Of 3700 children thought to have non-cardiac chest pain at initial paediatric cardiology clinic evaluation, none suffered cardiac death over a median of 4 years follow-up

2012 ◽  
Vol 17 (6) ◽  
pp. 190-191
Author(s):  
Jennifer Thull-Freedman
Keyword(s):  
Chest Pain ◽  
Cardiac Death ◽  
Paediatric Cardiology ◽  
Cardiology Clinic

Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lauren East ◽  
Zainab Mahmoud ◽  
Amanda Verma
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Vital Signs ◽  
Wilcoxon Test ◽  
Initial Visit ◽  
Office Visits ◽  
Paired Data ◽  
Cardiology Clinic ◽  
Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

scholarly journals Socioeconomic Assessment and Impact of Social Security on Outcome in Patients Admitted with Suspected Coronary Chest Pain in the City of Salta, Argentina

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Ricardo A. León de la Fuente ◽  
Patrycja A. Naesgaard ◽  
Stein Tore Nilsen ◽  
Leik Woie ◽  
Torbjoern Aarsland ◽  
...  
Keyword(s):  
Chest Pain ◽  
Social Security ◽  
Low Socioeconomic Status ◽  
Cardiac Death ◽  
Insurance Coverage ◽  
Total Mortality ◽  
Socioeconomic Class ◽  
The Impact ◽  
The City

Low socioeconomic status is associated with increased mortality from coronary heart disease. We assessed total mortality, cardiac death, and sudden cardiac death (SCD) in relation to socioeconomic class and social security in 982 patients consecutively admitted with suspected coronary chest pain, living in the city of Salta, northern Argentina. Patients were divided into three socioeconomic classes based on monthly income, residential area, and insurance coverage. Five-year follow-up data were analyzed accordingly, applying univariate and multivariate analyses. At follow-up, 173 patients (17.6%) had died. In 92 patients (9.4%) death was defined as cardiac, of whom 59 patients (6.0%) were characterized as SCD. In the multivariate analysis, the hazard ratios (HRs) for all-cause and cardiac mortality in the highest as compared to the lowest socioeconomic class were 0.42 (95% confidence interval (CI), 0.22–0.80),P=0.008, and 0.39 (95% CI, 0.15–0.99),P=0.047, respectively. Comparing patients in the upper socioeconomic class to patients without healthcare coverage, HRs were 0.46 (95% CI, 0.23–0.94),P=0.032, and 0.37 (95% CI, 0.14–1.01),P=0.054, respectively. In conclusion, survival was mainly tied to socioeconomic inequalities in this population, and the impact of a social security program needs further attention.

scholarly journals Complement component 7 is associated with total- and cardiac death in chest-pain patients with suspected acute coronary syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Reidun Aarsetøy ◽  
Thor Ueland ◽  
Pål Aukrust ◽  
Annika E. Michelsen ◽  
Ricardo Leon de la Fuente ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Death ◽  
Complement Component ◽  
Coronary Syndrome ◽  
Norwegian Population ◽  
All Cause Mortality ◽  
Total Death ◽  
Pain Patients

Abstract Background Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. Aim To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. Methods Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. Results At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07–1.47) and cardiac death [HR 1.28 (95% CI 1.02–1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. Conclusions CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS. Clinical trial registration ClinicalTrials.gov Identifier: NCT01377402, NCT00521976.

scholarly journals A Rare Case of Cardiogenic Shock following Severe Multivessel Coronary Vasospasm

2019 ◽  
Author(s):  
Reza Rahmani ◽  
Amirfarhangh Zand Parsa ◽  
Alborz Sherafati ◽  
Rouzbeh Kosari ◽  
Vahid Mohhamadi ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Death ◽  
Rare Case ◽  
Recurrent Attack ◽  
St Segment Elevation ◽  
St Segment ◽  
Life Threatening ◽  
Vascular Beds ◽  
Typical Chest Pain

Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected.

