scholarly journals PEMBERIAN TERAPI OKSIGEN PADA PASIEN ACUTE CORONARY SYNDROME DENGAN CHEST PAIN DI INSTALASI GAWAT DARURAT

2017 ◽  
Vol 13 (3) ◽  
Author(s):  
Dewi Rachmawati
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Pain Patient ◽  
Coronary Syndrome ◽  
Chest Pain Patient

Emergency nurses’s somehow actually routine use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome is done, without know that routine oxygen theraphy may potentially cause harm. The used method was by collecting and analyzing related textbook and articles with the use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome. The literatures were obtained from textbook and electronic articles such as ScienceDirect, World Health Organization, Google Scholar, PubMed and ClinicalKey with textbook and article criteria that were published from 2000 to 2015. The result is routine use of supplemental oxygen theraphy for Acute Coronary Syndrome (ACS) with chest pain based on physical assessment and level of oxygen saturation. The patient of ACS with chest pain without sign and symtoms hypoxia or respiratory distress, syok and heart failure with oxygen saturation ≥94% then without oxygen theraphy, if the patient with one or all of sign and symtoms above with oxygen saturation <94% then oxygen therapy can be given with initial administration is 4 L/minute and in titration until oxygen saturation ≥94% with administered more than than 6 hours. The next reassessment is done to the patient. If the condition of the airway patent, the patient can breathe spontaneously, normal breathing (especially rhythm, depth and no respiratory muscle use), respiratory or oxygenation problems minimally and oxygen saturation > 94% then oxygen therapy can be given with nasal cannul 4-6L / minute or simple mask from 6- 10L / minute. If the patient is emergency condition with airway patent, spontaneous breathing with adequate depth ventilation and requiring oxygen in high concentrations may then be provided with a non-rebreathing mask. The conclucion is routine use of supplemental oxygen theraphy in acute coronary syndrom with chest pain not recommended and the oxygen theraphy can be given if the patient with oxygen saturation <94% or sign and symtoms hypoxia or respiratory distress, breathlessness, syok and heart failure Key word :Acute Coronary Syndrome, Chest Pain, Emergency Unit, Oxygen Therapy 

Circulating secretoneurin concentrations are increased in patients with acute coronary syndrome and provide prognostic information

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Myhre ◽  
A.H Ottesen ◽  
A.L Faaren ◽  
S.H Tveit ◽  
J Springett ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Myocardial Ischemia ◽  
Funding Source ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Favorable Prognosis ◽  
Risk Of Mortality ◽  
Pain Patients

Abstract Background Secretoneurin (SN) is associated with both myocardial ischemia and cardiomyocyte Ca2+ handling, and circulating SN levels provide incremental prognostic information to established risk indices in patients with acute heart failure, acute respiratory failure, and after cardiac arrest. Purpose To determine whether SN concentrations are increased in patients with acute coronary syndrome (ACS), and assess the prognostic value of SN among patients with suspected ACS. Methods We included 402 patients hospitalized with chest pain at a teaching hospital and adjudicated all hospitalizations as ACS or non-ACS by two physicians working independently. Blood samples were drawn within 24 h from hospital admission and SN was measured by a novel ELISA assay. Patients were followed for mean 6.2 years and mortality was obtained from the Norwegian Cause of Death Registry. Results SN concentrations were higher in patients with ACS (n=161 [40%]) compared to patients with chest pain without ACS (n=241 [60%]): median 32.8 (IQR 27.5–42.8) vs. 28 (24.5–34.0) pmol/L, p&lt;0.001. The C-statistics of SN was 0.66 (95% CI: 0.61–0.71) to separate chest pain patients with ACS from chest pain patients without ACS compared to 0.82 (0.78–0.86) for high-sensitivity cardiac troponin T (hs-cTnT). Patients with ECG changes reflective of acute myocardial ischemia had higher SN concentrations (p=0.005). Sixty-five (16%) patients died during follow-up. Stratifying patients according to SN concentrations separated patients with a poor and favorable prognosis, and patients with SN in the top quartile had 4-fold higher risk of mortality compared to the patients with low SN concentrations (Figure). Higher SN concentrations were also associated with increased risk of mortality in Cox regression models, including in models that adjusted for age, sex, blood pressure, previous myocardial infarction, atrial fibrillation, and heart failure: hazard ratio 1.71 (1.03–2.84), p=0.038. The C-statistics of SN to separate patients with poor prognosis from favorable prognosis was 0.72 (0.65–0.79) and adding SN on top of hs-cTnT improved prognostication as assessed by the integrated discrimination index: 0.05±0.014, p&lt;0.001. Conclusions SN concentrations are increased in patients with ACS and provide prognostic information in patients with chest pain. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Akershus Unviersity Hospital, CardiNor AS

scholarly journals An audit of paramedic administration of oxygen therapy to patients with suspected acute coronary syndrome

