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.

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.

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 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.

scholarly journals Predictive factors for myocardial infarction in pre-hospital emergency care

2020 ◽  
Author(s):  
Tomasz P Ilczak ◽  
Michał Ćwiertnia ◽  
Marek Kawecki ◽  
Monika Mikulska ◽  
Wioletta Waksmańska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Predictive Factors ◽  
Emergency Care ◽  
Individual Risk ◽  
Coronary Reperfusion ◽  
Hospital Emergency ◽  
Medical Response ◽  
Myocardial Infraction ◽  
Group B

Abstract Background: Identifying predictive factors based on procedures carried out by emergency medical teams may speed up the diagnosis of AMI. By shortening the time between the onset of the pain and the initiation of coronary reperfusion, patient prognosis can be improved Methods: The study was conducted on residents of the Bielsko-Biała district, served by state ambulance service Medical Response Teams (MRT). The patients were assigned to the following groups: Group A (n = 338) - patients with chest pain in whom infarction with elevation of the ST segment (ST-ACS) was diagnosed on the basis of an ECG, Group B (n=300) - patients with chest pain in whom an infarction was not diagnosed. A factor structural test for the studied parameters was used to determine their significance. An odds ratio (OR) was established for statistically significant parameters, and multi-dimensional logistic regression analysis was conducted. The significance of the odds ratios (OR) was estimated for individual risk factors based on 95% confidence intervals (CI). Results: It can be stated with 95% probability that the significant parameters: Male (p=0.00001), Age 51-70(p=0.00307), Breathing rate less than 12/min(p=0.02711), Pulse below 60 min (p=0.00165), Edemas (p=0.00075), Moist skin(p<0.01), Sinus rhythm (p=0.00004), Additional ventricular beats(p=0.00133) increase the risk of myocardial infraction. Conclusion: Identifying the predictors of myocardial infarction specific to pre-hospital emergency care is essential for improving the detection of AMI and shortening the time between calls to the MRT and the initiation of coronary reperfusion.

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.

scholarly journals Recommendation for Inclusion of Surface Echocardiography in Evaluation of Chest Pain in Acute Emergency Care

2021 ◽  
Vol 5 (02) ◽  
pp. 097-102
Author(s):  
Viju Wilben ◽  
Dhruvin Limbad ◽  
Bijay BS ◽  
Srinath TS ◽  
Muralidhar Kanchi
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Emergency Care ◽  
Predictive Value ◽  
Confusion Matrix ◽  
True Negative ◽  
Coronary Syndrome ◽  
Bedside Echocardiography ◽  
St Segment

Abstract Objective  A significant number of conditions may mimic acute myocardial infarction when patients present to acute emergency care (AEC) with chest pain. A proportion of such patients may exhibit ST segment abnormality on the electrocardiogram (ECG) which is due to conditions other than acute coronary syndromes (ACS) or myocardial infarction. The American Heart Association/American College of Cardiology guidelines (2015) algorithm for ACS does not include echocardiographic evaluation in the assessment of chest pain. Patients with chest pain may be subjected to investigations and interventions based on ECG leading unwarranted invasive procedures, which may prove unnecessary, futile, and even detrimental. This study was performed to determine if a bedside echocardiography would help identify the conditions that do not need intervention and might possibly change the treatment pathway at the right time. Materials and Methods In a prospective observational study design, adult patients presenting to AEC with chest pain were included in the study. After the assessment of airway, breathing and circulation, and initiation of bed side monitoring, a 12-lead ECG was obtained. Patients exhibiting a significant ST change on ECG were subjected to bedside echocardiography, that is, two-dimensional (2D) transthoracic echocardiography (2D-TTE) with a cross reference to a consultant cardiologist for the precise assessment and diagnosis. The findings of echocardiography were correlated with electrocardiogram for possible diagnostic coronary angiography and percutaneous coronary intervention. The results of ECG, echocardiography, and coronary angiography (if done) were analyzed to determine the sensitivity and specificity of echocardiography for ACS. Results Among 385 patients in the study, 312 were suspected to suffer acute coronary syndrome; among these patients, eight patients turned out to have chest pain due to non-ACS. Of the 73 patients, the chest pain was suspected to be not of cardiac ischemia origin; among these patients, 66 patients were true negative and 7 patients were false positive. Echocardiography was the predictive of ischemic chest pain with a predictive value of 97.7%. The specificity of echocardiography calculated from the above confusion matrix was 90.4% and sensitivity was 97.4%. The positive predictive value of 2D-TTE was 97.7% and negative predictive value was 89.1%. The overall accuracy of bedside 2D-TTE was 96.1%. Conclusion Echocardiography was found to be an effective tool in aiding diagnosis of a patient presenting to AEC with chest pain and ST-T changes in ECG. A significant percentage of patients (18.7%) presented to AEC with chest pain, ST-T changes and found to have causes other than ACS, and screening echocardiography (2D-TTE) was able to identify 90.4% of those cases. From this study, we conclude that bedside echocardiography had high specificity (90.4%) and sensitivity (97.43%) in identifying regional wall motion abnormality due to ACS. Hence, bedside echocardiography is recommended in patients with chest pain and ST-segment abnormality to avoid unnecessary delay in diagnosis and invasive interventions in non-ACS.

