Chest pain, breathlessness, and fatigue

2020 ◽  
pp. 3276-3284
Author(s):  
Jeremy Dwight
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Past Medical History ◽  
Diagnostic Challenge ◽  
The Face ◽  
Life Threatening ◽  
The Individual

The symptoms of chest pain, breathlessness, and fatigue present a frequent diagnostic challenge in the outpatient and acute medical departments, as well as the emergency department. They have a broad differential diagnosis that includes several life-threatening pathologies. The cardiovascular history routinely includes assessment of risk factors and those aspects of the patient’s past medical history that make cardiovascular disease more likely. The presence of numerous risk factors may, on occasion, prompt the physician to proceed to further investigation even in the face of a relatively unconvincing history. Most diagnoses are made on the basis of patient history, and the physician is always compelled to return to the initial history and examination to put the findings of any investigations into context and to plan therapy appropriate for the individual patient.

Distress in My Chest: The Approach to a Student Presenting With “Chest Pain”

2018 ◽  
Vol 33 (6) ◽  
pp. 366-371
Author(s):  
Timothy Gay ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Emergency Medical Services ◽  
Primary Healthcare ◽  
School Setting ◽  
Initial Assessment ◽  
Level Of Care ◽  
Life Threatening

Occasionally, students present with chest pain in the school setting. Therefore, it is important to develop a differential diagnosis for chest pain, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider’s office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of a student presenting with chest pain.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

Abstract 16592: The Diamond-Forrester Criterion Significantly Overestimates the Risk of Obstructive Coronary Artery Disease in Patients Presenting to the Emergency Department With Low-Risk Chest Pain

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Todd Lecher ◽  
William R Davidson ◽  
Andrew Foy
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Pretest Probability ◽  
Low Risk ◽  
High Cholesterol ◽  
Observation Unit ◽  
Diamond Forrester

Introduction: We sought to (1) classify patients who underwent stress echocardiography in an emergency department observation unit based on their pretest probabilities of obstructive CAD using the Diamond-Forrester criterion, (2) to compare observed versus expected frequencies of obstructive CAD based on the Diamond-Forrester risk categories of low (<25%), intermediate (25-75%), and high (>75%) pretest probability of disease, and (3) to test the association of traditional cardiovascular risk factors (age, gender, hypertension, diabetes, high cholesterol, and smoking) with obstructive CAD. METHODS: Retrospective review of the electronic medical record for patients who presented to the emergency department with chest pain and underwent observation followed by stress echocardiography between the period January 1, 2012 to December 31, 2012. Patients were classified as low, intermediate, or high risk for obstructive CAD using the Diamond-Forrester criterion. Main outcome measures were stress echocardiography results as well as receipt of cardiac catheterization and results. RESULTS: A total of 504 patients were included in the final analysis. Overall, 4.8% had a positive stress test and only 1.2% had angiographic evidence of obstructive CAD. In each category of risk, the observed frequency of obstructive CAD was significantly lower than expected. Having a high pretest probability as defined by the Diamond-Forrester criterion was significantly associated with obstructive CAD. Age, gender, diabetes, hypertension, high cholesterol, and smoking were not independently associated with evidence of obstructive CAD; nor were any composites of these risk factors. CONCLUSIONS: The traditional Diamond-Forrester criterion significantly overestimates the probability of obstructive CAD in ED observation unit patients. Reliance on the Diamond-Forrester criterion and other traditional risk factors associated with obstructive CAD in the outpatient setting could lead to faulty Bayesian reasoning, overuse of non-invasive imaging, and improper interpretation of test results in an ED population of low-risk chest pain patients. Further work is required to determine an optimal risk-assessment strategy for this patient population.

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e239697
Author(s):  
Sarah Cheyney ◽  
Zachary Field ◽  
Jacqueline Kropf ◽  
Steve Carlan
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Topical Anaesthetic ◽  
Over The Counter ◽  
Perimenopausal Woman ◽  
Threatening Condition ◽  
Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

A qualitative exploration of the prescribing and use of statins in asymptomatic people in Ireland: A case of medicalisation, biomedicalisation and pharmaceuticalisation

2020 ◽  
pp. 136345932094606
Author(s):  
Paula Byrne ◽  
Órla O’Donovan ◽  
Susan M Smith ◽  
John Cullinan
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
High Cholesterol ◽  
Medical Problems ◽  
The Public ◽  
Socially Constructed ◽  
The Status ◽  
The Face ◽  
Notable Increase ◽  
Qualitative Exploration

There has been a notable increase in the use of statins in people without cardiovascular disease but who may be at risk in the future. The majority of statin users now fall into this category but little research has focused exclusively on this group. Debate has ensued regarding medicating asymptomatic people, and processes described variously as medicalisation, biomedicalisation and pharmaceuticalisation are used to explain how this happens. These overlapping and interrelated processes require issues to be ‘problemised’ as medical problems requiring medical solutions given the prevailing understandings of health, risk and disease. However, current understandings of risk and disease are not simply the result of technological and scientific advances, they are also socially constructed. We interviewed members of the public, GPs and others, and found that rather than high cholesterol being seen as one of several risk factors that contributes to heart disease, it tended to be promoted simplistically to the status of a disease needing treatment of itself. Statins were justified by those taking them as different to ‘unnecessary medicines’. However, some participants demonstrated resistance to statins, worried about over-medicalisation and deviated from accepted practices, indicating a complex ‘muddling through’ in the face of uncertainty.

scholarly journals High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

2011 ◽  
Vol 49 (12) ◽  
Author(s):  
Michael Christ ◽  
Thomas Bertsch ◽  
Steffen Popp ◽  
Philipp Bahrmann ◽  
Hans-Jürgen Heppner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Emergency Physician ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Clinical Work ◽  
Life Threatening ◽  
Acute Mi ◽  
Minor Disease ◽  
Pain Patients

AbstractEvaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.

The Uncertainty of Cardiovascular Disease Risk Calculation—What is the Best Risk Model for the Individual?

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Ronald S. LaFleur ◽  
Laura S. Goshko
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Clinical Decision Making ◽  
Risk Model ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Patient Specific ◽  
Model Parameters ◽  
Risk Models ◽  
The Individual

Cardiovascular disease (CVD) continues to be a leading cause of death. Accordingly, risk models attempt to predict an individual's probability of developing the disease. Risk models are incorporated into calculators to determine the risk for a number of clinical conditions, including the ten-year risk of developing CVD. There is significant variability in the published models in terms of how the clinical measurements are converted to risk factors as well as the specific population used to determine b-weights of these risk factors. Adding to model variability is the fact that numbers are an imperfect representation of a person's health status. Acknowledgment of uncertainty must be addressed for reliable clinical decision-making. This paper analyzes 35 published risk calculators and then generalizes them into one “Super Risk formula” to form a common basis for uncertainty calculations to determine the best risk model to use for an individual. Special error arithmetic, the duals method, is used to faithfully propagate error from model parameters, population averages and patient-specific clinical measures to one risk number and its relative uncertainty. A set of sample patients show that the “best model” is specific to the individual and no one model is appropriate for every patient.

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