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Acute coronary syndrome without chest pain

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https://www.readbyqxmd.com/read/28198635/impact-of-comorbidities-by-age-on-symptom-presentation-for-suspected-acute-coronary-syndromes-in-the-emergency-department
#1
Larisa A Burke, Anne G Rosenfeld, Mohamud R Daya, Karen M Vuckovic, Jessica K Zegre-Hemsey, Maria Felix Diaz, Josemare Tosta Daiube Santos, Sahereh Mirzaei, Holli A DeVon
BACKGROUND: It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions. AIMS: Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis. METHODS: A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study...
February 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/28195938/low-adverse-event-rates-but-high-emergency-department-utilization-in-chest-pain-patients-treated-in-an-emergency-department-observation-unit
#2
Anthony M Napoli, Janette Baird, Steven Tran, Jing Wang
OBJECTIVES: Nearly 40% of all previously admitted chest pain patients re-present to the emergency department (ED) within 1 year regardless of stress testing, and nearly 5% of patients return with a major adverse cardiac event (MACE). The primary objective of this study was to determine the prevalence of return visits to the ED among patients previously admitted to an ED chest pain observation unit (CPU). We also identified the patient characteristics and health risk factors associated with these return ED visits...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28193103/is-telemetry-monitoring-useful-in-patients-admitted-with-suspected-acute-coronary-syndrome
#3
Jack Perkins, Naveen K Voore, Jaideep Patel, Sathish Sanna, Edana Mann, Sammy Zakaria, Aysegul Gozu
Patients with a chief complaint of chest pain are frequently monitored by telemetry for evaluation of acute coronary syndrome (ACS). However, there is insufficient evidence to support this practice in younger patients without coronary artery disease (CAD). The objective is to assess outcomes of patients younger than 50 years of age and monitored by telemetry. Consecutive medical records of patients admitted for chest pain between January 1, 2009, and June 30, 2010, were reviewed. Patients were excluded who had a CAD history, an abnormal initial troponin, or an abnormal initial electrocardiogram...
February 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
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
#4
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/28062616/early-rule-out-and-rule-in-strategies-for-myocardial-infarction
#5
REVIEW
Louise A Cullen, Nicholas L Mills, Simon Mahler, Richard Body
BACKGROUND: Patients with chest pain comprise a large proportion of emergency presentations and place a major burden on healthcare resources. Therefore, efforts to safely and rapidly identify those with and without acute myocardial infarction (AMI) are needed. The challenge for clinicians is to accurately identify patients with acute coronary syndromes, while balancing the need to safely and rapidly reassure and discharge those without serious conditions. CONTENT: This review summarizes the evidence to date on optimum accelerated strategies for the rule-in and rule-out of AMI, using strategies focused on optimum use of troponin results...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28027073/value-of-the-coronary-artery-disease-consortium-rule-in-patients-with-acute-chest-pain-and-negative-troponins-referred-for-exercise-stress-testing
#6
Alberto Bouzas-Mosquera, Jesús Peteiro, Francisco J Broullón, Ramón Calviño-Santos, Víctor X Mosquera, Dolores Martínez, Juan C Yáñez, Nemesio Álvarez-García, José M Vázquez-Rodríguez
OBJECTIVE: To assess the value of the pretest probability (PTP) of coronary artery disease (CAD) for predicting stress testing results and coronary events in patients with acute chest pain and negative troponins. PATIENTS AND METHODS: A total of 3527 patients without a history of CAD referred to our chest pain unit with suspected acute coronary syndromes, nondiagnostic ECGs, and negative troponin levels underwent exercise stress testing. PTP was estimated with the CAD consortium prediction rule, and was categorized as low (<15%), low-intermediate (15-65%), intermediate-high (66-85%), and high (>85%)...
December 23, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27998631/emergency-department-cardiopulmonary-evaluation-of-low-risk-chest-pain-patients-with-self-reported-stress-and-anxiety
#7
Paul I Musey, Jeffrey A Kline
BACKGROUND: Chest pain is a high-risk emergency department (ED) chief complaint; the majority of clinical resources are directed toward detecting and treating cardiopulmonary emergencies. However, at follow-up, 80%-95% of these patients have only a symptom-based diagnosis; a large number have undiagnosed anxiety disorders. OBJECTIVE: Our aim was to measure the frequency of self-identified stress or anxiety among chest pain patients, and compare their pretest probabilities, care processes, and outcomes...
March 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27931543/efficacy-and-safety-of-the-intensive-dose-of-rosuvastatin-40mg-day-in-patients-with-acute-coronary-syndrome-and-at-high-risk-of-cardiovascular-disease-rosuvees-2
#8
Chetan P Shah, Bhaskar P Shah, Sameer I Dani, B B Channa, S S Lakshmanan, N C Krishnamani, Ashwani Mehta, P Moorthy
BACKGROUND: Randomized clinical trials have established the benefits of statin therapy in acute coronary syndromes (ACS) via their pleiotropic effects. AIM OF THE STUDY: This was a 12-week, open-label, multicenter, postmarketing observational study evaluating the efficacy and safety of rosuvastatin 40 mg/day in very high-risk or high-risk Indian patients according to NCEP ATP III guidelines. METHODOLOGY: One hundred and sixty two patients (age: 30 to 69 years) with evidence of coronary artery disease, hospitalized with chest pain with/without electrocardiogram changes and with non-ST segment elevation ACS and ST segment elevation ACS who received optimal reperfusion therapy were enrolled...
November 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27899069/gastric-dilatation-and-intestinal-obstruction-mimicking-acute-coronary-syndrome-with-dynamic-electrocardiographic-changes
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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...
March 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27692358/stiff-person-syndrome-masquerading-as-acute-coronary-syndrome
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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