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Acute coronary syndrome without chest pain

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https://www.readbyqxmd.com/read/29029109/early-diagnosis-of-acute-coronary-syndrome
#1
Hugo Katus, André Ziegler, Okan Ekinci, Evangelos Giannitsis, Wendy Gattis Stough, Stephan Achenbach, Stefan Blankenberg, Martina Brueckmann, Paul Collinson, Dorin Comaniciu, Filippo Crea, Wilfried Dinh, Grégory Ducrocq, Frank A Flachskampf, Keith A A Fox, Matthias G Friedrich, Kathy A Hebert, Anders Himmelmann, Mark Hlatky, Dominik Lautsch, Bertil Lindahl, Daniel Lindholm, Nicholas L Mills, Giorgio Minotti, Martin Möckel, Torbjørn Omland, Véronique Semjonow
The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources...
October 3, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28992867/early-exclusion-of-major-adverse-cardiac-events-in-emergency-department-chest-pain-patients-a-prospective-observational-study
#2
Yuk-Ki Leung, Nga-Man Cheng, Cangel Pui-Yee Chan, Anna Lee, Jeffrey Ka-Tak Wong, Bryan Ping-Yen Yan, Anil Tejbhan Ahuja, Colin Alexander Graham, Timothy Hudson Rainer
BACKGROUND: The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. OBJECTIVE: We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for early rule out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART (history, electrocardiogram, age, risk factors, troponin) score...
September 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28987132/improved-assessment-of-chest-pain-trial-impact-assessing-patients-with-possible-acute-coronary-syndromes
#3
Louise Cullen, Jaimi H Greenslade, Tracey Hawkins, Chris Hammett, Shanen O'Kane, Kimberley Ryan, Kate Parker, Jessica Schluter, Emily Dalton, Anthony Ft Brown, Martin Than, W Frank Peacock, Allan Jaffe, Peter K O'Rourke, William A Parsonage
OBJECTIVE: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. DESIGN, SETTING AND PARTICIPANTS: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women's Hospital) during February 2011 - March 2014. 1366 prospectively recruited patients presenting to the ED with symptoms of suspected acute coronary syndrome (ACS) were stratified into groups at low, intermediate or high risk of an ACS...
August 4, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28984671/early-coronary-angiography-for-survivors-of-out-of-hospital-cardiac-arrests-without-st-elevation
#4
Michael Goldfarb, Bojan Cercek
There are over 300,000 out-of-hospital cardiac arrests (OOHCA) in the United States each year, and the long-term survival rate is less than 10%. Despite improvements in postarrest management, the greatest drop-off in survival occurs during hospitalization, mostly due to myocardial dysfunction and neurological injury. Coronary artery disease is common in postcardiac arrest patients, with an incidence of approximately 60-80%. In patients with a chest pain syndrome and an ST-segment-elevation myocardial infarction pattern evident on the presenting electrocardiogram, immediate revascularization is recommended by cardiovascular societies due to established mortality benefits...
November 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28965522/apical-hypertrophic-cardiomyopathy-treated-as-st-elevation-myocardial-infarction
#5
Christopher J Parr, Rajat Sharma, Philip J Garber
Electrocardiographic changes resulting from apical hypertrophic cardiomyopathy may mimic an acute coronary syndrome. A 67-year-old Sudanese male without cardiac risk factors presented to hospital with chest pain and electrocardiographic findings of septal ST-segment elevation, ST-segment depression in V4-V6, and diffuse T-wave inversion. He was treated as an acute ST-elevation myocardial infarction with thrombolytics. There was no cardiac biomarker rise and coronary angiography did not reveal evidence of significant coronary arterial disease...
October 2, 2017: CJEM
https://www.readbyqxmd.com/read/28932553/the-relationship-between-apnoea-hypopnoea-index-and-gensini-score-in-patients-with-acute-myocardial-infarction-undergoing-emergency-primary-percutaneous-coronary-intervention
#6
Cai-Ping Zhu, Tao-Ping Li, Xiao Wang, Yu-Hua Zhao, Shi-Xi Zhou, Yan Fu, Yi-Wei Jiang, Xue-Ping Xiao
BACKGROUND: Sleep apnoea hypopnoea syndrome (SAHS) is characterised by repetitive nocturnal hypoxemia and has a high prevalence among patients with acute myocardial infarction (AMI). But there are few studies on patients with AMI undergoing emergency primary percutaneous coronary intervention (pPCI). In this study, we want to find the prevalence of SAHS among patients with AMI undergoing emergency pPCI and determine whether SAHS would worsen the condition among these people, and especially affect the damage degree of the coronary artery...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28923845/high-sensitivity-cardiac-troponin-i-as-a-gatekeeper-for-coronary-computed-tomography-angiography-and-stress-testing-in-patients-with-acute-chest-pain
#7
Maros Ferencik, Thomas Mayrhofer, Michael T Lu, Pamela K Woodard, Quynh A Truong, W Frank Peacock, Fabian Bamberg, Benjamin C Sun, Jerome L Fleg, John T Nagurney, James E Udelson, Wolfgang Koenig, James L Januzzi, Udo Hoffmann
BACKGROUND: Most patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) undergo noninvasive cardiac testing with a low diagnostic yield. We determined whether a combination of high-sensitivity cardiac troponin I (hs-cTnI) and cardiovascular risk factors might improve selection of patients for cardiac testing. METHODS: We included patients from the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) I and II trials who presented to the ED with acute chest pain and were referred for cardiac testing...
