scholarly journals The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Maria Francesca Secchi ◽  
Carlo Torre ◽  
Giovanni Dui ◽  
Francesco Virdis ◽  
Mauro Podda
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Conservative Treatment ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Diagnostic Procedures ◽  
Screening Colonoscopy ◽  
X Rays ◽  
Colonoscopic Perforation

Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia. Right chest wall and cervical subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and bilateral subdiaphragmatic free air were reported on the chest and abdominal X-rays. The patient was treated conservatively, with absolute bowel rest, total parental nutrition, and broad-spectrum intravenous antibiotics. Awareness of the potentially unusual clinical manifestations of retroperitoneal perforation following colonoscopy is crucial for the correct diagnosis and prompt management of colonoscopic perforation. Conservative treatment may be appropriate in patients with a properly prepared bowel, hemodynamic stability, and no evidence of peritonitis. Surgical treatment should be considered when abdominal or chest pain worsens, and when a systemic inflammatory response arises during the conservative treatment period.

scholarly journals Use of Circulating MicroRNAs to Diagnose Acute Myocardial Infarction

2012 ◽  
Vol 58 (3) ◽  
pp. 559-567 ◽  
Author(s):  
Yvan Devaux ◽  
Mélanie Vausort ◽  
Emeline Goretti ◽  
Petr V Nazarov ◽  
Francisco Azuaje ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
Correct Diagnosis ◽  
Patient Treatment ◽  
Healthy Controls ◽  
Clinical Model ◽  
Acute Mi ◽  
St Elevation

Abstract BACKGROUND Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS miRNA-208b and miR-499 were highly increased in MI patients (>105-fold, P < 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non–ST-elevation MI (n = 113) (P < 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P < 10−9). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented <3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.

Abstract 14029: New Findings in Women and Men Regarding Symptoms and Delay Times in Stemi

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eva Swahn
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Main Symptom ◽  
Atypical Symptoms ◽  
New Findings ◽  
Delay Times ◽  
Associated Symptoms ◽  
Prompt Diagnosis

Introduction: Myocardial infarction patients report higher prevalence of atypical symptoms in women, contributing to a less probability of a correct diagnosis. Studies exploring only the STEMI group where a prompt diagnosis is mandatory is lacking. We hypothesised that chest pain is equally common in women and men in a STEMI population. We further hypothesised that women have more associated symptoms than men in a STEMI population and thus a longer delay time. Methods: SymTime is a multicentre observational study where patients with a diagnosis of STEMI, admitted to CCUs where included. Within 24 h from admission they filled in a validated Swedish questionnaire, developed to measure how patients with MI describe their symptoms and actions in the pre-hospital phase. Results: 126 women and 406 men were included, mean age 70 and 64 (SD11) years respectively. After age adjustment, men had 5 times higher odds of having chest pain. Women had more symptoms in other typical locations. (Table) Only general feelings of illness (25 vs 13%, p = .001), fearfulness (31 vs 17 %, p.= 001) and nausea (49 vs 29 %, p < .001) were more common in women. Women had longer delay times from symptom onset to first medical contact, median time 1:30 hours: minutes vs 1:05 in men (p = 0.03). Conclusion: Women had significantly less chest pain, one reason for longer delay times in women. The prevalence of other typical MI symptoms such as pain in the chin/teeth, throat, shoulders, arms or back was higher in women. These findings should be communicated to the health care system as well as the community in order to get a prompt and correct diagnosis of STEMI in both genders. Table. Main symptom(s) in women and men with STEMI

Typical and atypical clinical signs and symptoms of myocardial infarction and delayed seeking of professional care among blacks

1997 ◽  
Vol 6 (1) ◽  
pp. 7-13 ◽  
Author(s):  
HO Lee
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
United States Department ◽  
Manual Search ◽  
Black Patients ◽  
Definitive Therapy ◽  
Clinical Signs And Symptoms

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.

Non-traumatic chest pain: pericarditis

2020 ◽  
Vol 12 (3) ◽  
pp. 1-5
Author(s):  
Andrew Mootham
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Treatment Regimen ◽  
Emergency Care ◽  
Signs And Symptoms ◽  
Heart Sounds ◽  
Scope Of Practice ◽  
Bacterial Pericarditis

Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction. Its signs and symptoms include chest pain, which may radiate to the arm and jaw and pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over each other) on auscultation of heart sounds. The diagnosis of straightforward pericarditis may be within the scope of practice of the emergency care practitioner. It should be possible for an emergency care practitioner to reach a working diagnosis and to initiate a treatment regimen, which would predominantly consist of providing analgesia to make the patient more comfortable.

scholarly journals SÍNDROME DE TAKOTSUBO Y ESTRÉS AGUDO.

