI. Patients with T2MI were older, often female, with more risk factors and comorbidities, and less ST segment elevation...
January 19, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28105733/vitamin-d-supplementation-for-sickle-cell-disease
#2
REVIEW
Htoo Htoo Kyaw Soe, Adinegara Bl Abas, Nan Nitra Than, Han Ni, Jaspal Singh, Abdul Razzak Bin Mohd Said, Ifeyinwa Osunkwo
BACKGROUND: Sickle cell disease is a genetic chronic haemolytic and pro-inflammatory disorder. The clinical manifestations of sickle cell disease result from the presence of mutations on the beta globin genes that generate an abnormal haemoglobin product (called haemoglobin S) within the red blood cell. Sickle cell disease can lead to many complications such as acute chest syndrome, stroke, acute and chronic bone complications (including painful vaso-occlusive crisis, osteomyelitis, osteonecrosis and osteoporosis)...
January 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28104706/selecting-patients-with-non-st-elevation-acute-coronary-syndrome-for-coronary-angiography-a-nationwide-clinical-vignette-study-in-the-netherlands
#3
Josien Engel, Judith M Poldervaart, Ineke van der Wulp, Johannes B Reitsma, Martine C de Bruijne, Jeroen J H Bunge, Maarten J Cramer, Wouter J Tietge, Ruben Uijlings, Cordula Wagner
OBJECTIVE: Cardiac guidelines recommend that the decision to perform coronary angiography (CA) in patients with Non-ST-Elevation Acute Coronary Syndrome (NST-ACS) is based on multiple factors. It is, however, unknown how cardiologists weigh these factors in their decision-making. The aim was to investigate the importance of different clinical characteristics, including information derived from risk scores, in the decision-making of Dutch cardiologists regarding performing CA in patients with suspected NST-ACS...
January 19, 2017: BMJ Open
https://www.readbyqxmd.com/read/28094851/blood-transfusion-for-preventing-primary-and-secondary-stroke-in-people-with-sickle-cell-disease
#4
REVIEW
Lise J Estcourt, Patricia M Fortin, Sally Hopewell, Marialena Trivella, Winfred C Wang
BACKGROUND: Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Stroke affects around 10% of children with sickle cell anaemia (HbSS). Chronic blood transfusions may reduce the risk of vaso-occlusion and stroke by diluting the proportion of sickled cells in the circulation...
January 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28087310/clinical-features-and-three-year-outcomes-of-takotsubo-stress-cardiomyopathy-observational-data-from-one-center
#5
Sigita Glaveckaitė, Pranas Šerpytis, Dovilė Pečiūraitė, Roma Puronaitė, Nomeda Valevičienė
OBJECTIVE: The natural history, management, and outcome of Takotsubo (stress) cardiomyopathy (TTC) is not clear. The aim of this study was to investigate clinical features, define prognostic predictors, and assess the clinical course and outcomes of patients with TTC. METHODS: We analyzed 64 patients (52 women) meeting the proposed Mayo Clinic diagnostic criteria for TTC. All patients were treated at Vilnius University Hospital Santariskiu Klinikos from 2001-01-01 to 2014-11-27...
November 16, 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/28079399/safety-and-efficacy-of-tissue-plasminogen-activator-tpa-and-deoxyribonuclease-dnase-for-complicated-pleural-effusions-secondary-to-abdominal-pathology
#6
Adnan Majid, Sebastian Ochoa, Sumit Chatterji, Sebastian Fernandez-Bussy, Fayez Kheir, Estefania Rivera, George Cheng, Erik Folch
RATIONALE: Exudative pleural effusions may arise secondary to inflammation of intra-abdominal structures. Pleural space loculations can complicate these effusions, preventing adequate chest tube drainage and leading to consideration of surgical intervention. Previous studies have demonstrated that intrapleural administration of tissue plasminogen activator (tPA) combined with human recombinant deoxyribonuclease (DNase) can improve fluid drainage and reduce surgery for patients with loculated parapneumonic effusions; however, the efficacy of this treatment has not been evaluated for complicated pleural effusions attributed to intraabdominal inflammation...