Abstract P069: Prognostic Impact of the Omega-3 Index in Chest Pain Patients With a Suspected Acute Coronary Syndrome and Low Dietary Intake of Omega-3

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ricardo A Leon de la Fuente ◽  
Patrycja A Naesgaard ◽  
Stein Tore Nilsen ◽  
Torbjoern Aarsland ◽  
Leik Woie ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Death ◽  
Smoking History ◽  
Dietary Habit ◽  
Prognostic Impact ◽  
Omega 3 ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Background: Epidemiological and interventional studies suggest that omega-3 (n-3) fatty acids derived from fish oil can reduce the occurrence of cardiovascular disease. Based on these observations, the omega-3 index [eicosapantaenoic acid (EPA) + docosahexaenoic acid (DHA) content in cell red blood membranes] has been suggested as a novel risk marker for cardiac death. Objective: To assess whether the omega-3 index can predict all-cause mortality, cardiac death and sudden cardiac death (SCD) following hospitalization with an acute coronary syndrome (ACS). Material and methods: The omega-3 index was measured in 572 consecutive patients admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit essentially based on red meat and a low intake of fish. The median age of the included patients was 63 years and 59 % were males. Clinical endpoints were collected during a 5-year follow-up period, median 3.64 years, range 1 day to 5.46 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. In our multivariable analysis we corrected for age, sex, arterial hypertension, diabetes, smoking history, body mass index, previous coronary heart disease, high-sensitivity C-reactive protein, brain natriuretic peptide, Troponin-T release and use of statins and beta-blockers. Results: No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median omega 3-index was 2.8%, and ranging from 1.9% in the lowest to 3.8% in the highest quartile. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. Conclusions: In a population with a low intake of fish and fish oils, the omega-3 index did not predict future fatal events in patients with acute chest pain and suspected ACS, suggesting that index levels less than 4% are too low to be protective.

Lost but not missing: factors associated with loss of follow-up in a paediatric cardiology clinic

2021 ◽  
pp. 1-5
Author(s):  
Lisa J. Gregorcyk ◽  
Michael Kelleman ◽  
Matthew E. Oster
Keyword(s):  
Age Groups ◽  
Time Interval ◽  
Paediatric Cardiology ◽  
Adequate Care ◽  
Modifiable Factors ◽  
Cardiology Clinic ◽  
Paediatric Practice ◽  
Race Ethnicity ◽  
Lost To Follow Up

Abstract Background: Loss of follow-up is a barrier to providing adequate care to paediatric cardiac patients. The purpose of this study was to determine variables associated with loss of appropriate paediatric cardiology follow-up, including potentially modifiable factors. We hypothesised having earlier recommend follow-up intervals was associated with less likelihood of loss of follow-up. Methods: We performed a retrospective cohort study of patients >5 years old seen in a large, outpatient paediatric practice from 2013 to 2016. Subjects were considered to be lost to follow-up if they did not have a subsequent outpatient encounter by 6 months after their recommend follow-up time interval. Results: Of the 8940 eligible patients, 45.9% were lost to follow-up. Recommended follow-up interval of 1 year was associated with less loss of follow-up (41.4%) as compared to 2-year intervals (51.6%) and 3 years (55.7%) (p < 0.001 for both). Other significant predictors of loss of follow-up included less severe heart disease, older age, and non-Hispanic Black race/ethnicity. Sex and payor type were not significant predictors. In the stratified analyses by severity of disease and age, longer recommended follow-up time was associated with greater loss of follow-up among all severity and age categories. Conclusions: Almost half of the patients in our cohort did not return to clinic within the recommended timeline. Shorter follow-up time was associated with less loss of follow-up among all categories of disease severity and age groups. Recommending shorter follow-up intervals may be one initiative for paediatric cardiologists to improve rates of follow-up.

