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Acute coronary syndrome without chest pain

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https://www.readbyqxmd.com/read/29623770/atypical-presentation-of-acute-coronary-syndrome-acs-a-case-report
#1
Axel Van Damme, Philippe Vanderheeren, Tine De Backer, Françine Desimpel
Case A 45-year-old man presented at the emergency department (ED) with stomach pain since eight days. The patient was not worried about his symptoms and requested only pain relief. The emergency physician requested a consult of the gastroenterologist. Clinical examination was unremarkable. However, 12-lead ECG and ischemic markers were suggestive of acute coronary syndrome (ACS) which led to admission at the cardiology department. Despite delayed presentation, the patient was still referred for urgent coronary angiogram after receiving heparin, ticagrelor and acetylsalicylic acid because of persistent pain...
April 6, 2018: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29622596/risk-stratifying-chest-pain-patients-in-the-emergency-department-using-heart-grace-and-timi-scores-with-a-single-contemporary-troponin-result-to-predict-major-adverse-cardiac-events
#2
Peter D W Reaney, Hamish I Elliot, Awsan Noman, Jamie G Cooper
BACKGROUND: The majority of patients presenting to the ED with cardiac sounding chest pain have a non-diagnostic ECG and the problem of differentiating those suffering an acute coronary syndrome from those without is familiar to all ED clinical staff. To stratify risk in these patients, specific scores have been developed. Recent work has focused on incorporating newer high-sensitivity cardiac troponin (hs-cTn) assays; however, issues regarding performance and availability of these assays remain...
April 5, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29615544/is-there-a-relationship-between-resistin-levels-and-left-ventricular-end-diastolic-pressure
#3
Özge Turgay Yıldırım, Aylin Yıldırır, Leyla Elif Sade, Senem Has Hasırcı, Hatice Kozan, Emre Özçalık, Kaan Okyay, Uğur Abbas Bal, Alp Aydınalp, Haldun Müderrisoğlu
OBJECTIVE: Resistin, a cysteine-rich peptide, is associated with atherosclerosis and diabetes. Resistin levels increase corresponding to coronary artery disease (CAD) and heart failure severity. Since resistin level tends to elevate with symptomatic heart failure, it is expected to be associated with left ventricular end-diastolic pressure (LVEDP). However, there is no relevant literature on the relationship between resistin levels and LVEDP. We aimed to evaluate the association between resistin levels and LVEDP, severity of CAD, carotid intima-media thickness (CIMT), and echocardiographic diastolic dysfunction parameters...
April 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29547229/diagnostic-and-prognostic-implications-of-troponin-elevation-without-chest-pain-in-the-emergency-department
#4
Maribel González-Del-Hoyo, Germán Cediel, Anna Carrasquer, Gil Bonet, Luciano Consuegra-Sánchez, Alfredo Bardají
OBJECTIVES: To analyze the prognostic implications of the absence of chest pain in emergency department patients with elevated troponin I levels. MATERIAL AND METHODS: Observational retrospective study of patients for whom troponin I level was analyzed at least once between January 2012 and December 2013. Patient characteristics were recorded and survival was modeled. RESULTS: A total of 3629 patients were distributed in 4 groups according to troponin I level and chest pain as follows: chest pain without troponin I elevation (n = 1379), no chest pain and no troponin I elevation (n = 1196), chest pain with troponin I elevation (n = 517), and troponin I elevation but no chest pain (n = 537)...
2018: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29500619/reliability-of-the-care-rule-and-the-heart-score-to-rule-out-an-acute-coronary-syndrome-in-non-traumatic-chest-pain-patients
#5
Thomas Moumneh, Vanessa Richard-Jourjon, Emilie Friou, Fabrice Prunier, Caroline Soulie-Chavignon, Jacques Choukroun, Betty Mazet-Guilaumé, Jérémie Riou, Andréa Penaloza, Pierre-Marie Roy
In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study...
March 2, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29467360/atypical-presentation-of-acute-coronary-syndrome-and-importance-of-wellens-syndrome
#6
Kyaw Kyaw, Htun Latt, Sammy San Myint Aung, Nay Min Tun, Wut-Yi Phoo, Htwe Htwe Yin
BACKGROUND Acute coronary syndrome (ACS) is a common and potentially life-threatening condition encountered in emergency departments. Despite its dreaded nature, nearly one-third of ACS present without chest pain and may mislead clinicians. Additionally, Wellens' syndrome is a pre-infarction stage of significant proximal left anterior descending (LAD) artery stenosis, which can lead to extensive anterior wall myocardial infarction without timely intervention.  CASE REPORT We report the case of a 74-year-old woman presenting with isolated throat pain and Wellens' pattern in the initial EKG, which prompted the proper workup and management...
February 22, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29452690/utility-of-physician-selection-of-cardiac-tests-in-a-chest-pain-unit-to-exclude-acute-coronary-syndrome-among-patients-without-a-history-of-coronary-artery-disease
#7
Stacey J Howell, Jonathan Bui, Balasingam Thevakumar, Ezra A Amsterdam
There are few data on the utility of physician selection of cardiac tests, including no-test, in a chest pain unit (CPU) to rule out acute coronary syndrome in low-risk patients without a history of coronary artery disease. We analyzed consecutive low-risk patients admitted to our CPU between 2012 and 2014 and determined the proportion of patients selected for testing, the type of initial cardiac test selected, and the incidence of major adverse cardiac events (MACEs) at 30 days and 6 months. The study group comprised 619 patients: mean age 57 years (27 to 92), 332 women (54%), and 360 (58%) with multiple cardiac risk factors...
