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https://www.readbyqxmd.com/read/28207514/arginine-methylation-dysfunction-increased-risk-of-acute-coronary-syndrome-in-coronary-artery-disease-population-a-case-control-study
#1
Shengyu Zhang, Shuyang Zhang, Hongyun Wang, Wei Wu, Yicong Ye
The plasma levels of asymmetric dimethylarginine (ADMA) had been proved to be an independent cardiovascular risk factor. Few studies involved the entire arginine methylation dysfunction. This study was designed to investigate whether arginine methylation dysfunction is associated with acute coronary syndrome risk in coronary artery disease population.In total 298 patients undergoing coronary angiography because of chest pain with the diagnosis of stable angina pectoris or acute coronary syndrome from February 2013 to June 2014 were included...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28205445/severe-hypertriglyceridemia-induced-by-sirolimus-treated-with-medical-management-without-plasmapheresis
#2
Kazuhiko Kido, Rickey A Evans, Anil Gopinath, Jeremy D Flynn
: Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28204915/-acute-chest-pain-and-new-ecg-changes-in-pacemaker-patients-a%C3%A2-clinical-challenge
#3
Matthias Hoyme, Ralf Surber, P Christian Schulze, Dirk Prochnau
We report the case of a 82-year-old woman who was admitted to our institution with acute chest pain, nausea, and vomiting. Because of atrial fibrillation with intermittent bradycardia, a single-chamber pacemaker was implanted 4 years ago. The initial 12-lead ECG showed atrial fibrillation with a heart rate of 70 bpm, narrow QRS, and T‑wave inversions in the inferolateral leads. Coronary artery disease was excluded by immediate cardiac catheterization. A subsequent ECG three hours later showed a ventricular paced rhythm...
February 15, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28198635/impact-of-comorbidities-by-age-on-symptom-presentation-for-suspected-acute-coronary-syndromes-in-the-emergency-department
#4
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/28197284/st-segment-elevation-myocardial-infarction-door-to-balloon-time-improvement-project
#5
Saad Al Bugami, Jamilah Alrahimi, Abdullah Almalki, Farqad Alamger, Ahmed Krimly, Wail Al Kashkari
BACKGROUND: The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC))...
August 2016: Cardiology Research
https://www.readbyqxmd.com/read/28196622/non-cardiac-chest-pain-a-review-for-the-consultation-liaison-psychiatrist
#6
Kirsti A Campbell, Elizabeth N Madva, Ana C Villegas, Eleanor E Beale, Scott R Beach, Jason H Wasfy, Ariana M Albanese, Jeff C Huffman
BACKGROUND: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers...
December 9, 2016: Psychosomatics
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
#7
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/28195937/an-updated-protocol-for-evaluating-chest-pain-and-managing-acute-coronary-syndromes
#8
Christopher R Kelly, Ajay J Kirtane, Jennifer Stant, Gregg W Stone, Robert M Minutello, S Chiu Wong, Honeyleen Manuzon, Roxanne Gerow-Smith, Nancy Kelley, LeRoy E Rabbani
Clinical pathways can optimize care both across and within institutions, but regular updates to these pathways based on new clinical trials, professional guidelines, and Food and Drug Administration approvals are essential. Herein we describe the most recent revisions to the New York-Presbyterian Hospital (Columbia University Medical Center and Weill Cornell Medical Center) clinical pathway for acute coronary syndromes and chest pain, which incorporates novel data regarding the timing and administration of P2Y12 inhibition (including the intravenous P2Y12 inhibitor cangrelor) and the appropriateness of prolonged (>1 year) dual antiplatelet therapy for the secondary prevention of ischemic events...
