Typical and atypical clinical signs and symptoms of myocardial infarction and delayed seeking of professional care among blacks

1997 ◽  
Vol 6 (1) ◽  
pp. 7-13 ◽  
Author(s):  
HO Lee
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
United States Department ◽  
Manual Search ◽  
Black Patients ◽  
Definitive Therapy ◽  
Clinical Signs And Symptoms

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.

Advances in Medical Genetics: Huntington Disease

1987 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
Frederick Hecht
Keyword(s):  
Molecular Genetics ◽  
Huntington Disease ◽  
Age Of Onset ◽  
Late Onset ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
Medical Genetics ◽  
Clinical Signs And Symptoms ◽  
Huntington Chorea

Medical genetics is currently enjoying a time of exploration and discovery. Huntington disease has long been of interest in adult medicine. The onset of clinical signs and symptoms is usually delayed until midadulthood. It may seem strange in this context to focus on Huntington disease, but advances in molecular genetics have brought Huntington disease into the purview of pediatrics. These advances in molecular genetics make it possible to detect Huntington disease in a preclinical stage at or even before birth. The molecular approach does not replace prior approaches to Huntington disease but is synergistic and provides a model of the new genetics. Huntington disease is synonymous with Huntington chorea. It is named after George Huntington who, like his father and grandfather before him, studied the disease in families on Long Island, NY. Huntington disease is a more common hereditary disorder than phenylketonuria, which occurs in one of about 10,000 newborns in the United States. By contrast, about one in 2,000 persons is at risk for Huntington disease. Although most cases start clinically in midadulthood, usually between 35 and 42 years of age, there is great variability in age of onset. About 3% of cases are diagnosed as juvenile Huntington disease before the age of 15 years. Late onset is well known after 50 years of age.

Hyperviscosity Syndrome in Hematological Diseases and Therapeutic Apheresis

2005 ◽  
Vol 28 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
P. Accorsi ◽  
C. Passeri ◽  
D. Onofrillo ◽  
A. Iacone
Keyword(s):  
Acute Phase ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Therapeutic Management ◽  
Blood Components ◽  
Hyperviscosity Syndrome ◽  
Hematological Diseases ◽  
Definitive Therapy ◽  
Clinical Signs And Symptoms

The hyperviscosity syndrome classified into pleiocytosic, sclerotic and sieric syndromes according to the blood components involved are characterized by a different degree of clinical signs and symptoms related to rheological modification of blood. Therapeutic management of these syndromes is complex and the choice of apheresis treatment is generally restricted to emergency episodes in order to overcome the acute phase and to reverse the symptoms until definitive therapy is effective.

scholarly journals COVID-19–Related Internet Search Patterns Among People in the United States: Exploratory Analysis

10.2196/22407 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e22407
Author(s):  
Tony S Shen ◽  
Aaron Z Chen ◽  
Patawut Bovonratwet ◽  
Carol L Shen ◽  
Edwin P Su
Keyword(s):  
United States ◽  
Web Search ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
World Health ◽  
The Internet ◽  
Sources Of Information ◽  
Academic Medical ◽  
Clinical Signs And Symptoms

Background The internet is a well-known source of information that patients use to better inform their opinions and to guide their conversations with physicians during clinic visits. The novelty of the recent COVID-19 outbreak has led patients to turn more frequently to the internet to gather more information and to alleviate their concerns about the virus. Objective The aims of the study were to (1) determine the most commonly searched phrases related to COVID-19 in the United States and (2) identify the sources of information for these web searches. Methods Search terms related to COVID-19 were entered into Google. Questions and websites from Google web search were extracted to a database using customized software. Each question was categorized into one of 6 topics: clinical signs and symptoms, treatment, transmission, cleaning methods, activity modification, and policy. Additionally, the websites were categorized according to source: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), non-CDC government, academic, news, and other media. Results In total, 200 questions and websites were extracted. The most common question topic was transmission (n=63, 31.5%), followed by clinical signs and symptoms (n=54, 27.0%) and activity modification (n=31, 15.5%). Notably, the clinical signs and symptoms category captured questions about myths associated with the disease, such as whether consuming alcohol stops the coronavirus. The most common websites provided were maintained by the CDC, the WHO, and academic medical organizations. Collectively, these three sources accounted for 84.0% (n=168) of the websites in our sample. Conclusions In the United States, the most commonly searched topics related to COVID-19 were transmission, clinical signs and symptoms, and activity modification. Reassuringly, a sizable majority of internet sources provided were from major health organizations or from academic medical institutions.

