scholarly journals Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation†

2005 ◽  
Vol 26 (16) ◽  
pp. 1606-1611 ◽  
Author(s):  
Diana Rinkevich ◽  
Sanjiv Kaul ◽  
Xin-Qun Wang ◽  
Khim Leng Tong ◽  
Todd Belcik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment ◽  
And Function

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 75-83 ◽  
Author(s):  
Frank Breuckmann ◽  
Matthias Hochadel ◽  
Thomas Voigtländer ◽  
Michael Haude ◽  
Claus Schmitt ◽  
...  
Keyword(s):  
Chest Pain ◽  
Systolic Function ◽  
Clinical Signs ◽  
Acute Chest Pain ◽  
Final Diagnosis ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Invasive Management

Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). Methods: A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. Results: TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. Conclusions: About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.

Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study

2004 ◽  
Vol 148 (1) ◽  
pp. 129-136 ◽  
Author(s):  
Sanjiv Kaul ◽  
Roxy Senior ◽  
Christian Firschke ◽  
Xin-Qun Wang ◽  
Jonathan Lindner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Multicenter Study ◽  
Cardiac Imaging ◽  
St Segment Elevation ◽  
Incremental Value ◽  
St Segment

scholarly journals To Be or Not to Be … Acute Coronary Syndrome

2016 ◽  
Vol 62 (3) ◽  
pp. 363-367
Author(s):  
Pintilie Irina ◽  
Scridon Alina ◽  
Șerban Răzvan Constantin
Keyword(s):  
Chest Pain ◽  
Troponin I ◽  
Enzyme Inhibitor ◽  
Acute Myocarditis ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

AbstractIntroduction: The association between ST segment abnormalities, elevated cardiac enzymes, and chest pain is usually a marker of acute coronary injury. However, certain other pathologies can sometimes mimic acute coronary syndromes.Case report: A 40-year-old Caucasian male, former smoker, with no other cardiovascular risk factors, presented to the Emergency Department for typical ischemic, prolonged chest pain. The ECG demonstrated inverted T waves in leads I, II, aVL, and V3 to V6. The patient presented high cardiac necrosis markers (troponin I 2.65 ng/ml). Based on these findings, the case was interpreted as non-ST segment elevation myocardial infarction, but coronary angiography excluded the presence of significant coronary lesions. The ventriculography showed an efficient left ventricle, with mild hypokinesia of the two apical thirds of the anterior left ventricular wall. Cardiac magnetic resonance imaging demonstrated areas of hypersignal on the T2-weighted imaging sequence in the left ventricular myocardium, suggestive for acute myocarditis. The patient was started on antiplatelet, beta-blocker, and angiotensin converting enzyme inhibitor, with favorable evolution.Conclusion: This case underlines the polymorphic appearance of acute myocarditis, which can often mimic an acute coronary event.

scholarly journals Cardiac Involvement in Leptospirosis – An Unusual Manifestation

2020 ◽  
Author(s):  
Vanessa Barcelos ◽  
Ana Carolina Ferreira ◽  
António Xavier Fontes ◽  
Luís Dias ◽  
Humberto Costa ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Involvement ◽  
Clinical Findings ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
Cardiovascular Involvement ◽  
Severe Leptospirosis

Cardiovascular involvement by Leptospira is unusual. We report a case of a 29-year-old male sanitation worker who was diagnosed with leptospirosis (PCR testing for Leptospira spp. was positive in blood and urine). He had no classical clinical findings, and the presence of shock was the main worrisome finding. Within 24 hours of admission, the emergence of chest pain led us to consider cardiac involvement, which was demonstrated by diffuse supra-ST segment elevation, elevated troponin and NT-proBNP and an echocardiogram showing mildly left ventricular ejection fraction (LVEF 48–50%). There are several reports of cardiovascular involvement in severe leptospirosis but most patients are asymptomatic. In this case, the main key to diagnosis of perimyocarditis was the new onset of chest pain.

scholarly journals Typical chest pain and precordial leads ST-elevation in patients with pacemakers - are we always looking at an acute myocardial infarction?

2015 ◽  
Vol 72 (9) ◽  
pp. 837-840
Author(s):  
Marina Ostojic ◽  
Tatjana Potpara ◽  
Marija Polovina ◽  
Mladen Ostojic ◽  
Miodrag Ostojic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Pacemaker Implantation ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
St Segment ◽  
Typical Chest Pain

Introduction. Electrocardiographic (ECG) diagnosis of acute myocardial infarction (AMI) in patients with paced rhythm is difficult. Sgarbossa?s criteria represent helpful diagnostic ECG tool. Case report. A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarbossa?s criterion for AMI in patients with dual pacemakers (ST-segment elevation of ? 5 mm in the presence of the negative QRS complex). The patient was sent to catheterization lab where coronary angiogram reveled normal findings. ECG changes occurred due to pericardial reaction following two interventions: pacemaker implantation a month before and radiofrequency catheter ablation of AV junction two weeks before presentation in Emergency Department. Conclusion. This case report points out to the limitations of proposed criteria that aid in the recognition of AMI in patients with underlying paced rhythm and possible cause(s) of transient electrocardiographic abnormalities.

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