January 12, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28077467/gut-microbiota-dependent-trimethylamine-n-oxide-in-acute-coronary-syndromes-a-prognostic-marker-for-incident-cardiovascular-events-beyond-traditional-risk-factors
#7
Xinmin S Li, Slayman Obeid, Roland Klingenberg, Baris Gencer, François Mach, Lorenz Räber, Stephan Windecker, Nicolas Rodondi, David Nanchen, Olivier Muller, Melroy X Miranda, Christian M Matter, Yuping Wu, Lin Li, Zeneng Wang, Hassan S Alamri, Valentin Gogonea, Yoon-Mi Chung, W H Wilson Tang, Stanley L Hazen, Thomas F Lüscher
AIMS: Systemic levels of trimethylamine N-oxide (TMAO), a pro-atherogenic and pro-thrombotic metabolite produced from gut microbiota metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine, predict incident cardiovascular event risks in stable primary and secondary prevention subjects. However, the prognostic value of TMAO in the setting of acute coronary syndromes (ACS) remains unknown. METHODS AND RESULTS: We investigated the relationship of TMAO levels with incident cardiovascular risks among sequential patients presenting with ACS in two independent cohorts...
January 11, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28076734/effect-of-a-mass-media-campaign-on-ambulance-use-for-chest-pain
#8
Ziad Nehme, Peter A Cameron, Muhammad Akram, Harry Patsamanis, Janet E Bray, Ian T Meredith, Karen Smith
OBJECTIVES: To evaluate the impact of comprehensive public awareness campaigns by the National Heart Foundation of Australia on emergency medical service (EMS) use by people with chest pain. DESIGN, SETTING AND PARTICIPANTS: A retrospective analysis of 253428 emergency ambulance attendances for non-traumatic chest pain in Melbourne, January 2008 - December 2013. Time series analyses, adjusted for underlying trend and seasonal effects, assessed the impact of mass media campaigns on EMS use...
January 16, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28057790/novel-risk-markers-and-risk-assessments-for-cardiovascular-disease
#9
REVIEW
Mark R Thomas, Gregory Y H Lip
The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk stratification and a steady, but gradual progression toward precision medicine. Indeed, the generation of data in this area of research is explosive and when combined with new technologies and techniques provides the potential for more refined, targeted approaches to cardiovascular medicine...
January 6, 2017: Circulation Research
https://www.readbyqxmd.com/read/28055990/dilation-of-pediatric-eosinophilic-esophagitis-adverse-events-and-short-term-outcomes
#10
Calies Menard-Katcher, Glenn T Furuta, Robert E Kramer
OBJECTIVES: Although several studies report the experience with adult eosinophilic esophagitis (EoE) related stricture, outcomes for pediatric patients with EoE associated fibrostenosis and stricture is even more limited. To address this, we aim to identify the adverse event rate and short-term outcomes of the largest reported cohort of children with EoE to undergo esophageal dilation for management of symptomatic esophageal narrowing. METHODS: A retrospective assessment of all children, 18 years and younger, who underwent esophageal dilation at an academic children's hospital over a 5-year period was conducted...
July 18, 2016: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28048800/su-f-t-112-long-term-follow-up-of-nsclc-patients-treated-with-lung-sbrt-using-the-modified-conformal-arc-mdca-planning-technique
#11
E Ku, A Desai, D Fang, C Lawrence, C Iannuzzi, C Shi
PURPOSE: To assess long-term toxicity and primary tumor changes for Stage I/II non-small cell lung carcinoma (NSCLC) patients after treatment with lung SBRT using the modified dynamic conformal arc (MDCA) planning technique. METHODS: Clinical and radiograph data from electronic health records of 15 NSCLC patients treated with lung SBRT utilizing the MDCA technique between October 2011 and July 2014 were retrospectively reviewed. MDCA uses a coplanar beam arrangement, patient body center for the beam isocenter, and six partial rotation conformal arcs to target the tumor...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28041701/depression-and-chest-pain-in-patients-with-coronary-artery-disease
#12
Salim S Hayek, Yi-An Ko, Mosaab Awad, Andrea Del Mar Soto, Hina Ahmed, Keyur Patel, Michael Yuan, Spencer Maddox, Brandon Gray, Jamal Hajjari, Laurence Sperling, Amit Shah, Viola Vaccarino, Arshed A Quyyumi
BACKGROUND: Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression...
December 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28031149/diagnostic-and-prognostic-value-of-a-careful-symptom-evaluation-and-high-sensitive-troponin-in-patients-with-suspected-stable-angina-pectoris-without-prior-cardiovascular-disease
#13
Debbie M Madsen, Axel C P Diederichsen, Susanne E Hosbond, Oke Gerke, Hans Mickley
BACKGROUND AND AIMS: Typical angina pectoris (AP) and high-sensitive troponin I (hs-TnI) are independently associated with coronary artery disease (CAD) and future cardiovascular events (CVE). This study aimed to assess the individual and combined diagnostic and prognostic impact of symptoms and hs-TnI in stable chest pain patients without prior cardiovascular disease. METHODS: During a one-year period, 487 patients with suspected stable AP underwent invasive or CT-coronary angiography (significant stenosis ≥50%)...
