Risk stratification of patients with chest pain or anginal equivalents in the emergency department

AbstractWe studied whether previously developed cardiac risk scores —including history, ECG, age, risk factors, and troponin (HEART); Thrombolysis in Myocardial Infarction (TIMI); Global Registry of Acute Coronary Events (GRACE); and Emergency Department Assessment of Chest Pain (EDACS)—could be applied to predict major adverse cardiac events (MACE) in patients with possible coronary artery disease, including anginal equivalents. Patients with chest pain or anginal equivalents who underwent coronary computed tomographic angiography were included. The primary outcome was 30-day MACE. We compared the cardiac risk scores by the area under the receiver-operati ng characteristic curves (AUC). The primary outcome occurred in 200 patients (16.0%) of the 1247 patients included. For the prediction of MACE, the AUC of the HEART score (0.765) was superior to those of the TIMI (0.726), GRACE (0.612), and EDACS (0.631) scores. Among patients identified by each sco re as being at low risk, the MACE rate was the lowest for the HEART score (5.7%), followed by the TIMI (8.8%), EDACS (11.2%), and GRACE (12.2%) scores. At a sensitivity level of a 
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research

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This patient was working on his truck in a garage without ventilation and the vehicle was running. He felt dizzy and lost consciousness. The next thing he remembers is waking up in the ambulance. He was last seen normal at 09:00 AM and was found down at 10:30 AM. He denied chest pain, abdominal pain, SOB or any other symptoms, though he did endorse chest pressure when asked specifically.He underwent a routine ECG prior to hyperbaric therapy for CO poisoning:Obvious Massive STEMI, Proximal LAD OcclusionHis CO level returned at 34%.Further h/o revealed that he had had a proximal LAD stent placed for a Non-Occlusion MI more t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
In conclusion, supraphysiological doses of protein supplements, anabolic steroids, and other nutritional products bear a risk factor for CAD.
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Publication date: Available online 3 December 2019Source: Journal of Cardiology CasesAuthor(s): Kazunori Takemura, Masaharu Maegaki, Ryuta Nakamura, Tetsuro Takase, Kaneto Mitsumata, Tomoaki Tanabe, Imun TeiAbstractSpontaneous coronary artery dissection (SCAD) usually occurs in women, which can result in significant morbidities. A 38 year-old obese man who is currently smoking was referred to our hospital with chest pain. His electrocardiography and echocardiography suggested myocardial infarction in proximal region of left coronary artery. Emergent coronary angiography revealed 99% stenosis at mid portion of LAD and diffu...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
CONCLUSION: The results of this study indicated that there was a relationship between MAU and CSFP and confirmed that endothelial dysfunction is a contributing factor to CSFP. These findings are of utmost importance due to the prognostic value of MAU for both all-cause and cardiovascular mortality rates. PMID: 31802772 [PubMed - in process]
Source: Turk Kardiyoloji Dernegi arsivi - Category: Cardiology Authors: Tags: Turk Kardiyol Dern Ars Source Type: research
Introduction: Patients undergoing peripheral vascular surgery (PVS) have increased risk of post-op myocardial infarction (MI) and death due to coronary artery disease (CAD). Functionally significant coronary ischemia is often unrecognized since guidelines recommend no cardiac testing in patients with no CAD symptoms. A new non-invasive cardiac test, coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT), reliably identifies ischemia-producing coronary stenosis in chest pain patients but its value in peripheral vascular patients is unknown.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" In...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" In...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study clearly goes against what has been the common wisdom for the last 30, 40 years” and may lead to less testing and invasive treatment for such patients in the future, said Dr. Glenn Levine, a Baylor College of Medicine cardiologist with no role in the research. Some doctors still may quibble with the study, but it was very well done “and I think the results are extremely believable,” he said. About 17 million Americans have clogged arteries that crimp the heart’s blood supply, which can cause periodic chest pain. Cheap and generic aspirin, cholesterol-lowering drugs and blood pressure medic...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized onetime Research Source Type: news
Conclusion: Early rule out protocol is effective and safe.We refer interested readers to the following excellent reviews of high-sensitivity troponin implementation:Twerenbold, R. et al.JACC70 (8): 996 –1012.https://doi.org/10.1016/j.jacc.2017.07.718.Yader S. et al. 2016. Am J Med 129 (4): 354 –65.https://doi.org/10.1016/j.amjmed.2015.12.005.Response to the 2nd “Myth-busting” articleInterestingly, on Nov 5, Dr. Spiegel publishedanother “Myths in EM” piece in EM News: “Is hs-cTnT Worth the Downstream Testing?. The piece assesses a new randomized trial of the Roche hs -cTnT...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Rationale: Coronary angiography (CAG) findings of acute myocardial infarction (AMI) in pregnant women are characterized by a high incidence of normal coronary arteries. This is the first report of AMI with normal coronary arteries during pregnancy, showing coronary spasm and pregnancy-related acquired protein S (PS) deficiency. Patient concerns: A 30-year-old Japanese woman was admitted to an emergency department. One hour before admission, she developed sudden onset of precordial discomfort, back pain, and dyspnea. She was a primigravida at 39 weeks’ gestation and had no abnormality in the pregnancy thus far. S...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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