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36 papers 25 to 100 followers
Alexander C Fanaroff, Jennifer A Rymer, Sarah A Goldstein, David L Simel, L Kristin Newby
IMPORTANCE: About 10% of patients with acute chest pain are ultimately diagnosed with acute coronary syndrome (ACS). Early, accurate estimation of the probability of ACS in these patients using the clinical examination could prevent many hospital admissions among low-risk patients and ensure that high-risk patients are promptly treated. OBJECTIVE: To review systematically the accuracy of the initial history, physical examination, electrocardiogram, and risk scores incorporating these elements with the first cardiac-specific troponin...
November 10, 2015: JAMA: the Journal of the American Medical Association
Josephine Warren, Roxana Mehran, Usman Baber, Ke Xu, Daniele Giacoppo, Bernard J Gersh, Giulio Guagliumi, Bernhard Witzenbichler, E Magnus Ohman, Stuart J Pocock, Gregg W Stone
BACKGROUND: Acute kidney injury (AKI) is a well-recognized predictor of morbidity and mortality after percutaneous coronary intervention. However, the impact of AKI on the outcome of patients with acute coronary syndromes (ACS) in relation to coronary artery bypass grafting (CABG) has not been established. METHODS: Of the 17,421 patients who presented with non-ST-segment elevation ACS or ST-segment elevation myocardial infarction enrolled in the ACUITY and HORIZONS-AMI trials, 1,406 (8...
January 2016: American Heart Journal
Leili Pourafkari, Saeid Joudi, Samad Ghaffari, Arezou Tajlil, Babak Kazemi, Nader D Nader
BACKGROUND: Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. AIMS: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction...
January 2016: Balkan Medical Journal
Robert F Storey, Dominick J Angiolillo, Marc P Bonaca, Mark R Thomas, Heather M Judge, Fabiana Rollini, Francesco Franchi, Arif J Ahsan, Deepak L Bhatt, Julia F Kuder, Philippe Gabriel Steg, Marc Cohen, Rangasamy Muthusamy, Eugene Braunwald, Marc S Sabatine
BACKGROUND: The PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial studied 2 doses of ticagrelor, 90 mg twice a day (bid) and 60 mg bid, for long-term prevention of ischemic events in patients with prior myocardial infarction. Both doses similarly reduced the rate of ischemic events versus placebo. The pharmacokinetics and pharmacodynamics of ticagrelor 60 mg bid have not been studied...
March 15, 2016: Journal of the American College of Cardiology
Laxmi S Mehta, Theresa M Beckie, Holli A DeVon, Cindy L Grines, Harlan M Krumholz, Michelle N Johnson, Kathryn J Lindley, Viola Vaccarino, Tracy Y Wang, Karol E Watson, Nanette K Wenger
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease...
March 1, 2016: Circulation
Chun-Peng Ma, Xiao Wang, Qing-Sheng Wang, Xiao-Li Liu, Xiao-Nan He, Shao-Ping Nie
OBJECTIVE: To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED). METHODS: This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used...
January 2016: Journal of Geriatric Cardiology: JGC
Simon A Mahler, Robert F Riley, Gregory B Russell, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, John Bringolf, Stephanie B Elliott, David M Herrington, Gregory L Burke, Chadwick D Miller
OBJECTIVES: Accelerated diagnostic protocols (ADPs), such as the HEART Pathway, are gaining popularity in emergency departments (EDs) as tools used to risk stratify patients with acute chest pain. However, provider nonadherence may threaten the safety and effectiveness of ADPs. The objective of this study was to determine the frequency and impact of ADP nonadherence. METHODS: A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. This trial enrolled 282 adult ED patients with symptoms concerning for acute coronary syndrome without ST-elevation on electrocardiogram...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Margaret Duffy, Shashank Jain, Nicholas Harrell, Neil Kothari, Alluru S Reddi
The treatment of edema in patients with nephrotic syndrome is generally managed by dietary sodium restriction and loop diuretics. However, edema does not improve in some patients despite adequate sodium restriction and maximal dose of diuretics. In such patients, combination of albumin and a loop diuretic may improve edema by diuresis and natriuresis. The response to this combination of albumin and a diuretic has not been observed in all studies. The purpose of this review is to discuss the physiology of diuresis and natriuresis of this combination therapy, and provide a brief summary of various studies that have used albumin and a loop diuretic to improve diuretic-resistant edema...
October 7, 2015: Cells
Alastair J Moss, David E Newby
UNLABELLED: Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography...
February 15, 2016: Heart: Official Journal of the British Cardiac Society
Thomas F Lüscher
No abstract text is available yet for this article.
January 14, 2016: European Heart Journal
Raphael R Bruno, Norbert Donner-Banzhoff, Wolfgang Söllner, Thomas Frieling, Christian Müller, Michael Christ
BACKGROUND: Acute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory. METHODS: This review is based on pertinent articles and guidelines retrieved by a selective search in PubMed. RESULTS: History-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness...