November 28, 2016: Atherosclerosis
https://www.readbyqxmd.com/read/28009735/mock-pages-are-a-valid-construct-for-assessment-of-clinical-decision-making-and-interprofessional-communication
#14
Margaret L Boehler, Cathy J Schwind, Stephen J Markwell, Rebecca M Minter
IMPORTANCE: Answering pages from nurses about patients in need of immediate attention is one of the most difficult challenges a resident faces during their first days as a physician. A Mock Page program has been developed and adopted into a national surgical resident preparatory curriculum to prepare senior medical students for this important skill. OBJECTIVE: The purpose of this study is to assess standardized mock page cases as a valid construct to assess clinical decision making and interprofessional communication skills...
January 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28005272/prophylactic-versus-selective-blood-transfusion-for-sickle-cell-disease-in-pregnancy
#15
REVIEW
Babasola O Okusanya, Olufemi T Oladapo
BACKGROUND: Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies...
22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27987314/risk-benefit-and-cost-thresholds-for-emergency-department-testing-a-cross-sectional-scenario-based-study
#16
Arjun Prasad Meka, Jonathan Douglas Porath, Rahul Iyengar, Chelsea Morrow, Angela Fagerlin, William J Meurer
INTRODUCTION: While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. METHODS: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0...
December 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27986980/-chest-pain-in-the-emergency-department-differential-diagnosis-and-diagnostic-strategy
#17
T Köhnlein
Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.
January 2017: Der Internist
https://www.readbyqxmd.com/read/27968848/effect-of-danhong-injection-on-the-mobilisation-of-endothelial-progenitor-cells-to-vascular-repair-after-percutaneous-coronary-intervention-a-randomised-controlled-trial
#18
Zhen Hu, Hong Wang, Guanwei Fan, Han Zhang, Xiaoying Wang, Jingyuan Mao, Yingqiang Zhao, Yi An, Yuhong Huang, Chuan Li, Lianying Chang, Xianming Chu, Li Li, Yanfen Li, Yuan Zhang, Gangjian Qin, Xiumei Gao, Boli Zhang
BACKGROUND: Endothelial progenitor cells (EPCs) derived from bone marrow are associated with the repair of vascular injury by accelerating re-endothelisation, and represent a potential therapeutic target for ischaemic disease. Danhong injection (DHI), a Chinese Materia Medica standardised product extracted from Radix Salvia miltiorrhiza and Flos Carthamus tinctorius L, is effective in the treatment of ischaemic heart disease. We assessed the effect of DHI on the mobilisation of EPCs and vascular repair mediated by EPCs after percutaneous coronary intervention (PCI)...
October 2016: Lancet
https://www.readbyqxmd.com/read/27968766/indications-for-fibrinolysis-in-patients-with-st-segment-elevation-myocardial-infarction-from-guidelines-to-practice
#19
C Boivineau, L Orion, J Dimet, E Boiffard
BACKGROUND: European guidelines on managing ST segment elevation myocardial infarction (STEMI) during the first 12hours recommend fibrinolysis when the time elapsing between the first medical contact and balloon time (FMCBT) is more than 120minutes. AIM: To assess the real-life clinical efficacy of guidelines on fibrinolysis in managing STEMI and identify obstacles to their everyday implementation. METHODS: An observational study based on a permanent registry of reperfusion strategies and timing among patients treated in a French general hospital for STEMI with chest pain lasting for less than two hours...
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27964745/fewer-subsequent-relapses-and-lower-levels-of-il-17-in-takayasu-arteritis-developed-after-the-age-of-40%C3%A2-years
#20
Shoichi Fukui, Naoki Iwamoto, Toshimasa Shimizu, Masataka Umeda, Ayako Nishino, Tomohiro Koga, Shin-Ya Kawashiri, Kunihiro Ichinose, Yasuko Hirai, Mami Tamai, Hideki Nakamura, Toshiyuki Aramaki, Nozomi Iwanaga, Yasumori Izumi, Tomoki Origuchi, Kiyoshi Migita, Yukitaka Ueki, Shuntaro Sato, Atsushi Kawakami
BACKGROUND: The clinical characteristics of Takayasu arteritis (TAK) developing in individuals older than 40 years (TAK >40) are little-known. METHOD: We retrospectively analyzed 43 patients with TAK treated at three hospitals in Japan from April 2000 to March 2016. From medical records we collected baseline variables at diagnosis including clinical symptoms, laboratory data, and subsequent relapses. We compared these indices in the patients with TAK onset at >40 years of age (TAK >40) to those with TAK onset ≤40 years (TAK ≤40)...
December 13, 2016: Arthritis Research & Therapy
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