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Acute coronary syndrome without chest pain

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https://www.readbyqxmd.com/read/27899069/gastric-dilatation-and-intestinal-obstruction-mimicking-acute-coronary-syndrome-with-dynamic-electrocardiographic-changes
#1
H M M T B Herath, Anne Thushara Matthias, B S D P Keragala, W A E Udeshika, Aruna Kulatunga
BACKGROUND: ST elevation myocardial infarction is a medical emergency and the electrocardiogram is a part of the mainstay in the initial diagnosis. A variety of non-cardiac conditions have been known to mimic the electrocardiographic changes seen in acute coronary syndrome. We present a patient presenting with acute partial intestinal obstruction causing gastric distension and intestinal dilatation who also had dynamic electrocardiographic changes, mimicking anterior ST elevation myocardial infarction...
November 29, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27860148/a-review-of-rapid-access-cardiology-services-can-these-reduce-the-burden-of-acute-chest-pain-on-australian-and-new-zealand-health-services
#2
REVIEW
Harry Klimis, Aravinda Thiagalingam, Mikhail Altman, Emily Atkins, Gemma Figtree, Harry Lowe, N Wah Cheung, Pramesh Kovoor, A Robert Denniss, Clara K Chow
Chest pain is common and places a significant burden on hospital resources. Many patients with undifferentiated low to intermediate risk chest pain are admitted to hospital. Rapid Access Cardiology (RAC) services are hospital co-located cardiologist-led outpatient clinics that provide rapid assessment and immediate management but not long term management. This service model is described as part of chest pain management and the National Service Framework for coronary heart disease in the United Kingdom (UK)...
November 16, 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27846004/implementation-of-a-risk-stratification-and-management-pathway-for-acute-chest-pain-in-the-emergency-department
#3
Christopher W Baugh, Jeffrey O Greenberg, Simon A Mahler, Joshua M Kosowsky, Jeremiah D Schuur, Siddharth Parmar, George R Ciociolo, Christina W Carr, Roya Ghazinouri, Benjamin M Scirica
OBJECTIVES: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources. METHODS: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27769754/long-term-prognostic-value-of-a-negative-work-up-for-acute-coronary-disease-in-emergency-department-chest-pain-patients-without-known-coronary-artery-disease-a-cohort-study
#4
Anne-Maree Kelly, Sharon Klim
BACKGROUND: To determine the rate of all cause and cardiac death, new myocardial infarction (MI) or coronary revascularisation at over three years from index visit in emergency department chest pain patients without known coronary artery disease (CAD) at index presentation who had a negative electrocardiogram (ECG) and biomarker workup for acute coronary syndrome (ACS). METHODS: An unplanned sub-study of a prospective observational study of consecutive adult patients presenting to the ED with atraumatic chest pain (or equivalents)...
September 13, 2016: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27753895/os-01-04-whole-blood-viscosity-was-elevated-in-patients-with-both-hypertension-and-acute-coronary-syndrome
#5
Soo-Kyeong Song, Sang-Rok Lee, Lae-Young Jung, Yi-Shik Kim, Sun-Hwa Lee, Kyoung-Suk Rhee, Jei-Keon Chae, Won-Ho Kim, Jae-Ki Ko
OBJECTIVE: Wall shear stress contributes to atherosclerosis progression and plaque rupture. There were limited studies for hypertension as influence factor on whole blood viscosity (WBV) in acute coronary syndrome (ACS) patients. We evaluated the relations between WBV and hypertension in patients who visited to the emergency room by acute chest pain. DESIGN AND METHOD: From April 2013 through June 2015, we prospectively enrolled 471 acute chest pain patients who visited emergency room...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27727035/emergency-department-presentation-of-patients-with-spontaneous-coronary-artery-dissection
#6
Rachel A Lindor, Marysia S Tweet, Kiran A Goyal, Christine M Lohse, Rajiv Gulati, Sharonne N Hayes, Annie T Sadosty
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present. OBJECTIVES: We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers' awareness and recognition of this condition. PATIENTS AND METHODS: We performed a retrospective medical record review of all patients who presented to the ED of a single academic medical center from January 1, 2002 through October 31, 2015 and were subsequently diagnosed with SCAD by angiography...
