Comparison between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department

Evaluation of chest pain (CP) in the emergency department (ED) frequently employs a non-invasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE) or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA, compared to SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with CP who had normal or non-diagnostic ECGs, negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria (mDF), and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research

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I was shown this ECG with no other information:What do you think?Hint: try to see through the artifact!I answered immediately: " High lateral MI with posterior MI. OMI. " (Occlusion Myocardial Infarction)I asked, " Did the patient present with chest pain? "Here is the history:" A middle-aged male complained of about 18 hours of epigastric pain that radiated to the chest.  He also had an apparently new facial droop of equal duration.  A stroke code was called, NIH stroke scale was only 1, and attention was turned to the chest pain. "  BP was 148/83.How did I make this ECG diagnos...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
AbstractEvaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
If all three major coronary branches have similar degree of stenosis, the radionuclide used for perfusion study will have equal uptake in all regions of the myocardium. Thus a balanced three vessel coronary artery disease can produce a false negative myocardial perfusion scan. This situation is called balanced myocardial ischemia. In most cases this is picked up by the treadmill ECG usually done along with stress myocardial perfusion imaging. Since the ECG findings of myocardial ischemia does not depend on the relative perfusion in the coronary tree, ischemic changes will be noted in treadmill ECG even when nuclear ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Nuclear Cardiology Source Type: blogs
Abstract Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be r...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
Abstract The clinical evaluation of patients with an anomalous aortic origin of a coronary artery (AAOCA), a congenital abnormality of the origin or course of a coronary artery that arises from the aorta, is challenging given its first presentation being sudden cardiac arrest in about half of the patients. Symptoms of chest pain, shortness of breath and syncope during exertion should be of concern in evaluating young athletes and nonathletes. The lack of abnormal signs on the physical exam and electrocardiogram further adds to the difficulty in establishing the diagnosis. Additional imaging with echocardiography, computed ...
Source: Congenital Heart Disease - Category: Cardiology Authors: Tags: SPECIAL ISSUE ARTICLE Source Type: research
Abstract Over 8 million patients seek emergency department care for acute chest pain annually in the United States alone, and 
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - Category: Radiology Authors: Tags: Imaging Perspectives Source Type: research
Abstract ObjectivesCoronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. MethodsUsing administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test ...
Source: Academic Emergency Medicine - Category: Emergency Medicine Authors: Tags: Original Contribution Source Type: research
By ANISH KOKA, MD It is very early.  I am running to the ‘clinical decision unit’ (CDU) to see a patient of mine sent in the night before from a local skilled nursing facility.  Also known as clinical observation units,  ‘obs’ units, or short stay observation units, these units were designed to help decompress busy emergency rooms and divert unnecessary, expensive inpatient admissions.  The units are typically adjacent to emergency departments, and usually are run by emergency physicians. My particular patient was admitted due to an episode of chest pain at her facility.  A ...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized CCTA Chest Pain EHR Source Type: blogs
Conclusions and RelevancePatients with chest pain evaluated in the ED who do not have an MI are at very low risk of experiencing an MI during short- and longer-term follow-up in a cohort of privately insured patients. This low risk does not appear to be affected by the initial testing strategy. Deferral of early noninvasive testing appears to be reasonable.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
Abstract Non-electrocardiogram-gated contrast-enhanced computed tomography (non-ECG-gated CT) is available in most hospitals where patients with chest and/or back pain are admitted to the emergency department. Although it has been established as the initial diagnostic imaging modality for acute aortic dissection (AAD) and pulmonary thromboembolism (PE), its diagnostic ability for acute coronary syndrome (ACS) in the emergency department has not been elucidated. We retrospectively investigated 154 consecutive patients who required non-ECG-gated CT to differentiate AAD and PE in the emergency department, but had no...
Source: Heart and Vessels - Category: Cardiology Source Type: research
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