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https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#1
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28532437/management-of-kounis-syndrome-two-case-reports
#2
Majdi Omri, Hajer Kraiem, Olfa Mejri, Mounir Naija, Naoufel Chebili
BACKGROUND: Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic. CASE PRESENTATION: We discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction...
May 23, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28529261/clinical-implications-of-electrocardiograms-for-patients-with-type-a-acute-aortic-dissection
#3
Masami Kosuge, Kazuo Kimura, Keiji Uchida, Munetaka Masuda, Kouichi Tamura
Type A acute aortic dissection (AAD) is a serious cardiovascular emergency requiring urgent surgery. Timely accurate diagnosis is essential, but often challenging, because of the wide spectrum of clinical presentations. In patients with type A AAD, chest pain is the most common symptom; furthermore, ischemic ST-T changes such as ST-segment elevation or depression or negative T waves are frequently observed on presentation ECG. These clinical presentations of type A AAD are difficult to differentiate from those of acute coronary syndrome (ACS), which could lead to delayed diagnosis and treatment of type A AAD or misdiagnosis of ACS followed by inappropriate treatment...
May 19, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28528430/risk-classification-of-highly-sensitive-troponin-i-predict-presence-of-vulnerable-plaque-assessed-by-dual-source-coronary-computed-tomography-angiography
#4
Ting Liu, Guan Wang, Peiling Li, Xu Dai
Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS...
May 20, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28525723/effectiveness-of-a-decision-aid-in-potentially-vulnerable-patients-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#5
Kristin L Rising, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Victor M Montori, Erik P Hess
BACKGROUND: We test the hypotheses that use of the Chest Pain Choice (CPC) decision aid (DA) would be similarly effective in potentially vulnerable subgroups but increase knowledge more in patients with higher education and trust in physicians more in patients from racial minority groups. METHODS: This was a secondary analysis of a multicenter randomized trial in adults with chest pain potentially due to acute coronary syndrome. The trial compared an intervention group engaged in shared decision making (SDM) using CPC to a control group receiving usual care (UC)...
May 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28515825/late-presentation-of-aortic-aneurysm-and-dissection-following-cardiac-catheterization
#6
Abimbola Shofu, G Mustafa Awan, Bassam Omar, Ghazanfar Qureshi
We report a 63-year-old female with hypertension, hyperlipidemia, and prior pacemaker insertion for atrial fibrillation with symptomatic bradycardia, who was admitted with substernal chest pressure and diaphoresis. Her electrocardiogram revealed atrial fibrillation with demand ventricular pacing and her cardiac biomarkers were negative for acute coronary syndrome. Echocardiogram revealed normal left ventricular systolic function and normal aortic root diameter. Coronary angiography revealed 60-70% obtuse marginal lesion, otherwise mild disease...
April 2017: Cardiology Research
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#7
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28512745/implementation-of-multi-disciplinary-care-reduces-maternal-mortality-in-women-with-sickle-cell-disease-living-in-low-resource-setting
#8
Eugenia Vicky Asare, Edeghonghon Olayemi, Theodore Boafor, Yvonne Dei-Adomakoh, Enoch Mensah, Harriet Ghansah, Yvonne Osei-Bonsu, Selina Crabbe, Latif Musah, Charles Hayfron-Benjamin, Brittany Covert, Adetola A Kassim, Andra James, Mark Rodeghier, Michael R DeBaun, Samuel A Oppong
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic...
May 16, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28500860/interventions-for-preventing-silent-cerebral-infarcts-in-people-with-sickle-cell-disease
#9
REVIEW
Lise J Estcourt, Patricia M Fortin, Sally Hopewell, Marialena Trivella, Carolyn Doree, Miguel R Abboud
BACKGROUND: Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Silent cerebral infarcts are the commonest neurological complication in children and probably adults with SCD. Silent cerebral infarcts also affect academic performance, increase cognitive deficits and may lower intelligence quotient...
May 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28500682/red-blood-cell-transfusions-during-sickle-cell-anemia-vaso-occlusive-crises-a-report-from-the-magnesium-in-crisis-magic-study
#10
Monica L Hulbert, Julie A Panepinto, J Paul Scott, Robert I Liem, Lawrence J Cook, Timothy Simmons, David C Brousseau
BACKGROUND: Little is known about red blood cell (RBC) transfusion practices for children hospitalized for a sickle cell vaso-occlusive pain crisis (VOC). We hypothesized that transfusion would be associated with the development of acute chest syndrome (ACS), lower hemoglobin (Hb) concentration, and lack of hydroxyurea therapy. STUDY DESIGN AND METHODS: This is a secondary analysis of all children admitted for a sickle cell pain crisis enrolled in the Magnesium in Crisis (MAGiC) randomized trial; all had HbSS or S-β(0) thalassemia...
May 12, 2017: Transfusion
https://www.readbyqxmd.com/read/28500089/an-exploration-of-patients-experiences-of-participation-in-a-randomised-controlled-trial-of-the-manchester-acute-coronary-syndromes-macs-decision-rule
#11
Patricia van den Berg, Sarah Kendal, Helen V Alderson, Richard Body
BACKGROUND: As an important part of a pilot study to determine the feasibility of a large randomised controlled trial (RCT) comparing use of the Manchester Acute Coronary Syndromes (MACS) decision rule with standard care, we aimed to explore patient attitudes and potential barriers to participation in a trial of this nature. METHODS: We conducted a qualitative study nested within a pilot RCT comparing use of the MACS rule (which could enable some patients with chest pain to be discharged earlier) with standard care...