2019 ◽  
Vol 16 ◽  
Author(s):  
Christopher Chun Wen Wong ◽  
Prof. Anne Wilson ◽  
Prof. Hugh Grantham
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Oxygen Therapy ◽  
Adherence Rate ◽  
Current Guideline ◽  
The South ◽  
Coronary Syndrome ◽  
Suspected Acute Myocardial Infarction

IntroductionIn the past, high flow oxygen was routinely administered to patients with suspected acute myocardial infarction. Recent evidence has suggested there is no benefit from hyperoxaemia, and in these patients it might result in adverse outcomes. The Australian and New Zealand Council of Resuscitation (ANZCOR) guideline previously recommended routine oxygen therapy, but a recent change has occurred. The ANZCOR current guideline recommends selective use of oxygen therapy in patients with suspected acute myocardial infarction, to achieve oxygen saturations ≥94% and <98%. Because the change occurred recently, the South Australian paramedic adherence rate to the ANZCOR guideline was unknown. Therefore, the aim of this study was to determine the South Australian paramedic adherence rate to the ANZCOR oxygen use in acute coronary syndrome recommendations.MethodsA retrospective audit of patient case notes was conducted, for patients with chest pain presenting via ambulance to a tertiary hospital emergency department, during a 3-month period. Paramedic administration of oxygen therapy was then compared against the ANZCOR recommendations.ResultsParamedics treated a total of 111/139 (79.9%, CI 72.4–85.7%) in line with the ANZCOR guideline and the treatment of 28/139 (20.1%, CI 14.3–27.6%) fell outside of the recommendations.ConclusionAlthough the results demonstrated a degree of compliance, this could be improved through clinical education, a review of the local chest pain guidelines, an introduction of a drug protocol for oxygen therapy and future research investigating the reasons for non-compliance to the best practice guidelines.

Impact of Diabetes Mellitus on in Hospital Adverse Outcomes after First Episode of Acute Coronary Syndrome

2021 ◽  
Vol 15 (12) ◽  
pp. 3343-3344
Author(s):  
Muhammad Fahim ul Hassan ◽  
Nasir Iqbal ◽  
Muhammad Ijaz Bhatti ◽  
M. I. Hanif ◽  
H. A. Abdullah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Adverse Outcomes ◽  
Diabetic Group ◽  
First Episode ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Group A ◽  
Typical Chest Pain

Objective: To determine the impact of diabetes on adverse outcomes amongst patients presenting for the first time with acute coronary syndrome. Study design: Cohort Study Methodology: A total of 340 patients were enrolled in this study. At presentation patients were divided in two equal age and gender matched groups with 170 patients in Group-A having diabetes and another 170 being non-diabetics in Group-B. Patients were followed up for period of index hospitalization and all adverse outcomes were noted in both groups as per operational definition. Results: Mean age in Group-A with diabetes was 54±12.7 years whereas in non diabetics it was56±13.12 years. In both groups there was male predominance with approximately 60% males and 40% females. In diabetic group, 38% patients had typical chest pain, 62% patients had dyspnea, 20% patients had cardiogenic shock while in non diabetic group, 20% patients had typical chest pain, 40% patients had dyspnea, 10% patients had cardiogenic shock. In diabetic group, 38% patients had heart failure, 10% patients died while in non diabetics 20% had heart failure and 5% patients died. Conclusion: This study concluded that in hospital adverse outcomes after first episode of acute coronary syndrome were more frequent in diabetic patients as compare to non diabetic patients. Keywords: Acute coronary syndrome, Adverse outcomes, First attack

A PILOT STUDY: PLASMA GALECTIN-3 LEVEL IN HEART FAILURE PATIENTS

2017 ◽  
pp. 101-106
Author(s):  
Thi Thanh Hien Bui ◽  
Hieu Nhan Dinh ◽  
Anh Tien Hoang
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Kidney Disease ◽  
Heart Failure Patients ◽  
Coronary Syndrome ◽  
Nyha Classification ◽  
Galectin 3 ◽  
Severe Chronic Kidney Disease ◽  
Esc Guidelines

Background: Despite of considerable advances in its diagnosis and management, heart failure remains an unsettled problem and life threatening. Heart failure with a growing prevalence represents a burden to healthcare system, responsible for deterioration of patient’s daily activities. Galectin-3 is a new cardiac biomarker in prognosis for heart failure. Serum galectin-3 has some relation to heart failure NYHA classification, acute coronary syndrome and clinical outcome. Level of serum galectin-3 give information for prognosis and help risk stratifications in patient with heart failure, so intensive therapeutics can be approached to patients with high risk. Objective: To examine plasma galectin-3 level in hospitalized heart failure patients, investigate the relationship between galectin-3 level with associated diseases, clinical conditions and disease progression in hospital. Methodology: Cross sectional study. Result: 20 patients with severe heart failure as NYHA classification were diagnosed by The ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2012) and performed blood test for serum galectin-3 level. Increasing of serum galectin-3 level have seen in all patients, mean value is 36.5 (13.7 – 74.0), especially high level in patient with acute coronary syndrome and patients with severe chronic kidney disease. There are five patients dead. Conclusion: Serum galectin-3 level increase in patients with heart failure and has some relation to NYHA classification, acute coronary syndrome. However, level of serum galectin-3 can be affected by severe chronic kidney disease, more research is needed on this aspect Key words: Serum galectin-3, heart failure, ESC Guidelines, NYHA