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.

Women and coronary disease: relationship between descriptors of signs and symptoms and diagnostic and treatment course

1998 ◽  
Vol 7 (3) ◽  
pp. 175-182 ◽  
Author(s):  
S Penque ◽  
M Halm ◽  
M Smith ◽  
J Deutsch ◽  
M Van Roekel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chest Pain ◽  
Signs And Symptoms ◽  
The United States ◽  
Therapeutic Interventions ◽  
Initial Symptom ◽  
Men And Women ◽  
To Receive

BACKGROUND: Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and therapeutic interventions. PURPOSE: To explore the relationship between descriptors of signs and symptoms of coronary heart disease and follow-up care and to investigate any differences between male and female patients. METHODS: Structured interviews with patients and chart audits were used to assess initial signs and symptoms, associated cardiac-related signs and symptoms, and the diagnostic tests and interventions used for treatment. The sample consisted of 98 patients (51 women and 47 men) who were admitted with a medical diagnosis of myocardial infarction. RESULTS: Chest pain was the most common sign or symptom reported by both men and women. The 4 most common associated signs and symptoms were identical in men and women: fatigue, rest pain, shortness of breath, and weakness. However, significantly more women than men reported loss of appetite, paroxysmal nocturnal dyspnea, and back pain. Women were also less likely than men to have angiography and to receive i.v. nitroglycerin, heparin, and thrombolytic agents as part of acute management of myocardial infarction. CONCLUSION: Chest pain remains the initial symptom of acute myocardial infarction in both men and women. However, women may experience some different associated signs and symptoms than do men. Despite these similarities, men still are more likely than women to have angiography and to receive a number of therapies.

scholarly journals Approach to: Chest pain

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nasim Haghandish
Keyword(s):  
Myocardial Infarction ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Physical Examination ◽  
Signs And Symptoms

The diagnosis of chest pain is not always due to a cardiac cause such as a myocardial infarction. In fact, non-cardiac causes of chest pain may present with similar signs and symptoms. This article delves into the differential diagnosis of chest pain using an anatomical approach and describes how a thorough history, physical examination as well as specific tests are required to confirm each diagnosis.

Plasma Fibrinopeptide A and Beta-Thromboglobulin in Patients with Chest Pain

1983 ◽  
Vol 50 (02) ◽  
pp. 541-542 ◽  
Author(s):  
J T Douglas ◽  
G D O Lowe ◽  
C D Forbes ◽  
C R M Prentice
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Unstable Angina ◽  
Plasma Levels ◽  
Thrombin Generation ◽  
Acute Chest Pain ◽  
Fibrinopeptide A ◽  
Control Hospital ◽  
Hospital Patients ◽  
Platelet Release

SummaryPlasma levels of β-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p < 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

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