scholarly journals Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Alotaibi ◽  
Richard Body ◽  
Simon Carley ◽  
Elspeth Pennington
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Delphi Study ◽  
Prediction Models ◽  
Tension Pneumothorax ◽  
St Elevation Myocardial Infarction ◽  
Oesophageal Perforation ◽  
Telephone Triage ◽  
Life Threatening ◽  
St Elevation

Abstract Background Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. Methods We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%. Results A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. Conclusion Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.

ECG of the month

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.

PP23 Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for chest pain patients. A systematic review abstract

2021 ◽  
Vol 38 (9) ◽  
pp. A10.2-A10
Author(s):  
Ahmed Alotaibi ◽  
Abdulrhman Alghamdi ◽  
Charles Reynard ◽  
Richard Body
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Prediction Models ◽  
Meta Analysis ◽  
Final Diagnosis ◽  
Telephone Triage ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Pain Patients

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

scholarly journals A Study of Clinical Profile and Complications In Patients with ST-Elevation Myocardial Infarction Attending In College of Medical Sciences Teaching Hospital, Bharatpur (Chitwan), Nepal.

2021 ◽  
Vol 18 (1) ◽  
pp. 33-37
Author(s):  
Pradeep Thapa ◽  
Prakash Aryal ◽  
Rajani Baniya
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Chest Pain ◽  
Hospital Mortality ◽  
Teaching Hospital ◽  
Clinical Profile ◽  
St Elevation Myocardial Infarction ◽  
Medical Sciences ◽  
Acute Stemi ◽  
St Elevation

Background and Aims: ST-Elevation Myocardial Infarction (STEMI) is a leading cause of morbidity and mortality. This study aims to summarize the clinical profile and complications of patients with STEMI in a teaching hospital. Methods: This was a prospective hospital based descriptive and observational study conducted at College of Medical Sciences Teaching Hospital (CoMSTH), Bharatpur from January 2017 to July 2018 in 110 patients with a diagnosis of acute STEMI. Results: Out of 110 patients the mean age of presentation was 59.31 years and 64.5% were male. Typical chest pain (90%) was the most common presenting symptom and 45.5% patients presented within six hours of chest pain. Most common traditional risk factors were hypertension and smoking which were present in 44 (40%) cases, followed by diabetes in 33 (30%), dyslipidemia in 22 (20%). Majority of patients (49.1%) were in killips class I, and only 9 (8.2%) patients were in cardiogenic shock (killips class IV). Inferior wall was the most common in 30% patients followed by anteroseptal wall MI (23.6%), anterior wall MI (11.8%) and combined (anterior and inferior) in 10%. Revascularization with primary Percutaneous Coronary Intervention (PCI) was done in 46 (41.8%) patients, thrombolysis was done in 41 (37.3%) patients. Arrhythmias (39.1%) followed by heart failure (24.5%) were the common complications. The overall in-hospital mortality was 16 (14.5%). Conclusions: Patients with acute STEMI at College of Medical Sciences Teaching Hospital (CoMSTH) were predominantly male with hypertension and smoking as the commonest risk factors. Arrhythmias were the most common complications and in-hospital mortality rate was 14.5%.

ECG of the month

2021 ◽  
pp. 1-2
Author(s):  
Charles Bloe
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
Lost To Follow Up

In this issue's ECG of the month, Charles Bloe presents a case of a 36-year-old woman with severe central chest pain who had been lost to follow up after an ST-elevation myocardial infarction 4 years earlier.

Abstract 17143: Acute Coronary Syndromes Associated With SARS-CoV-2 Infection Admissions in a Medium Size Community Hospital

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ANDREEA-CONSTANTA STAN ◽  
Momcilo Durdevic ◽  
Rosario Florante ◽  
Arshavir Artashesyan ◽  
Henrik Elenius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Chest Pain ◽  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Type Ii ◽  
Primary Care Teams ◽  
Coronary Syndromes ◽  
St Elevation

Background: The presence of cardiovascular complications were reported in small studies of critical care patients admitted with SARS-CoV-2infection There is a dearth of data regarding presence of acute coronary syndromes (ACS) in patients admitted with symptomatic SARS-CoV-2 infection, the cause of the myocardial injury and particularities of management. Objectives: The aim of the study is to describe the presence and type ACS in patients admitted with symptomatic SARS-CoV-2 infection. Secondary outcomes were contributing factors, presenting symptoms and medical management. Methods: A descriptive, retrospective study of patients with a positive COVID-19 test and symptomatic infection admitted from 10 March 2020 to 10 April 2020 in our hospital. Results: There were a total of 127 patients admitted with symptomatic SARS-CoV-2 infection. The most common ACS was Type II Myocardial Infarction (MI). 16 patients were diagnosed with type II MI, 3 patients with Non ST elevation myocardial infarction (NSTEMI) and no patient was diagnosed with unstable angina and ST elevation myocardial infarction (STEMI). The most common cause of Type II MI was hypoxia followed by congestive heart failure and new onset atrial fibrillation. One patient has chest pain as presenting symptom. Except for Aspirin loading and use of beta blocker no other antischemic, statin or ACE/ARB medication was used for management of type II MI. All patients with Type II MI were managed by primary care teams. 3 patients developed NSTEMI and were managed by primary care teams with Cardiology consults. Anti-coagulation was considered for all patients. All patients received Aspirin loading, high intensity statin and beta blockers. Conclusions: Majority of patients with ACS had symptoms related to SARS-CoV-2 infection and chest pain was absent in 95% of cases. The most common ACS was type II MI- myocardial ischemia in context of hypoxia and the treatment was focused in treating the underlying cause rather than initiation of classical guideline directed therapy or invasive management. There were no cases of unstable angina and STEMI, results consistent with previous studies underlying the low incidence of STEMI cases during this pandemic.

