Chest pain in achalasia: Patient characteristics and clinical course☆, ☆☆

1999 ◽  
Vol 116 (6) ◽  
pp. 1300-1304 ◽  
Author(s):  
V ECKARDT ◽  
B STAUF ◽  
G BERNHARD
Keyword(s):  
Chest Pain ◽  
Clinical Course ◽  
Patient Characteristics

Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

1999 ◽  
Vol 14 (3) ◽  
pp. 67-72 ◽  
Author(s):  
John R. Richards ◽  
Stephen J. Ferrall
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Patient Characteristics ◽  
University Hospital ◽  
Medical Services ◽  
Shortness Of Breath ◽  
Study Objective ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

MIS-A associated myocardial injury: The art of diagnosis and follow-up

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Bellony Nzemenoh ◽  
◽  
Arianne C Agdamag ◽  
Valmiki Maharaj ◽  
Victoria Charpentier ◽  
...  
Keyword(s):  
Chest Pain ◽  
Early Identification ◽  
Myocardial Injury ◽  
Clinical Course ◽  
Full Recovery ◽  
Myocardial Inflammation ◽  
Severe Condition ◽  
Healthy Female ◽  
Inflammatory Syndrome

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19). Early identification of MIS-A led to a favorable clinical course and full recovery. Given the highly variable disease presentation yet potentially deadly outcome, providers must remain vigilant to recognize and treat MIS-A early Keywords: MIS-A; myocardial inflammation; SARS-CoV-2; COVID-19 disease.

scholarly journals Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

2020 ◽  
Vol 17 (24) ◽  
pp. 9502
Author(s):  
Frank M. Sanfilippo ◽  
Graham S. Hillis ◽  
Jamie M. Rankin ◽  
Donald Latchem ◽  
Carl J. Schultz ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Emergency Departments ◽  
Invasive Coronary Angiography ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Discharge Diagnosis ◽  
Coronary Syndrome ◽  
Interhospital Transfer ◽  
And Gender

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.

scholarly journals Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States

2020 ◽  
Author(s):  
Michael W Fried ◽  
Julie M Crawford ◽  
Andrea R Mospan ◽  
Stephanie E Watkins ◽  
Breda Munoz ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Mechanical Ventilation ◽  
Kidney Disease ◽  
Clinical Course ◽  
Patient Characteristics ◽  
The United States ◽  
Geographic Region ◽  
Hospitalized Patients

Abstract Background As coronavirus disease 2019 (COVID-19) disseminates throughout the United States, a better understanding of the patient characteristics associated with hospitalization, morbidity, and mortality in diverse geographic regions is essential. Methods Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The clinical course from admission, through hospitalization, and to discharge or death was analyzed. Results A total of 11 721 patients were included (majority were &gt;60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or a preexisting cardiovascular disease were associated with increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with increased odds of death (all P values &lt; .001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4232 on hydroxychloroquine. Conclusions This large observational cohort describes the clinical course and identifies factors associated with the outcomes of hospitalized patients with COVID-19 across the United States. These data can inform strategies to prioritize prevention and treatment for this disease.

Symptomatic myocardial infarction without chest pain: Prevalence and clinical course

1977 ◽  
Vol 40 (4) ◽  
pp. 498-503 ◽  
Author(s):  
Barry F. Uretsky ◽  
Donald S. Farquhar ◽  
Andrew F. Berezin ◽  
William B. Hood
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Course ◽  
Pain Prevalence

Research Article: Management of Pulmonary Embolism: Results from the German Chest Pain Unit Registry

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Stephan Settelmeier ◽  
Matthias Hochadel ◽  
Evangelos Giannitsis ◽  
Stavros Konstantinides ◽  
Thomas Voigtländer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Public Awareness ◽  
Critical Time ◽  
Acute Chest Pain ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Diagnostic Workup ◽  
Coronary Syndrome ◽  
Normal Left Ventricular

Introduction: Since 2008, specialized chest pain units (CPUs) were implemented across Germany ensuring structured diagnostics in acute chest pain. This study aims to analyze the management of pulmonary embolism (PE) patients in such certified CPUs. Methods: Data were retrieved from 13,902 patients enrolled in the German CPU registry and analyzed for the diagnosis of PE including patient characteristics, critical time intervals, diagnostic workup, treatment, and prognosis. PE patients were compared to the overall CPU patient cohort. Only patients with a complete 3-month follow-up were included. Results: Overall, 1.1% of all CPU patients were diagnosed with PE. Chest pain and dyspnea were the leading symptoms. Patients with PE were older, presented with higher heart rates, and more frequently exhibited signs of heart failure, despite a normal left ventricular function. PE patients showed significantly longer time delays between symptom onset and the first medical contact, while PE patients with chest pain presented earlier than PE patients with dyspnea only. Whereas more PE patients had to be transferred to the intensive care unit, in-CPU mortality and event rates over 3 months were low. Discussion/Conclusion: This study suggests a certain risk for underdiagnosis and consecutive potential undertreatment of PE patients in German Cardiac Society (GCS)-certified CPUs, which is thought to result from an anticipated focus on patients with acute coronary syndrome (ACS). Public awareness for PE beyond chest pain should be improved. Certified CPUs should be urged to implement strategic pathways for a better simultaneous diagnostic workup of differential diagnosis beyond ACS.

scholarly journals Misdiagnosis of prolonged psychogenic non-epileptic seizures as status epilepticus: epidemiology and associated risks

2021 ◽  
pp. jnnp-2021-326443
Author(s):  
Johannes Jungilligens ◽  
Rosa Michaelis ◽  
Stoyan Popkirov
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Individual Patient Data ◽  
Clinical Course ◽  
Epileptic Seizures ◽  
Patient Characteristics ◽  
Final Diagnosis ◽  
Treatment Trial ◽  
Anticonvulsant Medication ◽  
Treatment Escalation

ObjectiveTo determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.MethodsWe performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.ResultsAmong 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.ConclusionsMisdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.

scholarly journals The Radiologist as a Gatekeeper in Chest Pain

2021 ◽  
Vol 18 (12) ◽  
pp. 6677
Author(s):  
Silvia Pradella ◽  
Giulia Zantonelli ◽  
Giulia Grazzini ◽  
Diletta Cozzi ◽  
Ginevra Danti ◽  
...  
Keyword(s):  
Chest Pain ◽  
Invasive Coronary Angiography ◽  
Patient Characteristics ◽  
Coronary Syndrome ◽  
Aortic Pathology ◽  
Life Threatening ◽  
Ct Technology ◽  
Artery Disease ◽  
Rule Out

Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient’s stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.

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