April 1, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29425553/invasive-treatment-of-nstemi-patients-in-german-chest-pain-units-evidence-for-a-treatment-paradox
#8
Frank P Schmidt, Claus Schmitt, Matthias Hochadel, Evangelos Giannitsis, Harald Darius, Lars S Maier, Claus Schmitt, Gerd Heusch, Thomas Voigtländer, Harald Mudra, Tommaso Gori, Jochen Senges, Thomas Münzel
BACKGROUND: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients...
March 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29407892/the-impact-of-myocardial-bridge-on-coronary-artery-spasm-and-long-term-clinical-outcomes-in-patients-without-significant-atherosclerotic-stenosis
#9
Purumeh Nam, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Ahmed Mashaly, Yoonjee Park, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Seung-Woon Rha
BACKGROUND AND AIMS: Myocardial bridge (MB) and coronary artery spasm (CAS) can induce a sustained chest pain, acute coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes. METHODS: A total of 812 patients with MB without significant coronary artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the coronary artery with a decrease of more than 30% in diameter on the angiogram after intracoronary nitroglycerin infusion...
March 2018: Atherosclerosis
https://www.readbyqxmd.com/read/29361983/cardiac-computed-tomography-in-patients-with-symptomatic-new-onset-atrial-fibrillation-rule-out-acute-coronary-syndrome-but-with-intermediate-pretest-probability-for-coronary-artery-disease-admitted-to-a-chest-pain-unit
#10
Matthias Koopmann, Liane Hinrichs, Jan Olligs, Michael Lichtenberg, Lars Eckardt, Dirk Böse, Stefan Möhlenkamp, Johannes Waltenberger, Frank Breuckmann
BACKGROUND: Atrial fibrillation (AF) and coronary artery disease (CAD) may be encountered coincidently in a large portion of patients. However, data on coronary artery calcium burden in such patients are lacking. Thus, we sought to determine the value of cardiac computed tomography (CCT) in patients presenting with new-onset AF associated with an intermediate pretest probability for CAD admitted to a chest pain unit (CPU). METHODS: Calcium scores (CS) of 73 new-onset, symptomatic AF subjects without typical clinical, electrocardiographic, or laboratory signs of acute coronary syndrome (ACS) admitted to our CPU were analyzed...
January 24, 2018: European Journal of Medical Research
https://www.readbyqxmd.com/read/29352673/chest-pain-in-a-young-female
#11
Paul S Basel, Daniel Reschke, Michael D April
Acute Coronary Syndrome (ACS) is a common diagnosis in the emergency department (ED), the most severe manifestation of which is ST elevation on electrocardiogram (ECG). ST elevation reflects obstruction of flow through the coronary arteries, most commonly due to coronary atherosclerotic plaque rupture. However, alternative causes of coronary obstruction causing ST elevation are possible. Spontaneous coronary artery dissection (SCAD) is an unusual cause of ST elevation in ED patients which providers may encounter in patients without traditional atherosclerosis risk factors...
January 11, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29350536/diagnostic-accuracy-of-functional-imaging-and-biochemical-tests-for-patients-presenting-with-chest-pain-to-the-emergency-department-a-systematic-review-and-meta-analysis
#12
Mario Iannaccone, Sebastiano Gili, Ovidio De Filippo, Salvatore D'Amico, Marco Gagliardi, Maurizio Bertaina, Silvia Mazzilli, Sara Rettegno, Federica Bongiovanni, Paolo Gatti, Fabrizio Ugo, Giacomo G Boccuzzi, Salvatore Colangelo, Silvia Prato, Claudio Moretti, Maurizio D'Amico, Patrizia Noussan, Roberto Garbo, David Hildick-Smith, Fiorenzo Gaita, Fabrizio D'Ascenzo
BACKGROUND: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. METHODS: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included...
January 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29306269/sealone-safety-and-efficacy-of-coronary-computed-tomography-angiography-with-low-dose-in-patients-visiting-emergency-room-trial-study-protocol-for-a-randomized-controlled-trial
#13
Joonghee Kim, Joon-Won Kang, Kyuseok Kim, Sang Il Choi, Eun Ju Chun, Yeo Goon Kim, Won Young Kim, Dong Woo Seo, Jonghwan Shin, Huijai Lee, Kwang-Nam Jin, Soyeon Ahn, Seung Sik Hwang, Kwang Pyo Kim, Ru-Bi Jeong, Sang Ook Ha, Byungho Choi, Chang-Hwan Yoon, Jung-Won Suh, Hack-Lyoung Kim, Ju Kyoung Kim, Sujin Jang, Ji Seon Seo
OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-health-care-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#14
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 are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days...
March 2018: 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
#15
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)...
February 2018: 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
#16
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
#17
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...
February 1, 2018: 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
#18
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 (ACS) is safe when clinical assessment indicates low risk, biomarkers are negative, and electrocardiograms (ECGs) are nonischemic. 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...
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
#19
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
#20
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
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