scholarly journals Value of the Resting Electrocardiogram in Assessing Patients with Recent Onset Chest Pain A Study in Tertiary Care Hospital, Dhaka Bangladesh

2018 ◽  
Vol 9 (2) ◽  
pp. 65-68
Author(s):  
Udoy Shankar Roy ◽  
Md Murshidur Rahman Khan ◽  
Tapas Kanti Bhowmik ◽  
Ramendra Nath Sarker
Keyword(s):  
Myocardial Infarction ◽  
Peptic Ulcer ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Bypass Surgery ◽  
Chronic Stable Angina ◽  
Anxiety Neurosis ◽  
Ulcer Disease ◽  
Recent Onset

Background: Chest pain or discomfort caused by acute coronary syndrome (ACS) or angina has a potentially poor prognosis, emphasizing the importance of prompt and accurate diagnosis. To evaluate a clinic set up specifically to assess patients with recent onset chest pain, particularly those presenting with a normal resting electrocargram.Method: The cross-sectional study was carried out from September 2016 to August 2017 in cardiology department of Shaheed Suhrawardy Medical College hospital, Sher-E-Bangla Nagar, Dhaka. Total 1000 consecutive patients with recent onset chest pain were evaluated within 24 hours of general practitioner referral, to find out the clinical diagnosis and management.Results: Total 1000 patients (535 men and 465women, mean age 51.5±11.4 years with range from 32 to 70 years) were assessed over 12 months. Most of the patients 844 (84.4%) had symptoms in duration of ≤30 days. Majority 433 (43.3%) patients had peptic ulcer disease (PUD), 317 (31.7%) patients had chronic stable angina (CSA), 94 (9.4%) had unstable angina (UA), 92 (9.2%) had anxiety neurosis (AN) and 64 (6.4%) had myocardial infarction (MI). Regarding outcome of the patients 525 (52.5%) [PUD: 433+ AN: 91] patients considered to have noncardiac pain and referred to medicine outpatient department (OPD) without further follow up. In a further 317 patients (31.7%, CSA) arrangements were made for outpatient review. Ninety four patients (9.4%, UA) were referred to National Institute of Cardiovascular diseases (NICVD) for admission out of them 61 patients were admitted for medical treatment & 33 patients were discharged from emergency department whose troponin-I were negative. Remaining 64 (6.4%) acute MI patients were admitted into Coronary Care Unit (CCU) of NICVD, out of them 41 patients received streptokinase injection, 23 patients received Enoxaparin injection, after conservative treatment all patients were advised to do coronary angiography within 3 to 4 weeks. Among these 43 patients underwent coronary angiography within 4 weeks, 23 patients had coronary angioplasty, eleven patients had coronary bypass surgery and nine patients refused any intervention and discharged with medicine.Conclusion: This experience highlights the inadequacy of a routine electrocardiogram reporting service in patients with recent onset of chest pain. Clinical diagnosis found were peptic ulcer disease (PUD), chronic stable angina (CSA), unstable angina (UA), anxiety neurosis and myocardial infarction (MI). Regarding outcome of the patients were coronary angiography followed by coronary angioplasty, coronary artery bypass surgery, discharged with medicine and referred to out patients department of medicine unit.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 65-68

scholarly journals Downstream testing after CT coronary angiography: time for a rethink?

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001597
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Alice Veitch ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Communication Systems ◽  
Ct Coronary Angiography ◽  
Second Line ◽  
Recent Onset ◽  
Line Test ◽  
Artery Disease

ObjectiveWe surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.MethodsA prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.Results5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.ConclusionsWhile CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS)

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Whady A. Hueb ◽  
Paulo Rogério Soares ◽  
Sérgio Almeida de Oliveira ◽  
Shiguemituzo Ariê ◽  
Rita Helena A. Cardoso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Angioplasty ◽  
Bypass Surgery ◽  
Random Assignment

Background —Although coronary angioplasty and myocardial bypass surgery are routinely used, there is no conclusive evidence that these interventional methods offer greater benefit than medical therapy alone. This study is intended to evaluate, in a prospective, randomized, and comparative analysis, the benefit of the 3 current therapeutic strategies for patients with stable angina and single proximal left anterior descending coronary artery stenosis. Methods and Results —In a single institution, 214 patients with stable angina, normal ventricular function, and severe proximal stenosis (>80%) on the left anterior descending artery were selected for the study. After random assignment, 70 patients were referred to surgical treatment, 72 to angioplasty, and 72 to medical treatment. The primary end points were the occurrence of acute myocardial infarction or death and presence of refractory angina. After a 5-year follow-up, these combined events were reported in only 6 patients referred to surgery as compared with 29 patients treated with angioplasty and 17 patients who only received medical treatment ( P =0.001). However, no differences were noted in relation to the occurrence of cardiac-related death in the 3 treatment groups ( P =0.622). No patient assigned to surgery needed repeat operation, whereas 8 patients assigned to angioplasty and 8 patients assigned to medical treatment required surgical bypass after the initial random assignment. Surgery and angioplasty reduced anginal symptoms and stress-induced ischemia considerably. However, all 3 treatments effectively improved limiting angina. Conclusions —Bypass surgery for single-vessel coronary artery disease is associated with a lower incidence of medium-term and long-term events as well as fewer anginal symptoms than that found in the patients who underwent angioplasty or medical therapy. In this study, coronary angioplasty was only superior to medical strategies in relation to the anginal status. However, the 3 treatment regimens yielded a similar incidence of acute myocardial infarction and death. Such information should be useful when choosing the best therapeutic option for similar patients.