Cardiology clinic follow-up did not decrease return visits to the ED for chest pain patients

2014 ◽  
Vol 32 (10) ◽  
pp. 1208-1211 ◽  
Author(s):  
Aaron Barksdale ◽  
Jeff Hackman ◽  
Aaron Bonham ◽  
Matt Gratton
Keyword(s):  
Chest Pain ◽  
Cardiology Clinic ◽  
Return Visits ◽  
Pain Patients

scholarly journals Chest pain in paediatric patients referred to paediatric cardiology clinic at PSCC qassim

2013 ◽  
Vol 25 (2) ◽  
pp. 124
Author(s):  
Ali A. Al-Akhfash ◽  
Abdulrahman A. Almesnid ◽  
Zuhair Aalem ◽  
Suleiman Almesned
Keyword(s):  
Chest Pain ◽  
Paediatric Cardiology ◽  
Paediatric Patients ◽  
Cardiology Clinic

Angiopoietin-2 is a long-term predictor of all-cause mortality, cardiac death and sudden cardiac death in chest-pain patients with suspected acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Aarsetoey ◽  
T Ueland ◽  
P Aukrust ◽  
A.E Michelsen ◽  
V Ponitz ◽  
...  
Keyword(s):  
Chest Pain ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Funding Source ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Angiopoietin 2 ◽  
Pain Patients

Abstract Background Angiopoietin-2 (ANGPT2) is an important regulator of angiogenesis. Higher levels of ANGPT2 have been found to be associated with an adverse cardiovascular risk factor profile potentially reflecting maladaptive vascular remodelling including atherosclerotic plaque destabilization. Purpose To evaluate the prognostic utility of ANGPT2 added to conventional clinical risk factors for coronary heart disease, including B-type natriuretic peptide (BNP), troponin T (TnT) and C-reactive protein (CRP), in patients with suspected acute coronary syndrome (ACS). Methods 871 chest-pain patients with clinically suspected ACS from South-Western Norway and 982 patients from Northern Argentina were consecutively included in a prospective transatlantic cohort study. We measured plasma-concentrations of ANGPT2 in admission-samples from 1815 patients by enzyme immunoassay. Univariable- and multivariable Cox proportional-hazards models, applying both loge-transformed continuous values and quartiles (Q1–4), were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24-month follow-up. Of the patients with suspected ACS, 838 patients had TnT release above the detection-limit of 0.01 ng/mL. We performed subgroup analysis for all-cause mortality in patients with and without TnT release. Results Median age in the total population was 66.0 (Q1-Q3; 55.0–76.8) years and 60.4% were males. At 24-month follow-up, 254 patients (14%) had died, of which 150 (8.3%) suffered cardiac death and 76 (4.2%) SCD. ANGPT2 levels were significantly higher in patients who died compared to long-term survivors [3.87 (2.40–7.54) ng/mL versus 2.11 (1.48–3.22) ng/mL (median, 25 and 75% percentiles), p&lt;0.001]. In multivariable analysis, ANGPT2 concentrations in the highest quartile (Q4) as compared to the lowest (Q1) were significantly associated with all-cause mortality [Hazard Ratio (HR) 1.96 (95% confidence interval (CI); 1.12–3.42), p=0.018) and cardiac death [HR 2.23 (95% CI; 1.01–4.92), p=0.047] at 24-month follow-up. For SCD, ANGPT2 concentrations in both Q3 [HR 3.59 (95% CI; 1.05–12.3), p=0.041] and Q4 [HR 3.81 (95% CI; 1.12–12.9), p=0.032] as compared to Q1 were significantly related to outcome. These results were confirmed using loge-transformed continuous values of ANGPT2. ANGPT2 was also an independent predictor of all-cause mortality in both patients with and without TnT release. For patients with TnT &gt;0.01 ng/mL, HR for ANGPT2 in Q4 as compared to Q1 was 2.77 (95% CI: 1.41–5.44), p=0.003. For patients with TnT ≤0.01, HR for ANGPT2-Q4 was 2.67 (95% CI: 1.08–6.62), p=0.034. Conclusion High levels of ANGPT2 were found to independently predict all-cause mortality, cardiac death and sudden cardiac death in chest-pain patients with suspected ACS, irrespective of clinical demographics, troponin-release, CRP and BNP. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority

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