March 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28193103/is-telemetry-monitoring-useful-in-patients-admitted-with-suspected-acute-coronary-syndrome
#9
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/28191332/angiotensin-ii-type-1-receptor-gene-a1166c-polymorphism-was-not-associated-with-acute-coronary-syndrome-in-an-iranian-population
#10
Navid Delshad, Majid Ghayour-Mobarhan, Hamed Mirzaei, Kamal Razavi-Azarkhiavi, Mohsen Moohebati, Mitra Hassany, Jamal Kasaian, Mohammad Reza Etemadzadeh, Maryam Sadat Alavi, Javad Behravan
BACKGROUND: There are very limited data for Iranian populations on the predisposing genetic factors for acute coronary syndrome (ACS). OBJECTIVES: The objective of the present study was to investigate the association of the angiotensin II type 1 receptor (AT1R) gene polymorphism and ACS in an Iranian population. PATIENTS AND METHODS: This cross-sectional study was conducted among 263 subjects (97 men and 166 women). Patients (n = 128) aged 30 - 80 years with chest pain were recruited from the emergency department of Ghaem Hospital (Mashhad, Iran)...
November 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28186860/traumatic-rib-injury-patterns-imaging-pitfalls-complications-and-treatment
#11
Brett S Talbot, Christopher P Gange, Apeksha Chaturvedi, Nina Klionsky, Susan K Hobbs, Abhishek Chaturvedi
The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures...
February 10, 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28185080/wellens-syndrome-can-indicate-high-grade-lad-stenosis-in-case-of-left-bundle-branch-block
#12
Steffen Grautoff
Diagnosing acute myocardial infarction (AMI) in left bundle branch block (LBBB) is challenging. Modified Sgarbossa criteria are known to help detect AMI in LBBB. This is a report about an electrocardiogram (ECG) with Wellens' signs in combination with a pre-existing LBBB. The ECG of a patient with fluctuating chest pain showed very subtle and one day later more obvious Wellens'signs. A left anterior descending artery (LAD) stenosis was diagnosed and successfully treated. Wellens' syndrome can be diagnosed in a case of LBBB and help detect a high-grade LAD stenosis even if modified Sgarbossa criteria are not met...
February 9, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28176235/randomized-double-blind-crossover-study-comparing-dfn-11-injection-3%C3%A2-mg-subcutaneous-sumatriptan-with-6%C3%A2-mg-subcutaneous-sumatriptan-for-the-treatment-of-rapidly-escalating-attacks-of-episodic-migraine
#13
Roger K Cady, Sagar Munjal, Ryan J Cady, Heather R Manley, Elimor Brand-Schieber
BACKGROUND: A 6-mg dose of SC sumatriptan is the most efficacious and fast-acting acute treatment for migraine, but a 3-mg dose of SC sumatriptan may improve tolerability while maintaining efficacy. METHODS: This randomized, double-blind, crossover study compared the efficacy and tolerability of 3 mg subcutaneous (SC) sumatriptan (DFN-11) with 6 mg SC sumatriptan in 20 adults with rapidly-escalating migraine attacks. Eligible subjects were randomized (1:1) to treat 1 attack with DFN-11 and matching placebo autoinjector consecutively or 2 DFN-11 autoinjectors consecutively and a second attack similarly but with the alternative dose (3 mg or 6 mg)...
December 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28168514/limits-of-the-possible-diagnostic-image-quality-in-coronary-angiography-with-third-generation-dual-source-ct
#14
Marco M Ochs, Fabian Aus dem Siepen, Thomas Fritz, Florian Andre, Gitsios Gitsioudis, Grigorios Korosoglou, Sebastian Seitz, Yuriy Bogomazov, Christopher L Schlett, Roman Sokiranski, Andre Sommer, Friedemann Gückel, Matthias Brado, Hans-Ulrich Kauczor, Johannes Görich, Matthias G W Friedrich, Hugo A Katus, Sebastian J Buss
BACKGROUND: The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. METHODS: Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis...
