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Acute coronary syndrome without chest pain

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https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-healthcare-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#1
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome (ACS) are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the healthcare system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice decision aid (CPC) on overall healthcare utilization as well as utilization of specific services both during the index emergency department visit and in the subsequent 45 days...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29174752/acute-coronary-syndrome-in-octogenarians-expect-the-unexpected
#2
Samuel T Parnell, Austin T Smith
BACKGROUND: Ischemic heart disease is the leading cause of death in the United States and the world. Advanced age is the strongest risk factor for ischemic heart disease and the best independent predictor for poor outcomes after acute coronary syndrome (ACS). Elderly patients are at high risk for ACS, and numerous studies have shown that octogenarians in particular experience increased morbidity and mortality compared to younger patients. CASE REPORT: We describe a case of an 83-year-old woman who presented to the emergency department with a chief complaint of sore throat and was found to have a non-ST elevation myocardial infarction (NSTEMI) and was treated successfully with primary coronary intervention (PCI)...
November 22, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29170297/bet-2-sharing-decisions-for-patients-with-suspected-cardiac-chest-pain-in-the-emergency-department
#3
Abigail Ward, Richard Body
A short-cut review was carried out to establish whether shared decision making used alongside a decision aid can lead to greater patient satisfaction, lower healthcare resource use and non-inferior clinical outcomes in patients with suspected acute coronary syndromes. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of shared decision-making tools in the ED for management of patients with low-risk chest pain appears to be beneficial to the patient and the physician...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29138794/noninvasive-cardiac-testing-vs-clinical-evaluation-alone-in-acute-chest-pain-a-secondary-analysis-of-the-romicat-ii-randomized-clinical-trial
#4
Samuel W Reinhardt, Chien-Jung Lin, Eric Novak, David L Brown
Importance: The incremental benefit of noninvasive testing in addition to clinical evaluation (history, physical examination, an electrocardiogram [ECG], and biomarker assessment) vs clinical evaluation alone for patients who present to the emergency department (ED) with acute chest pain is unknown. Objective: To examine differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography [CCTA] or stress testing) vs clinical evaluation alone...
November 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29131477/a-risk-assessment-score-and-initial-high-sensitivity-troponin-combine-to-identify-low-risk-of-acute-myocardial-infarction-in-the-emergency-department
#5
John W Pickering, Dylan Flaws, Stephen W Smith, Jaimi Greenslade, Louise Cullen, William Parsonage, Edward Carlton, A Mark Richards, Richard Troughton, Christopher Pemberton, Peter M George, Martin P Than
OBJECTIVES: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. METHODS: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS...
November 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29122235/-acute-stress-and-broken-heart-syndrome-a-case-report
#6
Juliana Vergel, Sebastián Tamayo-Orozco, Andrés Felipe Vallejo-Gómez, María Teresa Posada, Diana Restrepo
INTRODUCTION: Stress has been associated with an acute heart failure syndrome of important morbidity and mortality. METHODS: Case report and non-systematic review of the relevant literature. CASE PRESENTATION: A 65-year-old woman with a history of an untreated generalized anxiety disorder, whom after the violent death of her son presented with oppressive chest pain irradiated to neck and left superior extremity, lasting for more than 30minutes, initial clinical suspect suggests acute coronary syndrome...
October 2017: Revista Colombiana de Psiquiatría
https://www.readbyqxmd.com/read/29121752/identification-of-coronary-artery-calcification-can-optimize-risk-stratification-in-patients-with-acute-chest-pain
#7
Daniel O Bittner, Richard A P Takx, Pedro V Staziaki, Sumbal Janjua, Tomas G Neilan, Nandini M Meyersohn, Michael T Lu, Anand M Prabhakar, John T Nagurney, Udo Hoffmann, Brian B Ghoshhajra
BACKGROUND: The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. METHODS AND RESULTS: We included 826 consecutive patients (mean age: 53±11years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis...
December 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29117666/prognostic-significance-of-non-chest-pain-symptoms-in-patients-with-non-st-segment-elevation-myocardial-infarction
#8
Inna Kim, Min Chul Kim, Keun Ho Park, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Myeong Chan Cho, Jong Jin Kim, Young Jo Kim, Youngkeun Ahn
Background/Aims: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. Methods: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128)...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29102364/immediate-and-1-year-follow-up-with-the-novel-nanosurface-modified-cobra-pzf-stent
#9
Luc Maillard, Alain Tavildari, Nicolas Barra, Jacques Billé, Patrick Joly, Patrick Peycher, Marc Silvestri, François Vochelet
BACKGROUND: The COBRA PzF coronary stent, which has a unique nano-coating of Polyzene-F, was developed to reduce the risk of stent thrombosis. AIMS: To report procedural and 1-year clinical outcomes following COBRA PzF coronary stent implantation in a real-world percutaneous coronary intervention (PCI) registry. METHODS: All patients assigned to treatment with the COBRA PzF in the GCS Axium Rambot Center, Aix-en-Provence, France between February 2013 to June 2014 were prospectively enrolled...
October 25, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29079376/validation-of-the-troponin-only-manchester-acute-coronary-syndromes-decision-aid-with-a-contemporary-cardiac-troponin-i-assay
#10
Patricia Va Den Berg, Gillian Burrows, Philip Lewis, Simon Carley, Richard Body
OBJECTIVES: The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity...
September 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29076052/assessment-of-acute-myocarditis-by-cardiac-magnetic-resonance-imaging-comparison-of-qualitative-and-quantitative-analysis-methods
#11
Massimo Imbriaco, Carmela Nappi, Marta Puglia, Marco De Giorgi, Serena Dell'Aversana, Renato Cuocolo, Andrea Ponsiglione, Igino De Giorgi, Maria Vincenza Polito, Michele Klain, Federico Piscione, Leonardo Pace, Alberto Cuocolo
BACKGROUND: To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM). METHODS: A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE)...
October 26, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29029775/-management-of-nstemi-in-a-hospital-without-interventional-cardiology-and-without-use-of-grace-score-does-the-clinician-appreciation-match-the-grace-score-calculated-retrospectively-for-the-coronarography-delay
#12
F Bouriche, S Yvorra, A Hassan, F Paganelli, L Bonello, S Luigi, F Attia
PURPOSE: The management of non-ST segment elevation acute coronary syndromes (NSTEACS) remains an issue for mobidity, mortality, and an economic stake. The first aim of the study was to evaluate the additional value of the GRACE score for the compliance with the recommended times to coronary angiography in an hospital without interventional cardiology. We also analysed the in-hospital and 6-month mortality and the predictive factors of compliance for the coronarography delays. METHODS: Retrospective monocenter cross-sectional study including consecutive patients with chest pain suggestive of a NSTEACS during 1 year...
November 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29029109/early-diagnosis-of-acute-coronary-syndrome
#13
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...
November 1, 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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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