October 8, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27692358/stiff-person-syndrome-masquerading-as-acute-coronary-syndrome
#7
Ashish Sharma, Myat Han Soe, Jagdeep Singh, Scott D Newsome
Stiff person syndrome (SPS) is a rare neuroimmunological disorder characterized by severe progressive muscle stiffness in axial and lower extremity musculature with superimposed painful muscle spasms. Although chest pain is a common reason for SPS patients presenting to the emergency room, this disorder is overlooked and not part of the differential diagnosis of chest pain. Herein, we report on a middle age male presenting with classic symptoms of SPS; however, due to the rarity of this disease, he was initially thought to have acute coronary syndrome...
2016: Journal of the National Medical Association
https://www.readbyqxmd.com/read/27669521/feasibility-and-safety-of-evaluating-patients-with-prior-coronary-artery-disease-using-an-accelerated-diagnostic-algorithm-in-a-chest-pain-unit
#8
Roy Beigel, Alexander Fardman, Ronen Goldkorn, Orly Goitein, Sagit Ben-Zekery, Nir Shlomo, Michael Narodetsky, Moran Livne, Avi Sabbag, Elad Asher, Shlomi Matetzky
An accelerated diagnostic protocol for evaluating low-risk patients with acute chest pain in a cardiologist-based chest pain unit (CPU) is widely employed today. However, limited data exist regarding the feasibility of such an algorithm for patients with a history of prior coronary artery disease (CAD). The aim of the current study was to assess the feasibility and safety of evaluating patients with a history of prior CAD using an accelerated diagnostic protocol. We evaluated 1,220 consecutive patients presenting with acute chest pain and hospitalized in our CPU...
2016: PloS One
https://www.readbyqxmd.com/read/27643241/os-01-04-whole-blood-viscosity-was-elevated-in-patients-with-both-hypertension-and-acute-coronary-syndrome
#9
Soo-Kyeong Song, Sang-Rok Lee, Lae-Young Jung, Yi-Shik Kim, Sun-Hwa Lee, Kyoung-Suk Rhee, Jei-Keon Chae, Won-Ho Kim, Jae-Ki Ko
OBJECTIVE: Wall shear stress contributes to atherosclerosis progression and plaque rupture. There were limited studies for hypertension as influence factor on whole blood viscosity (WBV) in acute coronary syndrome (ACS) patients. We evaluated the relations between WBV and hypertension in patients who visited to the emergency room by acute chest pain. DESIGN AND METHOD: From April 2013 through June 2015, we prospectively enrolled 471 acute chest pain patients who visited emergency room...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27596512/-a-rare-case-of-chest-pain
#10
Beáta Bodócsi, István Koncz, Zsigmond Hum, Orsolya Serfőző, József Pap-Szekeres, István Szabó
Chest pain is a common symptom in patients who visit Emergency Departments. The main task is to exclude life-threatening diseases such as acute coronary syndrome, pulmonary embolization and dissection of thoracic aorta. The authors present the history of a patient, who had an intense chest pain for 7 hours. In accordance with the diagnostic algorithm of chest pain, ECG, blood collection, chest X-ray and chest computed tomography angiography were performed. Acute coronary syndrome, pulmonary embolization and dissection of the thoracic aorta were excluded, however, chest computed tomography CT revealed a huge hiatal hernia as an incidental finding...
September 2016: Orvosi Hetilap
https://www.readbyqxmd.com/read/27574412/chest-pain-after-percutaneous-coronary-intervention-in-patients-with-stable-angina
#11
Chao-Chien Chang, Yueh-Chung Chen, Eng-Thiam Ong, Wei-Cheng Chen, Chia-Hsiu Chang, Kuan-Jen Chen, Cheng-Wen Chiang
BACKGROUND: Percutaneous coronary intervention (PCI) has been widely used to treat acute coronary syndrome but is only recommended as an additional treatment to medical therapy and risk modification in patients with refractory or progressing angina. The number of PCI in this patient population is still increasing. Post-PCI chest pain (PPCP) is one of the common problems of PCI. Its presentation and causes in patients with stable angina are poorly understood. PATIENTS AND METHODS: This study retrospectively collected clinical information of 167 patients who had stable angina and underwent elective PCI, including 70 patients with PPCP 24 hours after procedure and 97 patients without PPCP...
2016: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/27566720/two-dimensional-strain-echocardiography-for-diagnosing-chest-pain-in-the-emergency-room-a-multicentre-prospective-study-by-the-israeli-echo-research-group
#12
Avinoam Shiran, David S Blondheim, Sara Shimoni, Mohamed Jabarren, David Rosenmann, Alex Sagie, David Leibowitz, Marina Leitman, Micha Feinberg, Ronen Beeri, Salim Adawi, Avraham Shotan, Sorel Goland, Lev Bloch, Sergio L Kobal, Noah Liel-Cohen
AIMS: Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED). METHODS AND RESULTS: We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin...