May 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28500087/feasibility-of-the-manchester-acute-coronary-syndromes-macs-decision-rule-to-safely-reduce-unnecessary-hospital-admissions-a-pilot-randomised-controlled-trial
#12
Richard Body, Charles Boachie, Alex McConnachie, Simon Carley, Patricia Van Den Berg, Fiona E Lecky
BACKGROUND: Observational studies suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule can effectively 'rule out' and 'rule in' acute coronary syndromes (ACS) following a single blood test. In a pilot randomised controlled trial, we aimed to determine whether a large trial is feasible. METHODS: Patients presenting to two EDs with suspected cardiac chest pain were randomised to receive care guided by the MACS decision rule (intervention group) or standard care (controls)...
May 12, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28496094/apical-hypertrophic-cardiomyopathy-case-report-and-literature-review
#13
Tanya Doctorian, William J Mosley, Bao Do
BACKGROUND Apical hypertrophic cardiomyopathy (ApHCM) is a relatively rare form of hypertrophic cardiomyopathy that predominantly affects the apex of the left ventricle and typically has a nonobstructive physiology. Its variable presentation and clinical course render ApHCM a commonly delayed or missed diagnosis. CASE REPORT A 53-year-old Caucasian woman presented with chronic progressive chest pain. She was initially started on treatment for acute coronary syndrome. Diagnosis of ApHCM was initially missed on echocardiography, but made on subsequent cardiac catheterization and cardiac MRI...
May 12, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28494983/chest-pain-unit-network-in-germany-its-effect-on-patients-with-acute%C3%A2-coronary-syndromes
#14
EDITORIAL
Thomas Münzel, Gerd Heusch
No abstract text is available yet for this article.
May 16, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28489923/differences-of-microparticle-patterns-between-sickle-cell-anemia-and-hemoglobin-sc-patients
#15
Yohann Garnier, Séverine Ferdinand, Maryse Etienne-Julan, Gisèle Elana, Marie Petras, Lydia Doumdo, Benoit Tressières, Marie-Laure Lalanne-Mistrih, Marie-Dominique Hardy-Dessources, Philippe Connes, Marc Romana
Sickle cell anemia (SCA) and hemoglobin SC (HbSC) disease are the two most common forms of sickle cell disease (SCD), a frequent hemoglobinopathy which exhibits a highly variable clinical course. Although high levels of microparticles (MPs) have been consistently reported in SCA and evidence of their harmful impact on the SCA complication occurrences have been provided, no data on MP pattern in HbSC patients has been reported so far. In this study, we determined and compared the MP patterns of 84 HbSC and 96 SCA children, all at steady-state, using flow cytometry...
2017: PloS One
https://www.readbyqxmd.com/read/28487318/impact-of-coronary-calcification-on-clinical-management-in-patients-with-acute-chest-pain
#16
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/28486752/exosomes-contribute-to-endothelial-integrity-and-acute-chest-syndrome-risk-preliminary-findings
#17
Gabrielle Lapping-Carr, Abdelnaby Khalyfa, Stephanie Rangel, Wendy Darlington, Eric C Beyer, Radhika Peddinti, John M Cunningham, David Gozal
BACKGROUND: Acute Chest Syndrome (ACS) is one of the leading causes of death among children with Sickle Cell Disease (SCD). Disruption of microvascular integrity is critical to the pathophysiology of ACS, but the factors governing its phenotypic variability are incompletely understood. Because circulating exosomes have been implicated in vascular dysfunction in various diseases, we hypothesized that exosomes induce endothelial dysfunction in patients who experience ACS. PROCEDURE: Cross-sectional cohort study including 33 outpatients with SCD (without new health-related complaints or recent transfusions) and a cohort of control patients...
May 9, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28485315/assessment-of-1-year-outcomes-in-survivors-of-severe-acute-respiratory-distress-syndrome-receiving-extracorporeal-membrane-oxygenation-or-mechanical-ventilation-a-prospective-observational-study
#18
Zhi-Yong Wang, Tong Li, Chun-Ting Wang, Lei Xu, Xin-Jing Gao
BACKGROUND: Little is known about the long-term outcomes of severe acute respiratory distress syndrome (ARDS) patients requiring extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the 1-year outcomes of these patients or patients receiving mechanical ventilation (MV) and compare their health-related quality of life (HRQoL) to the general population. METHODS: Severe ARDS survivors admitted to two ICUs in China between January 2012 and January 2014 were enrolled...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28483589/takotsubo-cardiomyopathy-after-microwave-ablation-for-metastatic-liver-lesions
#19
Mostafa Afennas, Hans Bonnier, Danny Schoors
Takotsubo cardiomyopathy (TCMP) is characterized by transient and reversible left ventricular regional wall motion abnormalities triggered by acute and intense emotional or physical stress. We present a case of a 79 year old woman with a hypertensive crisis after microwave ablation (MWA) for metastatic liver lesions. Initial evaluation suggested an acute coronary syndrome with an ST segment elevation and with elevated serum troponin T. No associated chest pain or dyspnea was present. Further evaluation with ECG, echocardiography, coronarography with left ventricle angiogram and MRI was consistent with an apical ballooning syndrome...
April 29, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28482650/obesity-and-perioperative-noninvasive-ventilation-in-bariatric-surgery
#20
Michele Carron, Francesco Zarantonello, Giovanna Ieppariello, Carlo Ori
The incidence and prevalence of obesity continues to increase globally. Physicians will therefore provide care for an increasing number of obese patients in their clinical practice. Optimal management of these patients is required to minimize the risk of perioperative complications that increase morbidity and mortality. Obesity affects the respiratory function. It is generally associated with reduced lung volume with increased atelectasis, decreased lung and chest wall compliance, increased airway resistance, and moderate to severe hypoxemia...
June 2017: Minerva Chirurgica
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