scholarly journals COVID-19–Related Internet Search Patterns Among People in the United States: Exploratory Analysis (Preprint)

2020 ◽  
Author(s):  
Tony S Shen ◽  
Aaron Z Chen ◽  
Patawut Bovonratwet ◽  
Carol L Shen ◽  
Edwin P Su
Keyword(s):  
United States ◽  
Web Search ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
World Health ◽  
The Internet ◽  
Sources Of Information ◽  
Academic Medical ◽  
Clinical Signs And Symptoms

BACKGROUND The internet is a well-known source of information that patients use to better inform their opinions and to guide their conversations with physicians during clinic visits. The novelty of the recent COVID-19 outbreak has led patients to turn more frequently to the internet to gather more information and to alleviate their concerns about the virus. OBJECTIVE The aims of the study were to (1) determine the most commonly searched phrases related to COVID-19 in the United States and (2) identify the sources of information for these web searches. METHODS Search terms related to COVID-19 were entered into Google. Questions and websites from Google web search were extracted to a database using customized software. Each question was categorized into one of 6 topics: clinical signs and symptoms, treatment, transmission, cleaning methods, activity modification, and policy. Additionally, the websites were categorized according to source: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), non-CDC government, academic, news, and other media. RESULTS In total, 200 questions and websites were extracted. The most common question topic was transmission (n=63, 31.5%), followed by clinical signs and symptoms (n=54, 27.0%) and activity modification (n=31, 15.5%). Notably, the clinical signs and symptoms category captured questions about myths associated with the disease, such as whether consuming alcohol stops the coronavirus. The most common websites provided were maintained by the CDC, the WHO, and academic medical organizations. Collectively, these three sources accounted for 84.0% (n=168) of the websites in our sample. CONCLUSIONS In the United States, the most commonly searched topics related to COVID-19 were transmission, clinical signs and symptoms, and activity modification. Reassuringly, a sizable majority of internet sources provided were from major health organizations or from academic medical institutions.

Lyme Disease: An Overview

2000 ◽  
Vol 35 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Jean G. Dib ◽  
Horatio B. Fung ◽  
Raquel M. Tiu
Keyword(s):  
United States ◽  
Nervous System ◽  
Lyme Disease ◽  
Skin Lesion ◽  
Erythema Migrans ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
Disease Treatment ◽  
Clinical Signs And Symptoms

Lyme disease is the most common tick-borne illness in the United States. It occurs most commonly in areas that foster and harbor the deer tick. The number of reported cases of Lyme disease in the United States has increased steadily since 1982. The tick transmits an infection of the spirochete Borrelia burgdorferi that typically manifests as a localized skin lesion and erythema migrans. If left untreated, infection may lead to localized arthritis, heartblock, and/or disease of the nervous system. The diagnosis of Lyme disease is made primarily from clinical signs and symptoms that are suggestive of the disease. Treatment includes 10 to 27 days of antibiotics depending on stage of the disease. Vaccines for the prevention of Lyme disease are now licensed and the trend of increasing incidence of Lyme disease will likely be reversed.

scholarly journals Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000944 ◽  
Author(s):  
Arnav Kumar ◽  
Kimi Sato ◽  
Beni Rai Verma ◽  
Chandra Kanth Ala ◽  
Jorge Betancor ◽  
...  
Keyword(s):  
Chest Pain ◽  
Quantitative Assessment ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Criteria ◽  
Test Characteristics ◽  
Net Reclassification Improvement ◽  
Incremental Value ◽  
Clinical Signs And Symptoms

ObjectivesRecurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis.MethodsQuantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion.ResultsA total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, p<0.001) and higher DHE (OR: 1.32, p<0.001) were associated with ongoing recurrence of RP. Addition of DHE to conventional clinical criteria significantly increased the ability to diagnose ongoing recurrence (net reclassification improvement (NRI): 0.80, p<0.001; integrated discrimination improvement (IDI): 0.12, p<0.001). Among 150 patients with history of RP who presented with chest pain, higher DHE was still independently associated with ongoing recurrence (OR: 1.28, p<0.001), showed incremental value over clinical criteria (NRI: 0.76, p<0.001; IDI: 0.13, p<0.001) and demonstrated a sensitivity of 70% and specificity of 74%.ConclusionAmong patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.

