scholarly journals Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

CJEM ◽  
2006 ◽  
Vol 8 (03) ◽  
pp. 164-169 ◽  
Author(s):  
Robert Steele ◽  
Timothy McNaughton ◽  
Melissa McConahy ◽  
John Lam
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Diagnostic Test ◽  
Tertiary Care ◽  
Positive Likelihood Ratio ◽  
Care Hospital ◽  
Artery Disease

ABSTRACT Introduction: It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin. Objective: To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain. Design: Prospective observational cohort study with a 4-week follow-up of patients enrolled. Setting: Academic tertiary care hospital, with 60 000 visits/year. Inclusion criteria: Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain. Exclusion criteria: Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization. Results: 270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%–80%), and the specificity was 37% (34%–41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96–1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate. Conclusions: Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain.

scholarly journals Coronary artery disease in post-COVID patients: a prospective study

2021 ◽  
Vol 9 (9) ◽  
pp. 2766
Author(s):  
Abhinav Chhabra ◽  
Vinod Shisode ◽  
Richa Rajput
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Prospective Study ◽  
Tertiary Care ◽  
Care Hospital ◽  
Corona Virus ◽  
History Of ◽  
Artery Disease ◽  
A Prospective Study

Background: Corona virus disease 2019 or COVID-19 is defined as infectious illness caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The cardiovascular manifestations of COVID-19 has been a topic of immense interest amongst epidemiologists, physicians and cardiologists alike. Cytokine storm seen in patients with COVID-19 is known to cause damage to multiple organs including cardiac myocytes. Coronary arteries are also affected by direct damage as well as cytokine mediated injury to coronary endothelial cells.Methods: This was a prospective study conducted in the department of cardiology of a tertiary care hospital. 40 patients recovered from COVID-19 and having symptoms related to coronary artery disease were included in this study on the basis of a predefined inclusion and exclusion criteria. The presenting complaints such as chest pain, breathlessness and fatigue were asked for and were documented. An informed written consent was obtained from all the participants. A standard Judkins technique was used to do coronary angiography. Severity of stenosis was assessed in all the cases. The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant.Results: Out of 40 post COVID-19 patients presenting with symptoms attributable to coronary artery disease there were 34 (85%) males and 6 (15%) females with a M:F ratio of 1:0.17. The mean age of male and female patients was found to be 51.33±6.47 years and 44.50±6.82 respectively. 12 (30%) patients had history of hypertension, 8 (20%) had history of diabetes mellitus. 3 (7.5%) patients had history of asthma. Chest pain (95%), breathlessness (67.5%), reduced exertional capacity (55%) and diaphoresis (40%) were common presenting complaints. Slow flow due to endothelial dysfunction was the most common single finding and was seen in 8 (20%) patients. In 7 (17.5%) 51-60% stenosis with thrombosis was found whereas in 6 (15%) patients 81-90% stenosis with thrombosis was seen. In 3 (15%) patients 70-80% stenosis with thrombosis was found and in remaining 3 (7.5%) total occlusion was seen.Conclusions: A high index of suspicion and timely intervention is necessary to diagnose and manage coronary artery disease in post covid patients.

To Determine the Frequency of Extent of Coronary Artery Disease (CAD) with Troponin-I level >10 folds ULN in NSTEMI Patients at Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2757-2762
Author(s):  
Vinesh Kumar ◽  
Fawad Ali Siddiqui ◽  
Kiran Irfan ◽  
Muhammad Adeel Qamar ◽  
Ghulam Jaffar Shah ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Troponin I ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Vessel Disease ◽  
The Mean ◽  
Artery Disease ◽  
Single Vessel Disease

Introduction: Higher levels of troponins >10 folds of upper normal limits (UNL) are considered as high-risk patients on coronary angiography sufferers having high levels of troponin-I (>10 folds upper limit normal level) had extra three-vessel coronary artery disease involvement. Objectives: To determine the frequency of degree of cardiovascular disease with Troponin-I level >10 folds ULN in NSTEMI patients at tertiary care hospital. Methodology: It is a cross-sectional study comprising of a total 800 patients recruited from the Department of Cardiology, National Institute of Coronary Disease, Karachi Pakistan based on Exclusion/Inclusion criteria. Results: There are 678 male as well as 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. There have been 678 male and also 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. Conclusion: The higher troponin level found significantly associated with extent of CAD and three vessel disease. To understand the cardiovascular troponin condition of the sufferer as soon as feasible is crucial. Keywords: Extent of Coronary Artery Disease, NSTEMI, Troponin-I Level >10 Folds ULN

scholarly journals A CASE STUDY ON CLINICAL PHARMACIST INTERVENTIONS IN THE MANAGEMENT OF DIABETES COMPLICATED CORONARY ARTERY DISEASE IN HEALTH-CARE PRACTICE

2020 ◽  
pp. 1-4
Author(s):  
BHARATH KUMAR A ◽  
UMASHANKAR MS
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Ankle Brachial Index ◽  
Care Practice ◽  
Final Visit ◽  
Care Hospital ◽  
Pharmacist Interventions ◽  
Artery Disease

Objective: The objective of the study was to assess the clinical pharmacist interventions in the management of diabetes complicated coronary artery disease. Methods: In the present study, a case history of a 55-year-old female was suffering from diabetes with coronary artery disease was taken. The case was collected from the cardiology outpatient department in a tertiary care hospital. The case was analyzed from 1 to 3 months. The initial visit to the end of final visit her laboratory parameters was examined at the laboratory. Results: The test report of electrocardiogram revealed sinus rhythm. The patient was advised for an echocardiogram which confirmed coronary artery disease. The patient was subjected to a coronary angiogram, which revealed the presence of double-vessel disease. Her ankle-brachial index study test revealed peripheral artery disease. The patient was diagnosed with coronary artery disease, and she was prescribed with regular medications. The patient was monitored for 1-week duration and prescribed with coronary artery disease medications to normalize the condition. The patient was improved with the treatment and advised for regular follow-ups. Conclusion: The study concludes that there was an imperative need for regular health screening by the physician associated clinical pharmacist care services with an effective treatment modality that can reduce the coronary artery disease incidences in this patient.

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