scholarly journals Anxiety and depression symptoms in chest pain patients referred for the exercise stress test

Heart Views ◽  
2011 ◽  
Vol 12 (4) ◽  
pp. 161 ◽  
Author(s):  
Atoosheh Rohani ◽  
Fahimeh Zarei ◽  
Vahid Akbari
Keyword(s):  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Pain Patients

scholarly journals Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up

1970 ◽  
Vol 6 (1) ◽  
pp. 27-31
Author(s):  
Md Khurshed Ahmed ◽  
Mohammad Salman ◽  
Md Ashraf Uddin Sultan ◽  
Md Abu Siddique ◽  
KMHS Sirajul Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Angiogram ◽  
Ecg Changes ◽  
History Of

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

Using Incremental High-Sensitive Cardiac Troponin T to Increase the Diagnostic Accuracy of Exercise Stress Test

2021 ◽  
Vol 104 (2) ◽  
pp. 169-175
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardiac Troponin T ◽  
Delta Change ◽  
Artery Disease

Background: Exercise stress test (EST) is the most practical method to diagnose coronary artery disease (CAD). Although it has a high negative predictive value (NPV), the positive predictive value (PPV) is low. Objective: To increase the diagnostic accuracy of EST by combining the results with the delta change of high-sensitive cardiac troponin T (hscTnT) levels during stress exercise. Materials and Methods: The authors conducted a diagnostic study in patients presenting with chest pain and having intermediate pretest probability of CAD who underwent EST at Queen Sirikit Heart Center of the Northeast in Khon Kaen, Thailand, between July 2018 and January 2019. Two blood samples were collected to measure hs-cTnT at 5-minute before and at 1-hour after exercise. The diagnosis of CAD was made from the coronary angiography (CAG) or coronary computed tomography angiography (CCTA) result. The authors created a ROC curve from the hs-cTnT delta change, selected a value that had high sensitivity, and combined it with EST results to enhance the PPV predicting CAD. Results: Eighty-one patients were included in the present study. Thirty-one (38.3%) had positive EST, 47 (58.0%) had negative EST, and three (3.7%) had inconclusive results. To confirm the diagnosis of significant CAD, CAG was performed in 33 (40.7%) patients, and CCTA was performed in seven (8.6%) patients. Forty-two (51.8%) patients were determined not to have significant CAD based solely on negative EST results. Sixteen (19.8%) patients were in the CAD group and 65 (80.2%) in the non-CAD group. The average hs-cTnT at baseline, at 1-hour after EST, and delta change of patients in the CAD group were greater than those in the non-CAD group (7.81±3.62 ng/L and 4.83±2.97 ng/L, p<0.001, 9.21±4.41 ng/L and 4.94±2.92 ng/L, p<0.001, 17.99% and 9.18%, p=0.09, respectively). When the authors used a hs-cTnT delta-change of 3% as a cutoff point and combined this with the EST results, the PPV increased from 48% when using the EST alone to 63.2%. Conclusion: Combining hs-cTnT delta change during an EST with EST results could raise the PPV of CAD diagnosis in patients with chest pain who had intermediate CAD pretest probability. Keywords: Exercise stress test, Coronary artery disease, High-sensitive cardiac troponin T

Bizarre electrocardiographic changes during occlusion of a congenital coronary arteriovenous fistula

2012 ◽  
Vol 23 (2) ◽  
pp. 295-298 ◽  
Author(s):  
Ramazan Akdemir ◽  
Ekrem Yeter ◽  
Harun Kilic ◽  
Murat Yucel
Keyword(s):  
Chest Pain ◽  
Arteriovenous Fistula ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Arteriovenous Fistula ◽  
St Segment ◽  
History Of ◽  
Electrocardiographic Changes ◽  
Electrocardiographic Recordings

AbstractA 38-year-old man who had a history of percutaneous coronary artery coil occlusion was admitted to our hospital with chest pain and shortness of breath. His complaint was chest pain, which is typical. ST depressions were observed during the treadmill exercise stress test. Coronary angiography demonstrated the persistence of a coronary arteriovenous fistula and coils in the fistula. Primarily, additional coil placement inside the arteriovenous fistula was decided as the mode of treatment. The coil was first placed inside the arteriovenous fistula and then an attempt was made to detach it. However, it was unsuccessful after four trials and electrical detachment of more than 3 minutes. Finally, a 2.5 × 18-millimetre graft stent was deployed at 20 atmospheric pressure. Electrocardiographic recordings showed bizarre ST segment changes during the electrical detachment of the coil. In this report, we discuss the concealed bizarre electrocardiographic changes that were seen during coronary arteriovenous fistula occlusion.

scholarly journals Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin

2013 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Philippa Bennett ◽  
◽  
Philip Dyer ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Stress Tests ◽  
Prognostic Information ◽  
Artery Disease

Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin. Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events. Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively. Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.

scholarly journals Delayed onset Takotsubo syndrome following exercise ECG: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Aruni Ghose ◽  
Suvro Banerjee
Keyword(s):  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Exercise Stress ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
Exercise Ecg ◽  
Emotional Trigger

Abstract Background Takotsubo syndrome usually occurs immediately following a physical or emotional trigger. In some cases, a triggering stress may not be evident. A delayed manifestation of the syndrome may account for such cases. Case summary An asymptomatic 69-year-old woman presented for a routine cardiac check-up, which revealed normal electrocardiogram (ECG), echocardiography, and exercise ECG. She did not complain of any chest pain during or immediately after the tests. After about 24 h, she developed chest pain for which she was admitted with the provisional diagnosis of acute coronary syndrome. ECG showed dynamic T-wave changes with QTc prolongation. Cardiac biomarkers were mildly elevated. Characteristic reversible left ventricular dysfunction in absence of coronary stenosis ultimately led to the diagnosis of Takotsubo syndrome. Discussion Our case represents a delayed occurrence of Takotsubo syndrome triggered by a treadmill exercise stress test, which manifested about 24 h following the stressor. Such delayed manifestation may account for those cases of Takotsubo syndrome where no immediate triggering stressor is evident.

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