scholarly journals Pulmonary Embolism presenting as Syncope

2015 ◽  
Vol 12 (1) ◽  
pp. 37-41
Author(s):  
Dipak Mall ◽  
Yang Shaning
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Cardiac Care ◽  
Appropriate Treatment

The diagnosis of Pulmonary embolism can easily be missed if it is not considered as one of the major differential diagnosis in a case of syncope without chest pain. We describe a case of a 74years old female with pulmonary embolism induced syncope, which highlights one of the difficulties in diagnosing pulmonary embolism. In a patient presenting in syncope without chest pain but raised troponin, the possibility of pulmonary embolism should also be considered if it does not fit with myocardial infarction. Otherwise, the diagnosis can be easily missed and patients may not receive appropriate treatment resulting in increased mortality. Pulmonary embolism should be considered in the differential diagnosis of every syncopal event in Emergency department and Cardiac care units. DOI: http://dx.doi.org/10.3126/njh.v12i1.12343 Nepalese Heart Journal Vol.12(1) 2015: 37-41

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

Acute Pericardial Fat Necrosis

2010 ◽  
pp. 305-308
Author(s):  
Edward C. Rosenow
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Fat Necrosis ◽  
Pleuritic Chest Pain ◽  
Pericardial Fat

• Mostly left-sided • Affects females more than males • Acute severe pleuritic chest pain ∘ Differential diagnosis • Myocardial infarction • Pericarditis • Pulmonary embolism • Obesity may or may not be present • On CT, necrosis produces irregularity mimicking neoplasm but also fat density...

scholarly journals Spontaneous Sternal Fracture — A Misnomer

1986 ◽  
Vol 79 (3) ◽  
pp. 175-176 ◽  
Author(s):  
R C Bowyer ◽  
V L R Touquet
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Sudden Onset ◽  
Sternal Fracture ◽  
Uncomplicated Case ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Sternal Fractures

Spontaneous sternal fractures, although rare, may present to the Accident and Emergency Department as a severe central chest pain of sudden onset. These may be confused with myocardial infarction1 or pulmonary embolism2. Treatment in the uncomplicated case may be symptomatic with analgesics, but this fracture may require sternal wiring if paradoxical sternal movement embarrasses respiration. Spontaneous fracture of the sternum appears in the majority of cases to be due either to secondary metastatic infiltration, myelomatosis or extreme osteoporosis3. We report a case which emphasizes the importance of investigating these patients.

scholarly journals Meningococcemia Presenting as a Myocardial Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Lachant ◽  
David Trawick
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiogenic Shock ◽  
Neisseria Meningitidis ◽  
Early Recognition ◽  
Myocardial Dysfunction ◽  
Shortness Of Breath ◽  
Gram Negative ◽  
St Elevation

Neisseria meningitidisis an encapsulated gram negative diplococcus that colonizes the nasopharynx and is transmitted by aerosol or secretions with the majority of cases occurring in infants and adolescents. Meningococcemia carries a high mortality which is in part due to myocarditis. Early recognition and prompt use of antibiotics improve morbidity and mortality. We report a 55-year-old male presenting to the emergency department with chest pain, shortness of breath, and electrocardiogram changes suggestive of ST elevation MI who developed cardiogenic shock and multisystem organ failure fromN. meningitidis. We present this case to highlight the unique presentation of meningococcemia, the association with myocardial dysfunction, and the importance of early recognition and prompt use of antibiotics.

P2673Challenging time limits: Using a single high-sensitive troponin I to rule-out acute myocardial infarction in early presenters

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Hansen ◽  
C Bang ◽  
K G Lauridsen ◽  
C A Frederiksen ◽  
M Schmidt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Troponin I ◽  
Regional Hospital ◽  
Late Presenters ◽  
Siemens Healthcare ◽  
High Sensitive Troponin ◽  
Rule Out

Abstract Introduction According to ESC guidelines, an acute myocardial infarction (MI) can be excluded without serial troponin measurements in patients presenting with a single high-sensitive troponin below the 99th percentile and chest pain starting >6 hours prior to admission. However, it is unclear if single-testing of high-sensitive troponin can rule-out MI in early presenters. Purpose To investigate the diagnostic performance of a single value of high-sensitive cardiac troponin I (hs-cTnI) at presentation for ruling-out MI in patients presenting with chest pain to the Emergency Department irrespective of chest pain onset. Methods We conducted a substudy of preliminary data from the RACING-MI trial. We included patients presenting with chest pain suggestive of MI to the Emergency Department of a Regional Hospital. We used the Siemens hs-cTnI (Siemens Healthcare, TNIH, Limit of detection: 2.21 ng/L) and a diagnostic cut-off value <3 ng/L to rule-out MI at presentation. Two physicians independently adjudicated the final diagnosis based on all clinical information. Patients were stratified based on time from chest pain onset to hospital admission as very early (0–3 hours), early (3–6 hours) and late presenters (>6 hours). Results We included 989 patients with available hs-cTnI results at admission. MI was confirmed in 82 (8.3%) patients. Using hs-cTnI <3 ng/L as diagnostic cut-off value at presentation, 302 (30.5%) patients without MI were classified as rule-out. Overall, the negative predictive value (NPV) for MI was 100% (95% CI 98.7–100). Based on chest pain onset, 33.8% of patients were classified as very early, 12.8% as early, and 42.7% as late presenters, with 10.7% patients with unreported/unknown onset. NPV was 100% (95% CI 96.5–100) for very early, 100% (95% CI 88.3–100) for early and 100% (95% CI 97.3–100) for late presenters. Conclusions Using a single hs-cTnI value <3ng/L as diagnostic cut-off to rule-out MI seems to be safe and to allow rapid rule-out of MI in patients presenting with chest pain to the emergency department, even in very early presenters. ClinicalTrials.gov Identifier: NCT03634384. Acknowledgement/Funding Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.

