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https://www.readbyqxmd.com/read/27913538/sickle-cell-disease-when-and-how-to-transfuse
#1
Jo Howard
Blood transfusion remains an important therapeutic intervention in patients with sickle cell disease (SCD), aiming to both increase the oxygen carrying capacity of blood and to reduce the complications of vaso-occlusion. Simple, manual exchange and automated exchange can be effective in reducing the acute and chronic complications of SCD, and the advantages and disadvantages of each methodology mean they all have a role in different situations. Evidence for the role of emergency transfusion in the management of the acute complications of SCD, including acute pain and acute chest syndrome, comes from observational data...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913009/quantitative-changes-in-late-gadolinium-enhancement-at-cardiac-magnetic-resonance-in-the-early-phase-of-acute-myocarditis
#2
Enrico Ammirati, Francesco Moroni, Paola Sormani, Angelica Peritore, Angela Milazzo, Giuseppina Quattrocchi, Manlio Cipriani, Fabrizio Oliva, Cristina Giannattasio, Maria Frigerio, Alberto Roghi, Paolo G Camici, Patrizia Pedrotti
BACKGROUND: The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology. METHODS: We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms...
November 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27909035/randomised-controlled-pilot-study-to-investigate-the-effectiveness-of-thoracic-epidural-and-paravertebral-blockade-in-reducing-chronic-post-thoracotomy-pain-topic-feasibility-study-protocol
#3
Joyce Yeung, Teresa Melody, Amy Kerr, Babu Naidu, Lee Middleton, Kostas Tryposkiadis, Jane Daniels, Fang Gao
INTRODUCTION: Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months...
December 1, 2016: BMJ Open
https://www.readbyqxmd.com/read/27907878/ultrasound-in-cardiac-trauma
#4
Theodosios Saranteas, Andreas F Mavrogenis, Christina Mandila, John Poularas, Fotios Panou
In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening...
November 5, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27899132/cardiac-t1-mapping-and-extracellular-volume-ecv-in-clinical-practice-a-comprehensive-review
#5
REVIEW
Philip Haaf, Pankaj Garg, Daniel R Messroghli, David A Broadbent, John P Greenwood, Sven Plein
Cardiovascular Magnetic Resonance is increasingly used to differentiate the aetiology of cardiomyopathies. Late Gadolinium Enhancement (LGE) is the reference standard for non-invasive imaging of myocardial scar and focal fibrosis and is valuable in the differential diagnosis of ischaemic versus non-ischaemic cardiomyopathy. Diffuse fibrosis may go undetected on LGE imaging. Tissue characterisation with parametric mapping methods has the potential to detect and quantify both focal and diffuse alterations in myocardial structure not assessable by LGE...
November 30, 2016: Journal of Cardiovascular Magnetic Resonance
https://www.readbyqxmd.com/read/27899069/gastric-dilatation-and-intestinal-obstruction-mimicking-acute-coronary-syndrome-with-dynamic-electrocardiographic-changes
#6
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/27886421/pathophysiology-of-dyspnoea-in-acute-pulmonary-embolism-a-cross-sectional-evaluation
#7
Olivier Sanchez, Aurore Caumont-Prim, Elisabeth Riant, Laurent Plantier, Martin Dres, Bruno Louis, Marie-Anne Collignon, Benoit Diebold, Guy Meyer, Claudine Peiffer, Christophe Delclaux
BACKGROUND AND OBJECTIVE: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors...
November 25, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/27881283/cost-effectiveness-of-introducing-point-of-care-test-for-detection-of-level-of-glycogen-phosphorylase-in-early-diagnostic-algorithm-of-acute-coronary-syndrome
#8
Slobodan M Janković, Marina Kostić
BACKGROUND: The detection of specific biomarkers in the early phase of acute coronary syndrome (ACS) is important for the early diagnosis and appropriate management of patients with ACS. OBJECTIVES: To estimate the cost-effectiveness of introducing a diagnostic point-of-care (POC) test for determining the levels of glycogen phosphorylase BB isoform (GPBB) in a standard diagnostic algorithm for the early diagnosis of ACS within the health system of the Republic of Serbia...