scholarly journals Risk factor Analysis and Angiographic Profiles in First 228 Cases Undergone Coronary Angiography in Cardiac Cath Lab of Dhaka Medical College Hospital

1970 ◽  
Vol 3 (2) ◽  
pp. 122-125 ◽  
Author(s):  
AEMM Islam ◽  
M Faruque ◽  
AW Chowdhury ◽  
HIR Khan ◽  
MS Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Coronary Angiography ◽  
Medical Therapy ◽  
Stable Angina ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Single Vessel

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females. Key words: Risk factors; Coronary angiography. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9179 Cardiovasc. J. 2011; 3(2): 122-125

A study on the clinical profile and risk factors of ischemic heart disease in women

2021 ◽  
Vol 19 (3) ◽  
pp. 130-132
Author(s):  
Sarath Kumar Reddy B ◽  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Chest Pain ◽  
Ischemic Heart Disease ◽  
Stable Angina ◽  
Heart Diseases ◽  
Chronic Stable Angina ◽  
Clinical Profile ◽  
Ischemic Heart ◽  
Ischemic Heart Diseases

Background: Ischemic heart disease (IHD) is one of the principle causes of morbidity and of mortality in women1. Ischemic heart disease may manifest clinically as either chronic stable angina or acute coronary syndrome2 (ACS). Traditional risk factors (hypertension, diabetes, etc.) contribute to the development of IHD in both women and men. Some risk factors are unique to women (e.g., pregnancy-related complications, menopause), which cause increased mortality in women Aim: To study the risk factors and clinical profile of ischemic heart disease in women. Materials And Methods: Hospital-based prospective, cross-sectional study done in 50 patients with ischemic heart disease. Patients with a history of Chest pain suggestive of ischemic heart diseases and Electrocardiogram and cardiac biomarkers suggestive of ischemic heart disease were included in the study. Results: Maximum incidence of ischemic heart diseases is seen in the 6th decade. Mean age is 58.92 + 2.8years. 64%of the patients presented with chest pain, and 36% patients presented without any chest pain. After chest pain, the most common symptom was palpitations, seen in 56% patients, followed by sweating (44%). 30% presented to the medical facility within 3hours. 88% were diagnosed with acute coronary syndrome, and 12% were diagnosed with chronic stable angina. Women specific risk factors include the pregnancy-related complications seen in 10% patients, menopause attained in 86% patients, PCOS seen in 08% patients, use of oral contraceptive pills noticed in 08% patients, Other risk factors identified were hypothyroidism in 16% patients, connective tissue disorders like rheumatoid arthritis seen in 12% of the patients. Conclusion: Awareness regarding atypical symptoms as well as other symptoms of IHD should be created among women to avoid delayed complications. Simple lifestyle modifications like physical activity, diet modifications, etc., will reduce the number of women at risk for IHD.

Prospective randomized study of coronary bypass surgery for chronic stable angina

1978 ◽  
Vol 41 (2) ◽  
pp. 397 ◽  
Author(s):  
Frank Kloster ◽  
Louise Kremkau ◽  
Shahbudin Rahimtoola ◽  
Josef Rösch ◽  
Leonard Ritzmann ◽  
...  
Keyword(s):  
Stable Angina ◽  
Bypass Surgery ◽  
Randomized Study ◽  
Chronic Stable Angina ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Prospective Randomized Study

scholarly journals ST Segment Elevation Is Not Always Myocardial Infarction: A Case of Focal Myopericarditis

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Cyrus M. Munguti ◽  
Samuel Akidiva ◽  
Jacob Wallace ◽  
Hussam Farhoud
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Mri ◽  
St Segment Elevation ◽  
St Segment ◽  
Normal Coronary Angiography ◽  
Artery Disease

Protocols exist on how to manage STEMI patients, with well-established timelines. There are times when patients present with chest pain, ST segment elevation, and biomarker elevation that are not due to coronary artery disease. These conditions usually present with normal coronary angiography. We present a case that was clinically indistinguishable from STEMI and that was diagnosed with focal myopericarditis on cardiac MRI.

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