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.

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.

Benefit of late coronary reperfusion in patients with acute myocardial infarction and persistent ischemic chest pain

1994 ◽  
Vol 74 (6) ◽  
pp. 538-543 ◽  
Author(s):  
Bruce R. Brodie ◽  
Thomas D. Stuckey ◽  
Charles Hansen ◽  
Denise Muncy ◽  
Richard A. Weintraub ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Reperfusion

scholarly journals CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Rajesh Kumar Singhal ◽  
Harsha Kumar Gowardhan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Elderly Patients ◽  
The Elderly ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
Clinical Presentations ◽  
Myocardial Infraction

Background: The cardiovascular diseases (CVDs) have become the leading cause of mortality worldwide. There is an increasing burden on health care systems associated with MIs in the elderly, differences in clinical picture, and difficulties in dealing with elderly patients with myocardial infraction (MI). Aim: The aim of study is to evaluate the different clinical presentations, risk factors and complications of elderly patients presenting with acute myocardial infarction. Methods: This is a retrospective, cross sectional study done over a period of 1 year. A total of 100 elderly patients who were diagnosed as AMI were included in the study. We studied Demographic features, cardiovascular risk factors, varied clinical presentations Electrocardiogram (ECG) findings from the history proformas and documented. Results: A total of 100 patients diagnosed with MI were studied. Mean age of the study population was 69.41 years and were predominantly male (84%). The most common presenting symptom was chest pain (79%) followed by sweating (7%), followed by shortness of breath (5%), giddiness (4%) vomiting (3%) and palpitations (2%). hypertension was commonly seen in elderly (56%) followed by diabetes (39%), smoking (28%), dyslipidaemias (12%), history of CAD (9%) and obesity (6%).  Mortality rate was 26% and maximum (11%) patients belonged to age group >80 years. Conclusion: We conclude that chest pain is the most common presentation in elderly AMI patients, but other atypical symptoms such as shortness of breath, giddiness, vomiting, without chest pain can also be the common presenting signs. Early and prompt management as appropriate should be provided to avoid morbidity and mortality in elderly. Keywords: Clinical Profile, Mortality, Myocardial Infarction, Risk Factors.

scholarly journals THE EFFECTIVENESS OF USING ECG TELETRANSMISSION DURING EMERGENCY MEDICAL TEAM INTERVENTIONS

2021 ◽  
Vol 8 (1) ◽  
pp. 27-31
Author(s):  
Tomasz Ilczak ◽  
Monika Mikulska ◽  
Małgorzata Anna Rak ◽  
Michał Ćwiertnia ◽  
Piotr Białoń ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Interventional Cardiology ◽  
Time Of Arrival ◽  
Results Of Treatment ◽  
Medical Response ◽  
Significant Dependence ◽  
Emergency Medical ◽  
Response Team ◽  
Group B ◽  
Time Required

Aim: To determine the importance of electrocardiogram (ECG) teletransmission on the time required for decisions on diagnosis and treatment and the transport of patients with myocardial infarction. Material and methods: This study is retrospective in character and concerns the regional activities of the Bielsko Emergency Medical Services and the possibility of sending medical data electronically from a patient’s location to the clinic of interventional cardiology (CIC). Group A (n=237) included patients in whom the Medical Response Team (MRT) confirmed ST-Elevation Myocardial Infarction (STEMI) and carried out an ECG with data teletransmission to the CIC. Group B (n=101) included patients in whom the MRT confirmed STEMI and carried out an ECG without teletransmission. For both groups, the MRT recorded the time of arrival at the patient’s location and the time when the patient was handed over to the CIC. Results: A group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed STEMI. A significant dependence was demonstrated of the time t [mins] of teletransmission (p=0.00308). A significant dependence was demonstrated of the effect of distance s [kms] (p=0.00000). A significant dependence was demonstrated of the time t from the place of residence, taking into account the distance s (p=0.00929). Conclusions: Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with STEMI, and thus improves the results of treatment.

Chest Pain in an Out-of-Hospital Emergency Setting: No Relationship Between Pain Severity and Diagnosis of Acute Myocardial Infarction

Pain Practice ◽  
2014 ◽  
Vol 15 (4) ◽  
pp. 343-347 ◽  
Author(s):  
Michel Galinski ◽  
Diane Saget ◽  
Mirko Ruscev ◽  
Geraldine Gonzalez ◽  
Lydia Ameur ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Pain Severity ◽  
Emergency Setting ◽  
Hospital Emergency

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.

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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