September 2016: Value in Health Regional Issues
https://www.readbyqxmd.com/read/27867587/acute-chest-pain-in-a-triathlete-rupture-of-the-noncoronary-sinus-of-valsalva-into-the-right-ventricle
#9
Ernan Zhu, Ralf Westenfeld, Mareike Gastl, Florian Bönner, Alexander Assmann, Amir M Nia, Malte Kelm, Christian Jung
Sinus of Valsalva (SoV) aneurysm is a rare cardiac disease which can be congenital or acquired. A ruptured SoV aneurysm presents a clinical emergency and can lead to progressively deteriorating heart failure. Therefore, appropriate treatment requires prompt and accurate diagnosis. Most ruptured or nonruptured SoV aneurysms are diagnosed by the means of echocardiography. However, cardiovascular magnetic resonance (CMR) can provide information on precise anatomy and mechanisms due to its excellent soft tissue contrast and high resolution, and thereby allows for optimized preoperative planning of the repair strategy...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27865194/high-sensitivity-cardiac-troponin-t-levels-in-the-emergency-department-in-patients-with-chest-pain-but-no-myocardial-infarction
#10
Axel C Carlsson, Nadia Bandstein, Andreas Roos, Ola Hammarsten, Martin J Holzmann
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department. METHODS: We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27863892/pericarditis-mimicking-brugada-syndrome-a-case-report
#11
Manuel Monti, Giulia Olivi, Francesca Francavilla, Francesco Borgognoni
INTRODUCTION: Brugada syndrome (BrS) is a genetic heart disorder due to alteration of the ion channels function that causes an impaired in the cardiac conduction system. It is characterized by an abnormal electrocardiogram pattern and may be complicated by malignant ventricular arrhythmias. Pericarditis is an inflammation of the pericardium and 90% of isolated cases of acute pericarditis are idiopathic or viral. Acute pericarditis may appears with chest pain, fever, pericardial friction rub, and cardiac tamponade...
November 9, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27862670/do-gender-and-race-make-a-difference-in-acute-coronary-syndrome-pretest-probabilities-in-the-emergency-department
#12
Paul I Musey, Jeffrey A Kline
STUDY OBJECTIVES: To test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90 day returns, cost, and chest radiation exposure after these stratifications. METHODS: This is a secondary analysis of a prospective outcomes study of ED patients with chest pain and shortness of breath...
November 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
#13
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/27856131/impact-of-symptom-presentation-on-in-hospital-outcomes-in-patients-with-acute-myocardial-infarction
#14
Masashi Fujino, Masaharu Ishihara, Hisao Ogawa, Koichi Nakao, Satoshi Yasuda, Teruo Noguchi, Yukio Ozaki, Kazuo Kimura, Satoru Suwa, Kazuteru Fujimoto, Yasuharu Nakama, Takashi Morita, Wataru Shimizu, Yoshihiko Saito, Atsushi Hirohata, Yasuhiro Morita, Teruo Inoue, Atsunori Okamura, Masaaki Uematsu, Junya Ako, Michikazu Nakai, Kunihiro Nishimura, Yoshihiro Miyamoto
BACKGROUND: Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. METHODS: We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia...
November 14, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27852818/parents-acute-illnesses-hospitalizations-and-medication-changes-during-the-difficult-first-year-after-infant-or-child-nicu-picu-death
#15
Dorothy Brooten, JoAnne M Youngblut, Carmen Caicedo, Teresa Del Moral, G Patricia Cantwell, Balagangadhar Totapally
BACKGROUND AND OBJECTIVES: Infant/child death is described as a most stressful life event; however, there are few reports of effects on parent physical health during the first year after the death. The study's purpose is to examine the patterns of parent acute illnesses, hospitalizations, and medication changes over 1 to 13 months after neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) infant/child death in 3 racial/ethnic groups. METHODS: Secondary analyses were conducted with longitudinal data on parent health and functioning 1 to 13 months after infant/child NICU/PICU death...