September 18, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28868102/a-novel-electrocardiographic-sign-of-an-st-segment-elevation-myocardial-infarction-equivalent-de-winter-syndrome
#8
Mustafa Ugur Goktas, Ozgur Sogut, Mehmet Yigit, Onur Kaplan
Patients with de Winter syndrome, also termed anterior ST-segment elevation myocardial infarction (STEMI)-equivalent, represent 2% of all patients with acute anterior myocardial infarctions admitted to emergency departments (EDs). STEMI-equivalents do not present with classical electrocardiogram (ECG) changes but exhibit a critical stenosis of the left anterior descending (LAD) coronary artery. This is under-recognized by clinicians and is therefore associated with high morbidity and mortality. Here, we report a rare case of a novel, typical, STEMI-equivalent ECG pattern without obvious ST-segment elevation in a 34-year-old female who presented to our ED with substantial chest pain and a large, acute, transmural anterior myocardial infarction caused by acute occlusion of the LAD coronary artery...
August 2017: Cardiology Research
https://www.readbyqxmd.com/read/28832802/occult-metastatic-melanoma-presenting-as-an-acute-coronary-syndrome
#9
Tiago R Velho, Nádia Junqueira, André Sena, Hugo Ferreira, Catarina Carvalheiro, Nuno Guerra, Javier Gallego, Ângelo Nobre
Melanoma is a tumor that virtually involves any tissue and commonly metastasizes to the heart. It is usually not diagnosed because of the absent/nonspecific cardiac signs and symptoms. Herein, we present a case of a 41-year-old man without any cardiovascular risk factor, admitted to the emergency room with chest pain, diagnosed with a myocardial infarction. Due to the presence of a mass adjacent to the mitral valve on the cardiac ultrasound examination, causing mitral regurgitation, the patient was referred to surgery...
May 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28830367/mir-941-as-a-promising-biomarker-for-acute-coronary-syndrome
#10
Ruina Bai, Qiaoning Yang, Ruixi Xi, Lizhi Li, Dazhuo Shi, Keji Chen
BACKGROUND: Circulating miRNAs can function as biomarkers for diagnosis, treatment, and prevention of diseases. However, it is unclear whether miRNAs can be used as biomarkers for acute coronary syndrome (ACS). To this end, we applied gene chip technology to analyze miRNA expression in patients with stable angina (SA), non-ST elevation ACS (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI). METHODS: We enrolled patients with chest pain who underwent diagnostic coronary angiography, including five patients each with SA, NSTE-ACS, or STEMI, and five controls without coronary artery disease (CAD) but with three or more risk factors...
August 22, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28828027/psychological-features-of-takotsubo-cardiomyopathy-report-of-four-cases
#11
Yaser Jenab, Seyedeh Roghaieh Hashemi, Neda Ghaffari-Marandi, Hoda Zafarghandi, Nazila Shahmansouri
Takotsubo or stress-induced cardiomyopathy is a cardiomyopathy in which the patient has a sudden onset, reversible left ventricular systolic dysfunction without any significant coronary artery disease. Four women, who were at a mean age of 64 years and suffered from chest pain exacerbated by emotional stress, were admitted as cases of acute coronary syndrome and were completely evaluated through precise history taking, physical examination, and ECG. Coronary angiography or coronary multidetector computed tomography was used to exclude significant coronary artery disease...
