Physician Evaluation of Risk Factors for Acute Coronary Syndrome and Myocardial Infarction among Emergency Department Patients with Chest Pain

2004 ◽  
Vol 11 (5) ◽  
pp. 505-506
Author(s):  
T. James
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Syndrome ◽  
Emergency Department Patients

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

Initial Appraisal of Acute Coronary Syndromes

2005 ◽  
Vol 18 (5) ◽  
pp. 377-393
Author(s):  
Roshanak Aazami
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Risk Groups ◽  
The United States ◽  
Rapid Identification ◽  
Emergency Department Care ◽  
Coronary Syndrome ◽  
Emergency Department Patients ◽  
Pharmacologic Treatments

Acute coronary syndrome remains a daunting health care problem in the United States. One third of emergency department patients with chest pain will eventually have a diagnosis of acute coronary syndrome. During the past decade, there have been many advances in the treatment of acute coronary syndrome as well as a widespread movement in emergency medicine to streamline the process of its treatment. Goals of emergency department care include rapid identification of patients with acute myocardial infarction, exclusion of causes of nonischemic chest pain, stratification of patients with acute coronary ischemia into low-risk and high-risk groups, and initiation of pharmacologic treatments. These goals will be discussed in this review, with particular emphasis on pharmacologic treatments.

scholarly journals Higher Emergency Physician Chest Pain Hospitalization Rates Do Not Lead to Improved Patient Outcomes

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Shaw Natsui ◽  
Benjamin C. Sun ◽  
Ernest Shen ◽  
Rita F. Redberg ◽  
Maros Ferencik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Emergency Physician ◽  
Hospital Care ◽  
Level Variation ◽  
Admission Rates ◽  
Coronary Syndrome

Background: Wide variation exists for hospital admission rates for the evaluation of possible acute coronary syndrome, but there are limited data on physician-level variation. Our aim is to describe physicians’ rates of admission for suspected acute coronary syndrome and associated 30-day major adverse events. Methods: We conducted a retrospective analysis of adult emergency department chest pain encounters from January 2016 to December 2017 across 15 community emergency departments within an integrated health system in Southern California. The unit of analysis was the Emergency physician. The primary outcome was the proportion of patients admitted/observed in the hospital. Secondary analysis described the 30-day incidence of death or acute myocardial infarction. Results: Thirty-eight thousand seven hundred seventy-eight patients encounters were included among 327 managing physicians. The median number of encounters per physician was 123 (interquartile range, 82–157) with an overall admission/observation rate of 14.0%. Wide variation in individual physician admission rates were observed (unadjusted, 1.5%–68.9%) and persisted after case-mix adjustments (adjusted, 5.5%–27.8%). More clinical experience was associated with a higher likelihood of hospital care. There was no difference in 30-day death or acute myocardial infarction between high- and low-admitting physician quartiles (unadjusted, 1.70% versus 0.82% and adjusted, 1.33% versus 1.29%). Conclusions: Wide variation persists in physician-level admission rates for emergency department chest pain evaluation, even in a well-integrated health system. There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians. This suggests an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care.

scholarly journals Do You Know How Young Your Heart Is?

2018 ◽  
Vol 24 (2) ◽  
pp. 66-71
Author(s):  
Tase Cristina Ramona ◽  
Cojocaru Lucia ◽  
Rusali Andrei ◽  
Suta Cristina
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Young Patients ◽  
Good Clinical Outcome ◽  
Know How ◽  
Coronary Syndrome ◽  
First Time

Abstract We present the case of a 25 years old patient who was submitted to our unit with a first time acute coronary syndrome. Despite his young age he had multiple cardiovascular risk factors. Although the chest pain was atypical and the electrocardiogram on presentation had unspecific changes, repeated investigations established the diagnosis of anterolateral myocardial infarction. Per primam angioplasty with stent implantation in the proximal segment of left anterior descending artery was performed, with good clinical outcome. Awareness is the key in establishing the diagnosis of myocardial infarction in young patients.

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