2021 ◽  
Vol 32 (1) ◽  
pp. s17-s18
Author(s):  
Stalin Bismarck Castillo ◽  
Daniela Alejandra Pozo ◽  
Cecibel Estefanía Villacís ◽  
María José Portero
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Beta Blockers ◽  
Viral Myocarditis ◽  
Acute Chest Pain ◽  
Signs And Symptoms ◽  
Anatomical Variations ◽  
Underlying Disease ◽  
Angiotensin Ii Receptor ◽  
Catecholamine Levels

Introduction Takotsubo Syndrome (STk) is characterized by a transient systolic regional dysfunction on the left ventricle, usually diagnosed in 2% of the patients presenting with clinical suspicion of ST elevating myocardial infarction (STAMI). Main etiology is still unclear, correlating with pericardial artery spasm, microvascular alterations, viral myocarditis, heightened catecholamine levels with alteration of sympathetic system, and anatomical variations of the anterior descendent artery. Several emotional and physical triggers are linked to its development, but symptoms can arise in their absence. Most common signs and symptoms include: acute chest pain, dyspnea and syncope, initially indistinct to those of an acute myocardial infarction. Its presence varies according to the trigger: on those with a strong emotional trigger chest pain and palpitations, while on physical stress, underlying disease predominates (stroke, seizure). Case description A 58 year old female, without medical history of cardiovascular disease, was admitted to the hospital because of left sided chest pain, beginning 2 hours ago, most likely caused by emotional distress. On arrival, initial diagnosis was Acute Coronary Disorder (ACD). Coronarography, and anterior oblique right ventriculography confirming the diagnosis. Requiring mainly low-molecular-weight heparin anticoagulation during admission and novel anticoagulants for outpatient care, added to anxiety treatment. Follow-up started October 2019 and went on during 2020. Conclusion STk has similar characteristics to those of ACD on postmenopausal women. The present Clinical Case meets 3 of the 4 Mayo Criteria, and has 61 points on the InterTak score. Acute chest pain, dyspnea and syncope plus several additional studies can confirm STk. EKG showing ST elevation (90%), negative T wave on precordial leads (44%), Q wave present (15-27%). Elevation of the ST segment on V4 to V6 is higher than V1 to V3, with absence of Q anomaly. Heightened troponin levels, but lower than AMI; Heghtened BPN or proBPN could be present. Myocardial stunning could be liked to catecholamine levels 2 to 3 times higher than AMI with Killip III. The recovery does not require treatment, but could require diuretics, beta blockers, ACEs, angiotensin-II receptor blockers, statins and acetylsalicylic acid. Prognosis is favorable with mortality under the 2%.

scholarly journals SARS-Cov-2: Epidemiological characteristics, clinical characteristics, diagnosis and prevention: A review of current knowledge

2021 ◽  
Vol 2 (2) ◽  
pp. 16-22
Author(s):  
Marina Fišeković-Kremić ◽  
Snežana Stojanović-Ristić
Keyword(s):  
Clinical Manifestation ◽  
Clinical Characteristics ◽  
Current Knowledge ◽  
Nasal Congestion ◽  
Clinical Manifestations ◽  
Diagnostic Procedures ◽  
X Rays ◽  
Runny Nose ◽  
Biochemical Analyses ◽  
Epidemiological Characteristics

The SARS-Cov-2 disease appeared in December 2019, when the new coronavirus was confirmed to be the cause of the disease. The objective of this article is to summarize previous research on the epidemiological characteristics, etiology, clinical characteristics, diagnosis, prevention, and control of the new SARS-Cov-2 infection. The SARS-Cov-2 virus belongs to the group of betacoronaviruses, which are single-stranded RNA viruses. The envelope has a crucial role in the pathogenicity of the virus. A viral infection can cause an excessive immune response in the patient, which is labeled as a "cytokine storm," and whose effect is extensive tissue damage. Three main routes of the transmission of the virus are: droplets, direct contact, aerosol. The incubation period is considered to be 1-14 days. The clinical manifestation ranges from asymptomatic, mild, to severe, and some cases end in death. The main clinical manifestations include fever, cough, and shortness of breath. Nasal congestion, a runny nose, a sore throat, headache, myalgia, diarrhea, loss of the sense of taste and/or smell have also been reported. The diagnostic procedures are the following: clinical manifestation, chest X-rays, biochemical analyses, epidemiological anamnesis. A positive nasopharyngeal or oropharyngeal swab (Ag test, and/or reverse transcription polymerase chain reaction (RT-PCR)) is used for etiological diagnosis. The SARS-Cov-2 infection has affected a large number of people and countries around the world. The application of preventive measures, early identification of infected persons, their isolation , and vaccination are currently the most effective mode in the battle against this virus. After the conclusion of the pandemic, it will be possible to estimate the health, social and economic impact of the virus.

