Cardiac stress tests – which one should I choose?

2010 ◽  
Vol 9 (1) ◽  
pp. 3-7
Author(s):  
Dhrubo Rakhit ◽  
◽  
Catherine Blakemore ◽  
Keyword(s):  
Chest Pain ◽  
Stress Tests ◽  
Stress Imaging ◽  
Common Cause ◽  
Medical Unit ◽  
Cardiac Stress ◽  
Acute Medical Unit ◽  
Basic Understanding

Chest pain is a common cause of presentation to the Acute Medical Unit and the use of cardiac stress imaging in these patients is becoming more widespread. This article aims to provide Acute Physicians with a basic understanding of the different modalities and how to select a particular test for a given patient.

scholarly journals Dissecting the Diagnosis – An Unusual Case of Pericarditis

2017 ◽  
Vol 16 (4) ◽  
pp. 200-203
Author(s):  
Louise Mundy ◽  
◽  
Purav Desai ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Unusual Case ◽  
Correct Diagnosis ◽  
Timely Manner ◽  
Medical Unit ◽  
Coronary Syndrome ◽  
Acute Medical Unit

Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes. This case highlights the importance of performing relevant investigations in a timely manner, in order to ensure that a correct diagnosis is made.

A patient presenting with collapse and breathlessness

2015 ◽  
Vol 14 (4) ◽  
pp. 193-194
Author(s):  
Shelley Raveendran ◽  
Katy Kyprianou ◽  
Kypros Zenonos ◽  
Sanjay Saraf ◽  
◽  
...  
Keyword(s):  
Heart Rate ◽  
Chest Pain ◽  
Respiratory Rate ◽  
Shortness Of Breath ◽  
Medical Unit ◽  
Acute Medical Unit

A 57-year-old man was admitted to the Acute Medical Unit with an episode of collapse following chest pain and shortness of breath. On examination he was tachycardic, and tachypnoeic with a heart rate of 120 beats per minute and a respiratory rate of 30.

scholarly journals A patient with palpitations

2014 ◽  
Vol 13 (4) ◽  
pp. 182-182
Author(s):  
Legate Philip ◽  
◽  
Kristel Longman ◽  
Neil Andrews ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Exercise Tolerance ◽  
Medical Unit ◽  
The Past ◽  
Acute Medical Unit

A 52 year old woman presented to the Acute Medical Unit with her 4th episode of palpitations in the past four weeks. Each episode was similar in nature and described as being acute in onset, fast and regular, associated with pre-syncope but never syncope or chest pain. The episodes lasted for 30 – 45 minutes and would self terminate. Of particular note, the episodes were not associated with exertion and she had a normal exercise tolerance.

scholarly journals An unusual cause of ‘musculoskeletal’ chest pain

2009 ◽  
Vol 8 (3) ◽  
pp. 111-113
Author(s):  
Nigel Lane ◽  
◽  
Adrian Mackie ◽  
Seema Srivastava ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract ◽  
Joint Infection ◽  
Sternoclavicular Joint ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Unusual Condition

Chest pain is a frequent cause of admission to an acute medical unit. In most cases the cause is initially considered to be either cardiac or respiratory, with musculoskeletal causes being considered a benign diagnosis of exclusion. We report a case of sternoclavicular joint infection, treated initially as a lower respiratory tract infection. The investigation and treatment of this unusual condition are discussed.