February 6, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28167641/prognostic-utility-of-a-modified-heart-score-in-chest-pain-patients-in-the-emergency-department
#15
James McCord, Rafael Cabrera, Bertil Lindahl, Evangelos Giannitsis, Kaleigh Evans, Richard Nowak, Tiberio Frisoli, Richard Body, Michael Christ, Christopher R deFilippi, Robert H Christenson, Gordon Jacobsen, Aitor Alquezar, Mauro Panteghini, Dina Melki, Mario Plebani, Franck Verschuren, John French, Garnet Bendig, Silvia Weiser, Christian Mueller
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013...
February 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28164636/diagnostic-and-prognostic-value-of-circulating-microrna-133a-in-patients-with-acute-myocardial-infarction
#16
Ling Yuan, Xiaoxiao Liu, Fang Chen, Lizhu Zhang, Xi Chen, Qiang Huang, Dan Wu, Chengjian Yang, Zhijun Han
BACKGROUND: The aim of this study was to examine the expression of circulating microRNA (miR)-133a in acute myocardial infarction (AMI) patients and assess its potential as a diagnostic and prognostic marker. METHODS: This study enrolled 222 consecutive patients who presented with chest pain symptoms suggestive of AMI in either the Department of Emergency or Department of Cardiology at Wuxi Second People's Hospital from October 2012 through December 2014. Of these, 102 were diagnosed with AMI and 120 with non-AMI chest pain...
July 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28164616/age-and-gender-tailored-cutoff-value-of-hs-ctnt-contributes-to-rapidly-diagnose-acute-myocardial-infarction-in-chest-pain-patients
#17
Shuo Yang, Wei Huai, Rui Qiao, Liyan Cui, Guihua Liu, Jian Wu, Aiwei Li, Jie Zhang
BACKGROUND: Hs-cTnT concentrations are age and gender related, therefore establishment of age and gender optimized cutoff values for hs-cTnT might be essential. We aimed to define the age and gender specific hs-cTnT 99th percentile in reference population and assess its diagnostic and prognostic performance in patients with suspected AMI. METHODS: In this prospective study, 1725 healthy individuals (18 - 97 years old) and 812 patients (15 - 98 years old) with chest pain with suspected AMI presenting to the emergency department were enrolled...
August 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28164409/emergency-physician-knowledge-attitudes-and-behavior-regarding-acep-s-choosing-wisely-recommendations-a-survey-study
#18
Michelle P Lin, Thomas Nguyen, Marc A Probst, Lynne D Richardson, Jeremiah D Schuur
OBJECTIVE: In 2013, the American College of Emergency Physicians joined the Choosing Wisely campaign; however, its impact on emergency physician behavior is unknown. We assessed knowledge, attitudes and self-reported behaviors regarding the Choosing Wisely recommendations. METHODS: We performed a cross-sectional survey of emergency physicians at a national meeting. We approached 819 physicians; 765 (93.4%) completed the survey. RESULTS: As a result of the Choosing Wisely campaign, most respondents (64...
February 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28163299/a-rare-case-of-acute-phlegmonous-esophagogastritis-complicated-with-hypopharyngeal-abscess-and-esophageal-perforation
#19
Yuan-Chun Huang, Ching-Yuan Cheng, Chiung-Ying Liao, Ching Hsueh, Yeu-Sheng Tyan, Shang-Yun Ho
BACKGROUND Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. CASE REPORT A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days...
February 6, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28159870/a-17-year-old-with-chest-pain
#20
Ankoor Y Shah, Megan Jamison, Hansel J Otero, Lawrence Jung, Lowell H Frank, Michael F Guerrera, A Yasmine Kirkorian
A 17-year-old male subject with a history of deep venous thrombosis presented with acute unilateral severe chest pain. His examination was nonspecific, and vital signs were normal. His initial laboratory evaluation revealed mild thrombocytopenia, elevated troponin levels, and critically elevated activated partial thromboplastin time. A computed tomography angiogram of the chest revealed a pulmonary embolus, and anticoagulation therapy was initiated. His course was complicated by the development of multiple thrombi and respiratory failure...
February 3, 2017: Pediatrics
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