scholarly journals Clinical outcomes of fibrinolytic therapy for prehospital treatment of acute myocardial infarction

2021 ◽  
Vol 37 ◽  
pp. e37071
Author(s):  
Priscila Fernandes Meireles Câmara ◽  
Marcos Antonio Ferreira Júnior ◽  
Allyne Fortes Vitor ◽  
Oleci Pereira Frota ◽  
Viviane Euzébia Pereira Santos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Prehospital Care ◽  
Signs And Symptoms ◽  
Fibrinolytic Therapy ◽  
Chest Discomfort ◽  
Prehospital Treatment

Fibrinolytic Therapy (FT) is an important form of treatment for cases of Acute Myocardial Infarction (AMI), especially in those places where Primary Percutaneous Coronary Intervention (PPCI) is not available, which is the main form of treatment and can be used even in the prehospital care. Aimed to describe the clinical outcomes of the use of FT in prehospital care for treating patients with AMI. This research covered a total of 53 patients and was carried out from march to october 2017, referring to the care provided from january 2015 to december 2016 in two stages, in which the first occurred with the Mobile Emergency Service (SAMU) and Walk-in Emergency Care Units (UPA), and the second in the referenced hospital services as gateways to those units. Data were collected from secondary sources. The clinical outcomes of FT considered in the form of absolute and relative frequencies and measures of central tendency were considered. The main signs and symptoms at admission were chest pain (84.62%), sweating (36.54%), dyspnea (26.92%), hypertension (19.23%), nausea (17.31%), malaise (17.31%) and emesis (13.46%). The main characteristic of chest discomfort was chest pain (70.45%). The FT drug administered in all patients was tenecteplase. The median time from symptom-to-door was 180 minutes, while symptom-reperfusion was 300 minutes and door-to-needle 160 minutes. Regarding the outcome, 74.47% had clinical improvement, 19.15% died, 4.25% had refractory AMI and 2.13% had reinfarction. The main characteristic of clinical improvement was the reversal of chest pain (68.57%), characterized as myocardial reperfusion criteria. The present study presented the main outcomes of FT use with improvement of those patients who were treated with it, and shorter times related to chest discomfort and the administration of FT were responsible for increasing the outcomes of clinical improvement and decreasing the outcome of death.

Pyogenic Arthritis of the Sacroiliac Joint in Pediatric Patients

PEDIATRICS ◽  
1980 ◽  
Vol 66 (3) ◽  
pp. 375-379
Author(s):  
Urs B. Schaad ◽  
George H. McCracken ◽  
John D. Nelson
Keyword(s):  
Pediatric Patients ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Etiologic Agent ◽  
Cast Immobilization ◽  
Radiographic Findings ◽  
Pyogenic Sacroiliitis ◽  
Bone Scans ◽  
Adequate Management

Clinical manifestations, diagnostic studies, and management of pyogenic sacroiliitis were reviewed in 77 pediatric patients. This infection occurs primarily in late childhood, is more common in boys, and has a subacute onset in about two thirds of cases. Recognition of the characteristic signs and symptoms of sacroiliac involvement coupled with radioisotope bone scanning substantially reduces the delay in correct diagnosis that averaged 3.9 weeks in all patients (4.8 weeks in those without and 1.7 weeks in those with bone scans performed). Joint aspiration under biplane fluoroscopic control and culture of the aspirated material is indicated in establishing the specific etiologic agent which is Staphylococcus aureus in most cases. Adequate management of pyogenic sacroiliitis consists of appropriately monitored antibiotic treatment and, if present, evacuation of pus. The use of spica cast immobilization offers no apparent beneficial effect. Indications for surgery include drainage of pus and removal of sequestered bone. With adequate management the prognosis of suppurative sacroiliitis in pediatric patients is excellent, despite persistent abnormal radiographic findings in most patients.

scholarly journals Heiner Syndrome and Milk Hypersensitivity: An Updated Overview on the Current Evidence