August 26, 2016: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/27506926/randomized-comparison-of-high-sensitivity-troponin-reporting-in-undifferentiated-chest-pain-assessment
#13
Derek P Chew, Christopher Zeitz, Matthew Worthley, Hugh Grantham, John Beltrame, Margaret Arstall, Penelope Coates, Carolyn Astley, Stephen Quinn, Julie Ratcliffe, Matthew Horsfall, Philip G Aylward
BACKGROUND: High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain. METHODS AND RESULTS: We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report; Roche Elecys)...
September 2016: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/27504338/acute-myocardial-infarction-following-blunt-chest-trauma-and-coronary-artery-dissection
#14
Safar Ali Abdolrahimi, Hamid Reza Sanati, Mohammad Mostafa Ansari-Ramandi, Saeed Oni Heris, Mohsen Maadani
Blunt chest traumatic coronary artery dissection is an uncommon cause of atherosclerotic and non-atherosclerotic Acute Myocardial Infarction (AMI). Injuries of the coronary artery after blunt chest trauma are caused by different mechanisms such as vascular spasm, dissection and intimal tear or rupture of an existing thrombus formation. Chest pain might be masked by other injuries in patients with multiple traumas in car accident. Present case report is on a 37-year-old male without any specific past medical history who reported to the emergency department of a hospital with chest discomfort and was discharged with the impression of chest wall pain...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27477409/coronary-intramural-hematoma-presenting-as-acute-coronary-syndrome
#15
Takenobu Shimada, Kazushige Kadota, Shunsuke Kubo, Seiji Habara, Kazuaki Mitsudo
We herein report a case of intramural hematoma without ongoing myocardial ischemia that healed spontaneously with conservative treatment. A 37-year-old woman was admitted due to chest pain. Acute coronary syndrome was diagnosed by electrocardiography and echocardiography. Coronary angiography showed 90% stenosis in the distal portion of the left anterior descending coronary artery, where intravascular ultrasound showed a hematoma, but optical coherence tomography could not detect the entry point. Therefore, we identified the intramural hematoma as the etiology...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27465009/agreement-between-patient-reported-and-cardiology-adjudicated-medical-history-in-patients-with-possible-ischemic-chest-pain-an-observational-study
#16
Alessandro Iliceto, Sara Louise Berndt, Jaimi H Greenslade, William A Parsonage, Christopher Hammett, Martin Than, Tracey Hawkins, Kate Parker, Shannen O'Kane, Louise Cullen
OBJECTIVE: Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history. METHODS: A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited...
September 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27448533/delays-in-the-treatment-of-patients-with-acute-coronary-syndrome-focus-on-pre-hospital-delays-and-non-st-elevated-myocardial-infarction
#17
REVIEW
K A Mol, B M Rahel, J G Meeder, B C A M van Casteren, P A Doevendans, M J M Cramer
Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement...
October 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27446769/takotsubo-cardiomyopathy-case-series-and-literature-review
#18
Natalie Chlus, Chase Cavayero, Pran Kar, Sunny Kar
Although originally considered to be uncommon, Takotsubo cardiomyopathy is becoming increasingly visible, annually comprising an increasing portion of suspected diagnoses of acute coronary syndrome. This condition is characterized by reversible left ventricular akinesis without significant coronary artery obstruction. This case study presents five patients diagnosed with Takotsubo cardiomyopathy, as confirmed by echocardiogram and angiography. All of the patients presented with classic myocardial chest pain and elevated troponins...
2016: Curēus
https://www.readbyqxmd.com/read/27393857/could-prioritisation-by-emergency-medicine-dispatchers-be-improved-by-using-computer-based-decision-support-a-cohort-of-patients-with-chest-pain
#19
Martin Gellerstedt, Nina Rawshani, Johan Herlitz, Angela Bång, Carita Gelang, Jan-Otto Andersson, Anna Larsson, Araz Rawshani
BACKGROUND: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity. METHODS: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model...
October 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27381858/association-between-comorbidities-and-absence-of-chest-pain-in-acute-coronary-syndrome-with-in-hospital-outcome
#20
Olivia Manfrini, Beatrice Ricci, Edina Cenko, Maria Dorobantu, Oliver Kalpak, Sasko Kedev, Božidarka Kneževic, Akos Koller, Davor Milicic, Zorana Vasiljevic, Lina Badimon, Raffaele Bugiardini
BACKGROUND: To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS: Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1...
August 2016: International Journal of Cardiology
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