An overview of lower limb cellulitis in an acute medical ward-a few lessons we can learn

2019 ◽  
Vol 18 (1) ◽  
pp. 4-9
Author(s):  
Si Hua Mabel Tan ◽  
◽  
Tian En Jason Tay ◽  
Pek Siang Edmund Teo ◽  
Stephanie Fook-Chong ◽  
...  
Keyword(s):  
Lower Limb ◽  
Readmission Rate ◽  
Hospital Admissions ◽  
Duration Of Treatment ◽  
Common Cause ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Previous Stroke ◽  
Patients With Diabetes ◽  
The Mean

Lower limb cellulitis is a common cause for hospital admissions. In this retrospective study, we assessed the characteristics and outcome of patients admitted in an acute medical unit. The mean duration of treatment was 10.48 days, with 95.5% receiving antibiotics for more than 5 days. Mean length of stay (LOS) was 5.19 days. 12-month readmission rate was higher in patients with diabetes, chronic kidney disease (CKD) and previous stroke. Diabetes, CKD, previous stroke, and elevated procalcitonin levels were independently associated with prolonged admission (>3 days).

scholarly journals Picture Quiz: An Acute, Blue, Swollen, Painful Leg

2012 ◽  
Vol 11 (4) ◽  
pp. 234-234
Author(s):  
R Honney ◽  
◽  
J Bhullar ◽  
P Swales ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Chest Pain ◽  
Bowel Habit ◽  
Recreational Drugs ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
History Of ◽  
History Of Pain ◽  
Previous Medical History

A 55 year old male presented to the Acute Medical Unit with a one hour history of pain and swelling of his right leg with resultant inability to weight bear. He denied any preceding history of trauma. Previous medical history was unremarkable. He was taking no regular medications, and did not use recreational drugs. There was no prior weight change, or alteration in bowel habit, no associated chest pain or dyspnoea and there were no risk factors for venous thromboembolism or arterial thrombotic disease. He was a lifelong non-smoker.

scholarly journals Acute medical unit clinical skills lab

2019 ◽  
Vol 6 (Suppl 1) ◽  
pp. 140-140
Author(s):  
Sarb Clare ◽  
Joe Wheeler
Keyword(s):  
Clinical Skills ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Skills Lab

scholarly journals Causes of discharge delays from the acute medical unit (AMU) in a tertiary level teaching hospital, Brunei Darussalam

2021 ◽  
pp. 201010582110061
Author(s):  
Dayang Nur Hilmiyah binti Awang Husaini ◽  
Justin Fook Siong Keasberry ◽  
Khadizah Haji Abdul Mumin ◽  
Hanif Abdul Rahman
Keyword(s):  
Observational Study ◽  
Discharge Planning ◽  
Patient Factors ◽  
Medical Unit ◽  
Prolonged Length ◽  
Acute Medical Unit ◽  
Brunei Darussalam ◽  
Medical Issues ◽  
Hospital Factors ◽  
Prolonged Hospital

Background: Many patients admitted to the acute medical unit experience a prolonged length of stay in hospital due to discharge delays. Consequently, this may impact the patients, healthcare institution and national economy in terms of patient safety, decreased hospital capacity, lost patient workdays and financial performance. Objectives: The main aim of this observational study was to identify the causes of discharge delays among acute medical unit patients admitted in the Raja Isteri Pengiran Anak Saleha Hospital, Brunei. Methods: A retrospective observational study, with data of patients admitted to the acute medical unit collected from Brunei Health Information Systems between September and December 2018. Statistical analyses were performed to obtain relevant results and any statistically significant associations. Results: A total of 357 patients were admitted to the acute medical unit over the 4-month period; 218 patients (61.1%) experienced discharge delays. Of these 218 patients, 158 patients (72.5%) encountered discharge delays mainly due to intrinsic patient factors, while the discharge delays in 88 patients (40.4%) were attributed to hospital factors. The main reason for discharge delays for patient factors was slow recovery among 67 patients (30.7%), whereas for hospital factors it was the weekend limitation of services available in 23 patients (10.6%). Conclusions: There were various causes of discharge delays identified among the 218 acute medical unit patients who experienced discharge delays. Older patients with frailty, polypharmacy and complex medical issues were more likely to have a prolonged hospital stay in the acute medical unit. Stringent inclusion criteria, increasing discharge planning as well as an effective multidisciplinary approach will aid in reducing discharge delays from the acute medical unit.

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

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