Cause and Outcome of Atypical Chest Pain in Patients Admitted to Hospital

In patients with acute chest pain the prime need, usually, is to diagnose and treat myocardial infarction or ischaemia. When a cardiac origin for the pain has been excluded, patients are commonly discharged without either a diagnosis or a plan for follow-up. We studied a group of such patients to see how far causation was pursued and how their mortality compared with that of patients with a proven cardiac cause for their symptoms. The study population was 250 patients admitted over five weeks with chest pain suspected of being cardiac in origin. Initial assessment included an electrocardiogram and measurement of troponin T. If neither of these indicated a cardiac event, the patient was deemed to have ‘atypical’ chest pain and the cause, where defined, was recorded. Outcomes at one year were determined by questionnaire and by assessment of medical notes. Of the 250 patients, 142 had cardiac pain (mean age 79 years, 58% male) and 108 atypical chest pain (mean age 60 years, 55% male). Of those with atypical pain, 40 were discharged without a diagnosis; in the remaining 68 the pain was thought to be musculoskeletal (25), cardiac (21), gastrointestinal (12) or respiratory (10) in origin. 41 patients were given a follow-up appointment on discharge. At one year, data were available on 103 (96%) patients. The mortality rate was 2.9% (3 patients) compared with 18.3% in those with an original cardiac event. Half of the patients with atypical pain had undergone further investigations and 14% had been readmitted. The yield of investigative procedures was generally low (20%) but at the end of the year only 27 patients remained undiagnosed. Patients with atypical chest pain form a substantial proportion of emergency admissions. The symptoms often persist or recur. The commonest causation is musculoskeletal, but a sizeable minority remain undiagnosed even after follow-up.

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Faculty Opinions recommendation of High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2811956.2477054 ◽

2010 ◽

Author(s):

Christopher de Filippi ◽

Puneet Gandotra

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Troponin T ◽

Cardiac Computed Tomography ◽

Acute Chest Pain ◽

High Sensitivity ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T ◽

Pain Patients

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The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Emergency Radiology ◽

10.1007/s10140-021-01911-8 ◽

2021 ◽

Author(s):

Vincenzo Russo ◽

Camilla Sportoletti ◽

Giulia Scalas ◽

Domenico Attinà ◽

Francesco Buia ◽

...

Keyword(s):

Chest Pain ◽

Emergency Radiology ◽

Acute Chest Pain ◽

Radiology Workflow ◽

Radiology Department ◽

Atypical Chest Pain ◽

Triple Rule Out ◽

Good Diagnostic Accuracy ◽

Rule Out ◽

Ct Studies

Abstract Purpose To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. Methods Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. Results Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. Conclusions Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.

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ECG of the month

British Journal of Cardiac Nursing ◽

10.12968/bjca.2021.0008 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1-1

Author(s):

Charles Bloe

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Acute Chest Pain ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Lost To Follow Up

In this issue's ECG of the month, Charles Bloe highlights a case of a 36-year-old woman presenting with severe acute chest pain after previously being lost to follow up post ST-elevation myocardial infarction.

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Persistent psychological distress in resettled refugee women-at-risk at one-year follow-up: Contributions of trauma, post-migration problems, loss, and trust

Transcultural Psychiatry ◽

10.1177/1363461520965110 ◽

2020 ◽

pp. 136346152096511

Author(s):

Lyn Vromans ◽

Robert D. Schweitzer ◽

Mark Brough ◽

Mary Asic Kobe ◽

Ignacio Correa-Velez ◽

...

Keyword(s):

At Risk ◽

Psychological Distress ◽

Somatic Symptoms ◽

Initial Assessment ◽

Community Members ◽

Refugee Women ◽

Distress Level ◽

One Year ◽

Refugee Literature

The mental health of women has been largely neglected in the refugee literature, notwithstanding the specific gender-related issues that confront women seeking asylum. Furthermore, a specific category of women, deemed to be women-at-risk, face particular challenges in their journey and resettlement process. This longitudinal study investigated psychological distress in refugee women-at-risk one year after resettlement in Australia. Follow-up survey of 83 women-at-risk (mean age = 33.41 years; SD = 11.93) assessed: trauma events and symptoms; loss events and loss distress; level of post-migration problems; anxiety, depression, and somatic symptoms; and absence of trust in community members. Participants demonstrated no symptom change since initial assessment ( p > .05). Substantial proportions of women reported traumatization (39%), PTSD (20%), anxiety (32%), and depression (39%) above clinical cut-offs, and high levels of somatization and loss distress. Post-migration problems, trauma events, and region of birth were associated with all symptoms, with post-migration problems the strongest predictor. Absence of trust in community members was associated with trauma, depression, and somatic symptoms. Initial trauma and somatic symptoms were associated with follow-up traumatic and somatic symptoms. Loss and trauma events were associated with loss distress. Findings underline the role of post-migration problems on psychological distress and the need to consider women’s psychological wellbeing in the context of their trauma and loss history, potential impacts of ethnicity, and complex socio-cultural dynamics underpinning issues of trust within communities. Effective service delivery requires that practitioners screen for and address psychological distress in women-at-risk at least up to 18 months after resettlement.

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Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage

American Heart Journal ◽

10.1016/j.ahj.2012.05.015 ◽

2012 ◽

Vol 164 (2) ◽

pp. 194-200.e1 ◽

Cited By ~ 24

Author(s):

Juan Sanchis ◽

Alfredo Bardají ◽

Xavier Bosch ◽

Pablo Loma-Osorio ◽

Francisco Marín ◽

...

Keyword(s):

Chest Pain ◽

Troponin T ◽

Acute Chest Pain ◽

Myocardial Damage ◽

High Sensitivity ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T

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Depression risk in patients with heart failure in primary care practices in Germany

International Psychogeriatrics ◽

10.1017/s1041610216000867 ◽

2016 ◽

Vol 28 (11) ◽

pp. 1889-1894

Author(s):

Marcel Konrad ◽

Jens Bohlken ◽

Michael A Rapp ◽

Karel Kostev

Keyword(s):

Heart Failure ◽

Primary Care ◽

Health Insurance ◽

Control Group ◽

Patients With Heart Failure ◽

Study Population ◽

Care Practices ◽

One Year ◽

Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

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