Women and coronary disease: relationship between descriptors of signs and symptoms and diagnostic and treatment course

1998 ◽  
Vol 7 (3) ◽  
pp. 175-182 ◽  
Author(s):  
S Penque ◽  
M Halm ◽  
M Smith ◽  
J Deutsch ◽  
M Van Roekel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chest Pain ◽  
Signs And Symptoms ◽  
The United States ◽  
Therapeutic Interventions ◽  
Initial Symptom ◽  
Men And Women ◽  
To Receive

BACKGROUND: Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and therapeutic interventions. PURPOSE: To explore the relationship between descriptors of signs and symptoms of coronary heart disease and follow-up care and to investigate any differences between male and female patients. METHODS: Structured interviews with patients and chart audits were used to assess initial signs and symptoms, associated cardiac-related signs and symptoms, and the diagnostic tests and interventions used for treatment. The sample consisted of 98 patients (51 women and 47 men) who were admitted with a medical diagnosis of myocardial infarction. RESULTS: Chest pain was the most common sign or symptom reported by both men and women. The 4 most common associated signs and symptoms were identical in men and women: fatigue, rest pain, shortness of breath, and weakness. However, significantly more women than men reported loss of appetite, paroxysmal nocturnal dyspnea, and back pain. Women were also less likely than men to have angiography and to receive i.v. nitroglycerin, heparin, and thrombolytic agents as part of acute management of myocardial infarction. CONCLUSION: Chest pain remains the initial symptom of acute myocardial infarction in both men and women. However, women may experience some different associated signs and symptoms than do men. Despite these similarities, men still are more likely than women to have angiography and to receive a number of therapies.

Management of cocaine poisoning

2016 ◽  
Author(s):  
Nicholas J. Johnson ◽  
Judd E. Hollander
Keyword(s):  
Chest Pain ◽  
Excitatory Amino Acid ◽  
Beta Blockers ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
The Body ◽  
Cardiac Biomarkers ◽  
Severe Toxicity ◽  
Clinical Signs And Symptoms

Cocaine is powerful central nervous system (CNS) stimulant derived from the coca plant. It affects the body via a number of mechanisms including blockade of fast sodium channels, increased catecholamine release, inhibition of catecholamine reuptake, and increased concentration of excitatory amino acid concentrations in the CNS. It is rapidly absorbed via the aerodigestive, respiratory, gastrointestinal, and genitourinary mucosa, and also may be injected. When injected intravenously or inhaled, cocaine is rapidly distributed throughout the body and CNS, with peak effects in 3–5 minutes. With nasal insufflation, absorption peaks in 20 minutes. Its half-life is approximately 1 hour. Common clinical manifestations include agitation, euphoria, tachycardia, hyperthermia, and hypertension. Chest pain is a common presenting complaint among cocaine users; 6% of these patients will have myocardial infarction. Other life-threatening sequelae include stroke, intracranial haemorrhage, seizures, dysrhythmias, and rhabdomyolysis. Clinical signs and symptoms, as well as severity of intoxication, should dictate the diagnostic evaluation and treatment of cocaine intoxicated patients. If the patient has chest pain, an ECG, chest radiograph, and measurement of cardiac biomarkers should be performed. A brief observation period may be useful in these patients. Many manifestations of cocaine intoxication, including agitation, hypertension, and chest pain, are effectively treated with benzodiazepines. Beta-blockers should be avoided in patients with suspected cocaine intoxication. Special attention should be paid to pregnant patients and those who present after ingesting packets filled with cocaine, as they may exhibit severe toxicity if these packets rupture.

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