November 15, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27847339/analytical-evaluation-of-a-new-point-of-care-system-for-measuring-cardiac-troponin-i
#16
Danielle Wm Kemper, Veronique Semjonow, Femke de Theije, Diederick Keizer, Lian van Lippen, Johannes Mair, Bernadette Wille, Michael Christ, Felicitas Geier, Pierre Hausfater, David Pariente, Volkher Scharnhorst, Joyce Curvers, Jeroen Nieuwenhuis
OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS: Li-heparin whole blood and plasma were used to perform analytical studies. The sample type comparison study was performed at 4 different hospitals. The 99th percentile upper reference limit (URL) study was performed using Li-heparin plasma, Li-heparin whole blood and capillary blood samples from 750 healthy adults, aging from 18 to 86years...
November 12, 2016: Clinical Biochemistry
https://www.readbyqxmd.com/read/27847253/necessity-of-hospitalization-and-stress-testing-in-low-risk-chest-pain-patients
#17
Neil Beri, Nicholas A Marston, Lori B Daniels, Richard M Nowak, Donald Schreiber, Christian Mueller, Allan Jaffe, Deborah B Diercks, Nicholas Wettersten, Christopher DeFilippi, W Frank Peacock, Alexander T Limkakeng, Inder Anand, James McCord, Judd E Hollander, Alan H B Wu, Fred S Apple, John T Nagurney, Cecilia Berardi, Chad M Cannon, Paul Clopton, Sean-Xavier Neath, Robert H Christenson, Christopher Hogan, Gary Vilke, Alan Maisel
BACKGROUND: Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI). OBJECTIVES: The goal of this study was to demonstrate that patients with a normal electrocardiogram and cTnI<0.040μg/l and copeptin<14pmol/l at presentation and after 2 h may be candidates for early discharge with outpatient follow-up potentially including stress testing. METHODS: This study uses data from the CHOPIN trial which enrolled 2071 patients with acute chest pain...
October 29, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27846010/does-uric-acid-level-provide-additional-risk-stratification-information-in-emergency-patients-with-symptoms-of-possible-acute-coronary-syndrome
#18
Harry Jin, Jaimi H Greenslade, William A Parsonage, Tracey Hawkins, Martin Than, Louise Cullen
OBJECTIVE: Elevated uric acid levels have been associated with the presence and severity of coronary artery disease (CAD). This study aimed to assess the clinical utility of serum uric acid levels to identify patients at high risk of acute coronary syndrome (ACS) in those who presented to the emergency department (ED) with chest pain. METHODS: This was a prospective observational study of 951 adult patients who were being evaluated for ACS in a single ED. Serum uric acid was taken on presentation...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846006/chest-pain-risk-scores-can-reduce-emergent-cardiac-imaging-test-needs-with-low-major-adverse-cardiac-events-occurrence-in-an-emergency-department-observation-unit
#19
Hao Wang, Katherine Watson, Richard D Robinson, Kristina H Domanski, Johnbosco Umejiego, Layton Hamblin, Sterling E Overstreet, Amanda M Akin, Steven Hoang, Meena Shrivastav, Michael Collyer, Ryan N Krech, Chet D Schrader, Nestor R Zenarosa
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography. METHODS: A prospective observational single center study was conducted from January 2014 through June 2015...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846005/novel-emergency-department-risk-score-discriminates-acute-coronary-syndrome-among-chest-pain-patients-with-known-coronary-artery-disease
#20
Matthew T Crim, Scott A Berkowitz, Mustapha Saheed, Jason Miller, Amy Deutschendorf, Gary Gerstenblith, Peter Hill, Frederick K Korley
BACKGROUND: Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS: We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital...
December 2016: Critical Pathways in Cardiology
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