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

scholarly journals Novel Antiplatelet Agent Use for Acute Coronary Syndrome in the Emergency Department: A Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
M. Curial ◽  
E. Nath ◽  
E. Lang
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Current Evidence ◽  
Final Decision ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background. Acute Coronary Syndrome (ACS) is a clinical condition encompassing ST Segment Elevation Myocardial Infarction (STEMI), Non-ST Segment Elevation Myocardial Infarction (NSTEMI), and Unstable Angina (UA) and is characterized by ruptured coronary plaque, ischemic stress, and/or myocardial injury. Emergency department (ED) physicians are on the front lines of ACS management. The role of new antiplatelet agents ticagrelor and prasugrel in acute ED management of ACS has not yet been defined.Objective. To critically review clinical trials using ticagrelor and prasugrel in the treatment of ACS and inform practitioners of their potential utility in treating ACS in the ED.Results. Trials on the efficacy of ticagrelor and prasugrel achieve statistical significance in decreasing composite endpoints in select patient populations.Conclusion. The use of ticagrelor and prasugrel as first line ED treatment of ACS is not well established. Current evidence supports the use of several agents with the final decision based on treatment protocols conjointly developed between cardiology and emergency medicine (EM). Further clinical trials involving head-to-head trials or comparisons of drug-based strategies are required to show superiority in reducing cardiac endpoints with regard to ED initiation of treatment.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

Clots Kill: Hematologic Pharmacology for ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 32 (6) ◽  
pp. 35-41
Author(s):  
Stacy H. James
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Agents ◽  
Thrombin Inhibitors ◽  
Fibrinolytic Agents ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Drugs that work on the hematologic system play an important role in helping to limit the morbidity and mortality that can be associated with an acute coronary syndrome. The pharmacology of the fibrinolytic agents, thrombin inhibitors, and antiplatelet agents is described. A case study of a woman having an ST-segment elevation myocardial infarction is reviewed to highlight the importance of drugs that work on the hematologic system.

scholarly journals Old and New Players in Oral Antiplatelet Therapy in Treatment of Acute Coronary Syndrome

1970 ◽  
Vol 1 (1) ◽  
pp. 49-55
Author(s):  
SC Kohli
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Antiplatelet Drugs ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Oral antiplatelet therapy plays an important role in treating patients with acute coronary syndrome (ACS), including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) and patients with ST-segment elevation myocardial infarction (STEMI). All antiplatelet drugs in addition to inhibiting acute arterial thrombosis have danger of interfering with the physiologic role of platelet hemostasis. Bleeding is a major factor in evaluating the utility of available and upcoming antiplatelet drugs and their combination regimes. The role of anti platelet agents in the treatment of ACS has undergone significant changes over the past several years. Aspirin, thienopyridines, and glycoprotein (GP) IIb/IIIa inhibitors are now standard parts of the treatment of STEMI, NSTEMI and UA whether an early invasive or an initial conservative strategy is chosen. Antiplatelet drugs have an important role in secondary prevention in the patients of ischaemic heart disease. Keywords: Acute Coronary Syndrome; antiplatelet therapy; thienopyridines. DOI: http://dx.doi.org/10.3126/njms.v1i1.5799   Nepal Journal of Medical Sciences. 2012; 1(1): 49-55

scholarly journals Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burden in Patients With Acute Coronary Syndrome

2019 ◽  
Vol 25 ◽  
pp. 107602961882441 ◽  
Author(s):  
Hakan Duman ◽  
Göksel Çinier ◽  
Eftal Murat Bakırcı ◽  
Handan Duman ◽  
Ziya Şimşek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Coronary Thrombus ◽  
St Segment

Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 [48.7%]) and ST-segment elevation myocardial infarction (178 [51.3%]). The CAR was significantly higher in patients with higher thrombus burden (24.4 [1.2-30.2] vs 31.9 [2.2-31.3], P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio [OR]: 0.047; 95% confidence interval [CI]: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil–lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker for increased coronary thrombus burden that is associated with adverse CV outcomes.

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