P2674Rapid rule-out of myocardial infarction with a novel high precision point-of-care troponin assay appears safe and effective

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Aldous ◽  
J Pickering ◽  
J Young ◽  
P George ◽  
A Watson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Decision Making ◽  
Emergency Department ◽  
Chest Pain ◽  
High Precision ◽  
Primary Outcome ◽  
Point Of Care ◽  
High Sensitivity ◽  
Research Fellowship ◽  
Rule Out

Abstract Background High sensitivity troponin assays were developed to improve analytical sensitivity and precision at the decision cut-points for the diagnosis and rule out of acute myocardial infarction (AMI). Central laboratory assays have achieved this but point of care assays, which have the ability to accelerate decision making due to much shorter turnaround times, have remained lacking. Purpose To ascertain the threshold for decision making and subsequent clinical utility for ruling out AMI on presentation in patients attending the emergency department acutely with chest pain, using a high precision point of care troponin assay (TnI Nx), (i-STAT, Abbott). Methods We measured arrival TnI-Nx concentrations in stored plasma samples in adults presenting acutely to the emergency department with chest pain. The primary outcome was an AMI or cardiac death on index admission or within 30 days. We used 2000 bootstrapped data sets to derive and validate a suitable threshold for TnI-Nx before calculating diagnostic test performance. We pre-specified this threshold must have a <1% false negative rate for the primary outcome. We compared this with a core laboratory high sensitivity troponin I (hs-TnI) (Abbott Architect) using the early rule-out cut-point (European Society of Cardiology) at the limit of detection (2 ng/L). Results We recruited 1320 patients of whom 192 (14.1%) had the primary outcome. The TnI-Nx threshold was determined to be 8 ng/L with subsequent sensitivity of 99.0% (95% confidence interval: 97.3% to 100%), negative predictive value of 99.7% (99.2% to 100%) and specificity of 59.0% (56.0% to 62.0%). The hs-TnI had a sensitivity of 99.5% (98.2% to 100%), negative predictive value of 99.7% (99.0% to 100%), and specificity of 28.4% (25.8% to 31.2%) at 2ng/L. Conclusion A high precision point of care assay, TnI-Nx, with a decision threshold of 8ng/L, has comparable rule out performance compared with a core laboratory high sensitivity assay and therefore could potentially be used for early decision making in the assessment of acute chest pain. Acknowledgement/Funding Research grant from Abbott Point of Care. Senior Research Fellowship from ECF, CMRF and CDHB. Clinical Research Fellowship from NZ HRC

Cardiac magnetic resonance in the intensive and cardiac care unit

2015 ◽  
Author(s):  
Juerg Schwitter ◽  
Jens Bremerich
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Wide Spectrum ◽  
Cardiac Care ◽  
User Friendliness ◽  
Area At Risk ◽  
Acute Cardiac Care

Current applications of cardiac magnetic resonance offer a wide spectrum of indications in the setting of acute cardiac care. In particular, cardiac magnetic resonance is helpful for the differential diagnosis of chest pain by the detection of ischaemia, myocardial stunning, myocarditis, and pericarditis. Also, Takotsubo cardiomyopathy and acute aortic diseases can be evaluated by cardiac magnetic resonance and are important differential diagnoses in patients with acute chest pain. In patients with restricted windows for echocardiography, according to guidelines, cardiac magnetic resonance is the method of choice to evaluate complications of an acute myocardial infarction. In an acute myocardial infarction, cardiac magnetic resonance allows for a unique characterization of myocardial damage by quantifying necrosis, microvascular obstruction, oedema (i.e. area at risk), and haemorrhage. These features will help us to understand better the pathophysiological events during infarction and will also allow us to assess new treatment strategies in acute myocardial infarction. To which extent the information on tissue damage will guide patient management is not yet clear, and further research, e.g. in the setting of the European Cardiovascular MR registry, is ongoing to address this issue. Recent studies also demonstrated the possiblity to reduce costs in the management of acute coronary syndromes when cardiac magnetic resonance is integrated into the routine work-up. In the near future, applications of cardiac magnetic resonance will continue to expand in the acute cardiac care units, as manufacturers are now strongly focusing on this aspect of user-friendliness. Finally, in the next decade or so, magnetic resonance imaging of other nuclei, such as fluorine and carbon, might become a reality in clinics, which would allow for metabolic and targeted molecular imaging with excellent sensitivity and specificity.

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