April 2017: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#12
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
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
#13
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/28685795/the-risk-of-acute-coronary-syndrome-in-ramadan
#14
Asma Sriha Belguith, Houda Baccouche, Mohamed Habib Grissa, Hamdi Boubaker, Wahid Bouida, Kaouthar Beltaief, Adel Sekma, Nizar Fredj, Nasri Bzeouiche, Zied Zina, Riadh Boukef, Mohamed Soltani, Semir Nouira
BACKGROUND: Data on the effect of fasting on coronary disease are rare and controversial. The aim of our study was to investigate the influence of Ramadan on the prevalence of acute coronary syndrome among chest pain patients in the emergency department of Monastir. METHODS: It was a prospective study, performed in the emergency department of Fattouma Bourguiba University Hospital of Monastir, during the 3 months before, during and after Ramadan from 2012 to 2014...
October 2016: La Tunisie Médicale
https://www.readbyqxmd.com/read/28659139/the-unique-value-of-cardiovascular-magnetic-resonance-in-patients-with-suspected-acute-coronary-syndrome-and-culprit-free-coronary-angiograms
#15
Roman Panovský, Júlia Borová, Martin Pleva, Věra Feitová, Petr Novotný, Vladimír Kincl, Tomáš Holeček, Jaroslav Meluzín, Ondřej Sochor, Radka Štěpánová
BACKGROUND: Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. RESULTS: Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications...
June 28, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28647935/evaluation-of-patients-with-acute-chest-pain-using-spect-myocardial-perfusion-imaging-prognostic-implications-of-mildly-abnormal-scans
#16
Ronen Goldkorn, Alexey Naimushin, Roy Beigel, Ekaterina Naimushin, Michael Narodetski, Shlomi Matetzky
BACKGROUND: While patients presenting to emergency departments (ER) with chest pain are increasingly managed in chest pain units (CPU) that utilize accelerated diagnostic protocols for risk stratification, such as single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), data are lacking regarding the prognostic implications of mildly abnormal scans in this population. OBJECTIVES: To evaluate the prognostic implications of mildly abnormal SPECT MPI results in patients with acute chest pain...
June 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28487318/impact-of-coronary-calcification-on-clinical-management-in-patients-with-acute-chest-pain
#17
RANDOMIZED CONTROLLED TRIAL
Daniel O Bittner, Thomas Mayrhofer, Fabian Bamberg, Travis R Hallett, Sumbal Janjua, Daniel Addison, John T Nagurney, James E Udelson, Michael T Lu, Quynh A Truong, Pamela K Woodard, Judd E Hollander, Chadwick Miller, Anna Marie Chang, Harjit Singh, Harold Litt, Udo Hoffmann, Maros Ferencik
BACKGROUND: Coronary artery calcification (CAC) may impair diagnostic assessment of coronary computed tomography angiography (CTA). We determined whether CAC affects efficiency of coronary CTA in patients with suspected acute coronary syndrome (ACS). METHODS AND RESULTS: This is a pooled analysis of ACRIN-PA (American College of Radiology Imaging Network-Pennsylvania) 4005 and the ROMICAT-II trial (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) comparing an initial coronary CTA strategy to standard of care in acute chest pain patients...
May 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28462739/improving-early-exclusion-of-acute-coronary-syndrome-in-primary-care-the-added-value-of-point-of-care-troponin-as-stated-by-general-practitioners
#18
Michelle M A Kip, Amber M Noltes, Hendrik Koffijberg, Maarten J IJzerman, Ron Kusters
Aim To investigate general practitioners' (GPs') desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements. BACKGROUND: Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8-15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs...
May 2, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28455489/st-segment-elevation-myocardial-infarction-with-acute-stent-thrombosis-presenting-as-intractable-hiccups-an-unusual-case
#19
Fan Zhang, Nosakhare Douglas Tongo, Victoria Hastings, Parisa Kanzali, Ziqiang Zhu, Hal Chadow, Shahrokh E Rafii
BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease...
April 29, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28418520/rapid-rule-out-of-acute-myocardial-infarction-with-a-single-high-sensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection-a-collaborative-meta-analysis
#20
John W Pickering, Martin P Than, Louise Cullen, Sally Aldous, Ewoud Ter Avest, Richard Body, Edward W Carlton, Paul Collinson, Anne Marie Dupuy, Ulf Ekelund, Kai M Eggers, Christopher M Florkowski, Yonathan Freund, Peter George, Steve Goodacre, Jaimi H Greenslade, Allan S Jaffe, Sarah J Lord, Arash Mokhtari, Christian Mueller, Andrew Munro, Sebbane Mustapha, William Parsonage, W Frank Peacock, Christopher Pemberton, A Mark Richards, Juan Sanchis, Lukas P Staub, Richard Troughton, Raphael Twerenbold, Karin Wildi, Joanna Young
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016)...
May 16, 2017: Annals of Internal Medicine
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