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1710
Author(s):  
Stefania Arasi ◽  
Carla Mastrorilli ◽  
Luca Pecoraro ◽  
Mattia Giovannini ◽  
Francesca Mori ◽  
...  
Keyword(s):  
Respiratory Tract Infections ◽  
Clinical Manifestations ◽  
Failure To Thrive ◽  
Signs And Symptoms ◽  
Current Evidence ◽  
Recurrent Fever ◽  
X Rays ◽  
Critical Approach ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Infants affected by Heiner syndrome (HS) display chronic upper or lower respiratory tract infections, including otitis media or pneumonia. Clinically, gastrointestinal signs and symptoms, anemia, recurrent fever and failure to thrive can be also present. Chest X-rays can show patchy infiltrates miming pneumonia. Clinical manifestations usually disappear after a milk-free diet. The pathogenetic mechanism underlying HS remains unexplained, but the formation of immune complexes and the cell-mediated reaction have been proposed. Patients usually outgrow this hypersensitivity within a few years. The aim of this review is to provide an updated overview on the current evidence on HS in children, with a critical approach on the still undefined points of this interesting disease. Finally, we propose the first structured diagnostic approach for HS.

scholarly journals Sinais, sintomas e complicações do infarto agudo do miocárdio

2018 ◽  
Vol 12 (1) ◽  
pp. 247 ◽  
Author(s):  
Renata Soares Passinho ◽  
Cândida Caniçali Primo ◽  
Walckiria Garcia Romero Sipolatti ◽  
Mirian Fioresi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Nursing Care ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Nursing Diagnosis ◽  
Affected Person ◽  
Insuficiencia Cardiaca ◽  
Care Nursing

RESUMOObjetivo: analisar as produções científicas a respeito da frequência dos sinais, sintomas e complicações do infarto agudo do miocárdio. Método: revisão integrativa, com busca publicações entre 2010 a 2014 nas bases de dados LILACS, MEDLINE e CINAHL. O processo de análise dos 122 artigos selecionados deu-se por meio da leitura exploratória e crítica dos títulos, resumos e dos resultados das pesquisas, onde se buscaram os fenômenos relacionados ao IAM (sinais, sintomas e complicações). Resultados: A dor no peito (N = 75), a insuficiência cardíaca (N = 52), a dispneia (N= 24) e a arritmia (N= 20) foram os sinais e sintomas mais encontrados. Conclusão: a dor no peito é o sintoma mais frequente da doença. O reconhecimento precoce desses fenômenos irá contribuir para a melhoria do prognóstico da pessoa acometida. Descritores: Cuidados de Enfermagem; Diagnóstico de Enfermagem; Infarto Agudo do Miocárdio; Classificação; Enfermeiras e Enfermeiros; Cardiologia.ABSTRACTObjective: to analyze the scientific productions regarding the frequency of signs, symptoms and complications of acute myocardial infarction. Method: integrative review, with search publications between 2010 to 2014, in the databases LILACS, MEDLINE and CINAHL. The process of analysis of the 122 articles selected was based on the exploratory and critical reading of the titles, abstracts and results of the research, in which the AMI-related phenomena (signs, symptoms and complications) were searched. Results: chest pain (N = 75), heart failure (N = 52), dyspnea (N = 24) and arrhythmia (N = 20) were the most common signs and symptoms. Conclusion: chest pain is the most frequent symptom of the disease. The early recognition of these phenomena will contribute to the improvement of the prognosis of the affected person. Descriptors: Nursing Care; Nursing diagnosis; Acute Myocardial Infarction; Classification; Nurses and Nurses; Cardiology.RESUMENObjetivo: analizar las producciones científicas acerca de la frecuencia de los signos, síntomas y complicaciones del infarto agudo de miocardio. Método: revisión integrativa, con búsqueda publicaciones entre 2010 a 2014, en las bases de datos LILACS, MEDLINE y CINAHL. El proceso de análisis de los 122 artículos seleccionados se dio por medio de la lectura exploratoria y crítica de los títulos, resúmenes y de los resultados de las investigaciones, donde se buscaron los fenómenos relacionados al IAM (signos, síntomas y complicaciones). Resultados: el dolor en el pecho (N = 75), la insuficiencia cardiaca (N = 52), la disnea (N = 24) y la arritmia (N = 20) fueron los signos y síntomas más encontrados. Conclusión: el dolor en el pecho es el síntoma más frecuente de la enfermedad. El reconocimiento precoz de estos fenómenos contribuirá a la mejora del pronóstico de la persona acometida. Descriptores: Cuidados de Enfermería; Diagnóstico de Enfermería; Infarto Agudo de Miocardio; Clasificación; Enfermeras y Enfermeras; Cardiología.

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