Impact on the Care of the Emergency Department Chest Pain Patient from the Chest Pain Evaluation Registry (CHEPER) Study

1997 ◽  
Vol 80 (5) ◽  
pp. 563-568 ◽  
Author(s):  
Louis G Graff ◽  
John Dallara ◽  
Michael A Ross ◽  
Anthony J Joseph ◽  
James Itzcovitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Pain Patient ◽  
Pain Evaluation ◽  
Chest Pain Patient

scholarly journals Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yue Yu ◽  
Ren-Qi Yao ◽  
Yu-Feng Zhang ◽  
Su-Yu Wang ◽  
Wang Xi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Linear Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Oxygen Therapy ◽  
Ambient Air ◽  
Supplemental Oxygen ◽  
Research Database ◽  
Icu Mortality

Abstract Background The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data. Methods Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings. Results A total of 2922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1230/2922) patients were exposed to oxygen therapy, and 57.9% (1692/2922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality [odds ratio (OR) 1.30; 95% confidence interval (CI) 0.92–1.82; P = 0.138] or ICU mortality (OR 1.39; 95% CI 0.83–2.32; P = 0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06–1.15; P <  0.001) and hospital LOS (OR 1.06; 95% CI 1.01–1.10; P = 0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups. Conclusion Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.

scholarly journals Efficacy of thrombolytics in patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Vasin ◽  
O Mironova ◽  
V Fomin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Thrombolytic Therapy ◽  
Prehospital Care ◽  
Optimal Choice ◽  
Hospital Treatment ◽  
Complication Rates ◽  
Coronary Syndrome ◽  
Thrombolytic Drug ◽  
Systemic Thrombolytic Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: The optimal choice of the thrombolytic drug for emergency revascularization in patients with acute coronary syndrome (ACS) still remains to be defined. Percutaneous coronary intervention is a more safe and effective method of reperfusion compared with thrombolytic therapy, that’s why the last is relatively not common nowadays. But in the COVID-19 era in a number of cases some patients with ACS can’t be quickly hospitalized due to different reasons like the absence of the nearest available cardiovascular center, or lack of an ambulance. A long period of chest pain forces the doctors to use systemic thrombolytic therapy. Purpose This study investigates the efficacy and safety of Alteplase, Prourokinase, Tenecteplase, and Streptokinase in patients with acute coronary syndrome. Methods A retrospective, open, non-randomized cohort study was conducted. We have analysed 600 patients with ACS, who underwent systemic thrombolytic therapy at the prehospital and in-hospital stages from 2009 to 2011. Patients were divided into several groups according to the thrombolytic agent administered: Alteplase (254 patients), Prourokinase (309 patients), Tenecteplase (6 patients), Streptokinase (31 patients). Treatments were to be given as soon as possible. The ECG reperfusion criterion was a decrease in the ST segment by 50% or more from the initial elevation. Results  Among 600 patients (mean age, 61 years (SD = 20); 119 women [19.7%]), 440 had successful reperfusion. The median time from chest pain onset to the start of treatment was 3 hours (P &lt; 0.001). The percentages of successful thrombolysis for each agent were similar: Alteplase 74,4% Prourokinase 71,2%, Tenecteplase 83%, Streptokinase 74,2%. No statistical differences were observed in thrombolytic results among these groups (OR: 0.60, 95% CI: 0,2868 to 1,217; P = 0.17). At the same time, the hospital treatment with prourokinase was more effective than prehospital care with prourokinase: 110 successful reperfusions in 138 patients (79.7%) and 110 successful reperfusions in 171 patients (64.3%), respectively. Regardless of the onset of the attack (OR: 0.45, 95% CI: 0,2004 to 0,9913; P = 0.05). The effectiveness of the other thrombolytics cannot be compared between prehospital care and hospital treatment due to the rare use at the hospital stage in our cases. In the study, there was also no statistical difference in complication rates among the treatment groups. Among all patients, there were 9 fatal outcomes (1.5%): Alteplase 3,15% Prourokinase 1,9%, Streptokinase 3,22%. Conclusion(s): In patients with ACS, all thrombolytic drugs showed similar effectiveness. There is no difference in the safety and efficacy among the agents in our study, but there is a difference in cost and route of administration. However, upcoming prospective trials with long follow-up periods might be expected to determine the most appropriate systemic thrombolytic drug.

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