November 6, 2015: Deutsches Ärzteblatt International
Glenn N Levine, Eric R Bates, James C Blankenship, Steven R Bailey, John A Bittl, Bojan Cercek, Charles E Chambers, Stephen G Ellis, Robert A Guyton, Steven M Hollenberg, Umesh N Khot, Richard A Lange, Laura Mauri, Roxana Mehran, Issam D Moussa, Debabrata Mukherjee, Henry H Ting, Patrick T O'Gara, Frederick G Kushner, Deborah D Ascheim, Ralph G Brindis, Donald E Casey, Mina K Chung, James A de Lemos, Deborah B Diercks, James C Fang, Barry A Franklin, Christopher B Granger, Harlan M Krumholz, Jane A Linderbaum, David A Morrow, L Kristin Newby, Joseph P Ornato, Narith Ou, Martha J Radford, Jacqueline E Tamis-Holland, Carl L Tommaso, Cynthia M Tracy, Y Joseph Woo, David X Zhao
No abstract text is available yet for this article.
March 15, 2016: Journal of the American College of Cardiology
Benjamin Z Galper, Y Claire Wang, Andrew J Einstein
BACKGROUND: Several approaches have been proposed for risk-stratification and primary prevention of coronary heart disease (CHD), but their comparative and cost-effectiveness is unknown. METHODS: We constructed a state-transition microsimulation model to compare multiple approaches to the primary prevention of CHD in a simulated cohort of men aged 45-75 and women 55-75. Risk-stratification strategies included the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the treatment of blood cholesterol, the Adult Treatment Panel (ATP) III guidelines, and approaches based on coronary artery calcium (CAC) scoring and C-reactive protein (CRP)...
2015: PloS One
Serena F Carville, Robert Henderson, Huon Gray
Acute ST-segment-elevation myocardial infarction (STEMI) results from complete obstruction to coronary artery blood flow accompanied by the appearance of ST-segment-elevation on the electrocardiogram. Emergency treatment is required to restore coronary perfusion, thereby limiting the extent of damage to the myocardium and the likelihood of early death or future heart failure. This concise guideline summarises key recommendations from the National Institute for Health and Care Excellence clinical guideline on acute management of STEMI (CG167), of relevance to all healthcare professionals involved...
August 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Jaana I Halonen, Sari Stenholm, Jaana Pentti, Ichiro Kawachi, S V Subramanian, Mika Kivimäki, Jussi Vahtera
BACKGROUND: Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known. METHODS AND RESULTS: Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009...
August 4, 2015: Circulation
Lakshmi Kannan, Vincent M Figueredo
A 31-year-old male smoker with diabetes mellitus presented to the emergency department with intermittent, exertional chest pain of 4 days' duration. Electrocardiography performed on arrival (Panel A) revealed anterolateral T-wave inversions with biphasic lateral T waves, which raised concern about..
January 1, 2015: New England Journal of Medicine
Anthony H Gershlick, Jamal Nasir Khan, Damian J Kelly, John P Greenwood, Thiagarajah Sasikaran, Nick Curzen, Daniel J Blackman, Miles Dalby, Kathryn L Fairbrother, Winston Banya, Duolao Wang, Marcus Flather, Simon L Hetherington, Andrew D Kelion, Suneel Talwar, Mark Gunning, Roger Hall, Howard Swanton, Gerry P McCann
BACKGROUND: The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain. OBJECTIVES: CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only. METHODS: After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U...
March 17, 2015: Journal of the American College of Cardiology
Koen Nieman, Udo Hoffmann
The efficient and reliable evaluation of patients with acute chest pain is one of the most challenging tasks in the emergency department. Coronary computed tomography (CT) angiography may play a major role, since it permits ruling out coronary artery disease with high accuracy if performed with expertise in properly selected and prepared patients. Several randomized trials have established early cardiac CT as a viable safe and potentially more efficient alternative to functional testing in the evaluation of acute chest pain...
April 14, 2015: European Heart Journal
Karen Sliwa, Mark R Johnson, Peter Zilla, Jolien W Roos-Hesselink
Valvular heart disease (VHD) in pregnant women, whether due to congenital or acquired aetiologies, poses a challenge to clinicians and their patients. Significant valve disease, which can affect a single valve or several valves, increases the risk of pregnancy to the mother and foetus and requires a careful preconception risk assessment and, subsequently during pregnancy, specialized care to minimize maternal and foetal morbidity and mortality. The goal of this paper is to provide a guide to risk assessment and to give an overview of the optimal cardiac and obstetric management, including surgical intervention, taking into consideration the resources available in higher and lower-to-middle income countries...
May 7, 2015: European Heart Journal
2015-03-08 16:41:06
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