18 CPAU vs MAU: Acute Chest Pain Unit Provides Rapid Specialist Assessment, Early Coronary Intervention and Reduced Length of Stay for Patients Admitted with Suspected Acute Coronary Syndrome at a Large District General Hospital

Acute coronary syndrome (ACS) is a leading cause of death among people in Bangladesh. The aim of the study was to analyze the clinical course and treatment strategies in patients with ACS and to determine to what extent management of ACS in a tertiary care general hospital in Bangladesh adhered to current guidelines. This study was carried out in the coronary care unit (CCU) of a tertiary care general hospital, Rajshahi, for a period of 3-months. A total number of 240 patients presenting with ACS were included in our study and the most common symptoms were acute chest pain (90%) and dyspnea (49%). The study group comprised of 27% female and 73% male patients with varying risk factors including hypertension (45%), hyperlipidemia (43%), family records of coronary artery disease (CAD) (20%), diabetes (17%) and smoking (15%). The most frequent ECG finding in patients was T wave change (71%), pathological Q wave (67%), ST segment elevation (33%), ST depression (9%), whereas, 12% patients with ACS reported to have normal ECG. Patients with ACS had elevated levels of SGOT and CK-MB. Troponin I level was positive in 100% of the patients with a mean peak troponin level of 1.5± 0.15ng/ml. In clinical setting, the patients were immediately managed with isosorbidedinitrate (58%), streptokinase (40%) and intravenous heparin (LMWH) followed by (46%) and (54%) of aspirin and aspirin-clopidogrel combinations respectively. In addition, long-term management with antihypertensive included β-blocker (58%), calcium channel blocker (29%), ACE-I (25%) and diuretics (12%). Anti-diabetic (18%) drugs were also prescribed in patients with co-existing diabetes and CAD. Adherence to guidelines is limited by lack of funds and resources in the hospital; however, attention must be paid to improve patient outcome. The average hospital stay ranges 2-3 days and hospital mortality was 10%.Asian J. Med. Biol. Res. March 2018, 4(1): 117-122

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101 Incorporation of stress echocardiography into an acute chest pain service provides excellent feasibility, early triaging and accurate risk stratification of patients with suspected acute coronary syndrome but non-diagnostic ECG and normal 12-h troponin

Heart ◽

10.1136/heartjnl-2012-301877b.101 ◽

2012 ◽

Vol 98 (Suppl 1) ◽

pp. A58.2-A59

Author(s):

B N Shah ◽

G Balaji ◽

A Al Hajiri ◽

I S Ramzy ◽

S Ahmadvazir ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Risk Stratification ◽

Stress Echocardiography ◽

Acute Chest Pain ◽

Coronary Syndrome

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Chest pain and chest pain units

10.1093/med/9780199687039.003.0008_update_001 ◽

2018 ◽

Author(s):

Eric Durand ◽

Aurès Chaib ◽

Etienne Puymirat ◽

Nicolas Danchin

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Acute Coronary Syndromes ◽

Acute Chest Pain ◽

The United States ◽

Cardiac Biomarkers ◽

Coronary Syndrome ◽

Cardiology Department ◽

Coronary Syndromes ◽

Rule Out

Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provide an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing can be performed to confirm or rule out an acute coronary syndrome. Eligible candidates include the majority of patients with non-diagnostic electrocardiograms. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains low in Europe.

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