scholarly journals Acute Myocardial Infarction in Snake bite Envenomation – A Case Report

2015 ◽  
Vol 16 (1) ◽  
pp. 46-47
Author(s):  
NS Neki
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Rare Complication ◽  
Snake Bite ◽  
St Elevation Myocardial Infarction ◽  
History Of ◽  
Electrocardiographic Changes ◽  
St Elevation

Snake bite envenomation is a common problem in tropical countries, especially in rural parts of India. We came across a 30 year old male who presented to the hospital after 4 hours with history of Russell’s viper snake bite developing acute non ST elevation myocardial infarction (MI). Myocardial infarction was confirmed by history of left sided chest pain radiating to left arm with diaphoresis and electrocardiographic changes with increased serum troponin levels. Myocardial infarction is a rare complication of snake bite hence case report.DOI: http://dx.doi.org/10.3329/jom.v16i1.22401 J MEDICINE 2015; 16 : 46-47

scholarly journals Situs Inversus: Inferior-Lateral ST-Elevation Myocardial Infarction on Right-Sided Electrocardiogram

2019 ◽  
Vol 3 (3) ◽  
pp. 307-309
Author(s):  
Mohamed Hamam ◽  
Howard Klausner
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Health Risks ◽  
St Elevation Myocardial Infarction ◽  
Diagnostic Challenge ◽  
Coronary Syndrome ◽  
Anatomical Anomaly ◽  
Syndrome Diagnosis ◽  
St Elevation ◽  
The Right

Dextrocardia is a rare anatomical anomaly in which the heart is located in the patient’s right hemithorax with its apex directed to the right. Although it usually does not pose any serious health risks, patients with undiagnosed dextrocardia present a diagnostic challenge especially in those presenting with chest pain. Traditional left-sided electrocardiograms (ECG) inadequately capture the electrical activity of a heart positioned in the right hemithorax, which if unnoticed could delay or even miss an acute coronary syndrome diagnosis. Here, we present a case of a patient with dextrocardia presenting with chest pain and diagnosed with ST-elevation myocardial infarction using a right-sided ECG.

P3629Invasive versus medical management of non-ST elevation myocardial infarction in cancer patients: knowledge is bliss

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D V Balanescu ◽  
T Donisan ◽  
M Lee ◽  
P Tran ◽  
S De Sirkar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Cancer Patients ◽  
Antiplatelet Therapy ◽  
Single Agent ◽  
St Elevation Myocardial Infarction ◽  
Invasive Treatment ◽  
Prior Chemotherapy ◽  
St Elevation ◽  
Active Cancer

Abstract Background Cancer patients with non-ST elevation myocardial infarction (NSTEMI) frequently present with comorbidities (e.g., anaemia, thrombocytopenia) that discourage invasive treatment. Purpose To compare outcomes of cancer patients with NSTEMI treated with optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) versus OMT alone and to identify variables associated with overall survival (OS). Methods All cancer patients diagnosed with NSTEMI between March 2016 and December 2018 at our institution were included. Patients were classified based on treatment of NSTEMI into 2 groups: invasive strategy or OMT alone. The invasive group was further classified into early (PCI≤72 hours since presentation) or delayed strategy (PCI>72 hours). Clinical and laboratory data, oncologic history, major adverse cardiovascular events, and survival were collected. Univariate Cox proportional hazards regression analyses were conducted to identify variables associated with OS. Results We included 201 patients with a mean age of 68±11 years, 136 (68%) of which were women. Median OS was 13 months. Factors influencing OS are presented in Table I. Patients receiving PCI had better OS compared to patients treated with OMT only (Figure 1, p<0.0001). Procedure-related complications were non-fatal and present in 2 (1.85%) cases. Table I Covariate Hazard Ratio (95% confidence interval) p-value Early invasive treatment (≤72 hours) 0.327 (0.207–0.516) <0.0001 Delayed invasive treatment (>72 hours) 0.496 (0.252–0.977) 0.0426 Presenting symptom: chest pain 0.406 (0.254–0.649) 0.0002 Presenting symptom: others 1.869 (1.223–2.855) 0.0039 Single agent antiplatelet therapy 0.434 (0.263–0.716) 0.0011 Dual agent antiplatelet therapy 0.294 (0.174–0.496) <0.0001 Statins 0.440 (0.276–0.703) 0.0006 Active cancer 4.487 (1.646–12.234) 0.0033 Prior chemotherapy 2.312 (1.328–4.023) 0.0030 Prior chest radiation 1.752 (1.065–2.884) 0.0272 Active chemotherapy 1.931 (1.271–2.934) 0.0021 Figure 1 Conclusions An invasive management of NSTEMI in cancer patients, especially within 72 hours, appears to be associated with improved OS. Patients presenting with symptoms other than chest pain were less likely to undergo PCI and had worse outcomes. Active cancer, a history of chest radiation, and active or prior chemotherapy were also associated with decreased OS. Acknowledgement/Funding None

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