The presenting symptoms as a predictor of the hospital arrival time intervals of patients with acute coronary syndrome

2018 ◽  
Vol 9 (11) ◽  
pp. 1856
Author(s):  
Tony Suharsono ◽  
Shynatry Ayu Andhika ◽  
Ahmad Hasyim Wibisono ◽  
Tina Handayani
Keyword(s):  
Acute Coronary Syndrome ◽  
Arrival Time ◽  
Time Intervals ◽  
Hospital Arrival ◽  
Presenting Symptoms ◽  
Coronary Syndrome

scholarly journals Prehospital paths and hospital arrival time of patients with acute coronary syndrome or stroke, a prospective observational study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Carine J. M. Doggen ◽  
Marlies Zwerink ◽  
Hanneke M. Droste ◽  
Paul J. A. M. Brouwers ◽  
Gert K. van Houwelingen ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Arrival Time ◽  
Hospital Arrival ◽  
Coronary Syndrome

Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature

2014 ◽  
Vol 13 (6) ◽  
pp. 483-493 ◽  
Author(s):  
Martha H Mackay ◽  
Pamela A Ratner ◽  
Michelle Nguyen ◽  
Myra Percy ◽  
Paul Galdas ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Symptom Onset ◽  
Large Body ◽  
Operational Definition ◽  
Treatment Seeking ◽  
Total Delay ◽  
Timely Initiation ◽  
Hospital Arrival ◽  
Coronary Syndrome ◽  
Definition Of

Background: Patients’ treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. Methods and results: We reviewed the English-language literature from 1998–2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. Conclusion: We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.

scholarly journals Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018798 ◽  
Author(s):  
Carla Araújo ◽  
Olga Laszczyńska ◽  
Marta Viana ◽  
Filipa Melão ◽  
Ana Henriques ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Cohort Study ◽  
Latent Class ◽  
Referred Pain ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
Tertiary Hospitals ◽  
Pain Knowledge ◽  
Definition Of

ObjectivesPrompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.DesignData were collected within a prospective cohort study (EPIHeart).SettingPatients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.ParticipantsPresenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.ResultsChest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).ConclusionsWhile there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.

Recurrent asymptomatic Takotsubo syndrome after 20 years: are we looking at the tip of the iceberg only?

2020 ◽  
Author(s):  
Giulia Iannaccone ◽  
Rocco Antonio Montone ◽  
Marco Giuseppe Del Buono ◽  
Maria Chiara Meucci ◽  
Riccardo Rinaldi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Myocardial Stunning ◽  
Physical Stress ◽  
Takotsubo Syndrome ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
Epicardial Coronary Artery

Takotsubo syndrome (TS) is an acute and reversible form of myocardial stunning preceded by emotional or physical stress, not explained by an obstruction of an epicardial coronary artery as in acute coronary syndrome. Over the last decades, TS is receiving growing attention, leading to an increase in awareness and diagnostic rate. Chest pain and dyspnea are the most common presenting symptoms; however, nonspecific presentations make the diagnosis challenging for clinicians. Here, we present the case of a 76-year-old female who experienced two completely asymptomatic episodes of TS 20 years apart.

scholarly journals Guideline adherence in acute coronary syndromes between telemedically supported paramedics and conventional on-scene physician care: A longitudinal pre–post intervention cohort study

2018 ◽  
Vol 25 (4) ◽  
pp. 1528-1537
Author(s):  
Sebastian Bergrath ◽  
Michael Müller ◽  
Rolf Rossaint ◽  
Stefan K Beckers ◽  
Diane Uschner ◽  
...  
Keyword(s):  
Guideline Adherence ◽  
Health Informatics ◽  
Acute Coronary Syndromes ◽  
Post Intervention ◽  
Time Intervals ◽  
Hospital Arrival ◽  
Coronary Syndrome ◽  
Physician Care ◽  
Time Requirements ◽  
Coronary Syndromes

Health informatics applications reduce time intervals in acute coronary syndromes, but their impact on guideline adherence is unknown. This pre–post intervention study compared guideline adherence between telemedically supported (n = 101, April 2014–July 2015) and conventional on-scene care (n = 120, January 2014–March 2014) in acute coronary syndrome. A multivariate logistic regression was performed for dependent variables: adverse events 0 versus 0, p = NA; electrocardiogram 101 versus 120, p = NA; acetylic salicylic acid 91 versus 102, p = 0.21; heparin 92 versus 112, p = 0.99; morphine 96 versus 107, p = 0.33; oxygen 83 versus 102, p = 0.92; glyceroltrinitrate 55 versus 90, p = 0.038; correct destination: 100 versus 119, p = 1.0. The time from ambulance arrival to hospital arrival was prolonged with telemedicine: 48.7 ± 11 min versus 35.5 ± 8.1 min, p < 0.001. Guideline adherence showed no differences except for glyceroltrinitrate. Prolonged time requirements are critical, though explainable. However, this approach enables a timely and high-quality backup strategy if only paramedics are on-scene.

scholarly journals The Gap In Meeting The Educational And Support Needs Of Women With Takotsubo Syndrome Compared To Women With An Acute Coronary Syndrome

2018 ◽  
Vol 11 (4) ◽  
pp. 133-144 ◽  
Author(s):  
Simone Claire Schubert ◽  
Angela Kucia ◽  
Anne Hofmeyer
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Stress Management ◽  
Takotsubo Syndrome ◽  
Participation Rates ◽  
Questionnaire Response ◽  
Educational Support ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
To Receive

Background: Takotsubo Syndrome is a condition that causes impairment in cardiac function in the absence of significant causative coronary artery disease. Takotsubo Syndrome is most commonly reported in older women, has identical presenting symptoms to acute coronary syndrome (ACS),but differs in cause, management and outcomes. Ongoing symptoms and recurrence of Takotsubo Syndrome are not uncommon but little support is available for these women.   Aims: This study compares (1) educational support and (2) participation rates in outpatient cardiac rehabilitation for women with Takotsubo Syndrome or acute coronary syndrome, and (3) ascertains whether or not they perceived similar benefits from these strategies.   Methods: 23 women with Takotsubo Syndrome and 23 age-matched women with acute coronary syndrome were mailed a structured questionnaire based on cardiac rehabilitation (CR) components.   Findings: The questionnaire response rate was 48% (n=11) for the Takotsubo Syndrome group and 30% (n=7) for the acute coronary syndrome group.  18% (n=2) of the women with Takotsubo Syndrome and 71% (n=5) of the women with acute coronary syndrome attended cardiac rehabilitation, with all attendees perceiving that it was beneficial in aiding their recovery.  Of the nine women with Takotsubo Syndrome that did not attend cardiac rehabilitation, 67% (n=6) perceived that it would have been helpful in aiding their recovery. Women with Takotsubo Syndrome were less likely to receive educational support about their condition, particularly stress management and participate in CR compared with women with ACS, despite perceiving that elements of CR would have been helpful in aiding their recovery.   Conclusions: Women with ACS had higher CR participation rates than those with Takotsubo Syndrome, and were more likely to receive educational support, particularly following hospital discharge.  The majority of women with Takotsubo Syndrome were not exposed to educational support in their recovery, suggesting a role for CR tailored to the needs of these women. Nurses can take practical steps to address these gaps by providing emotional support and education for women with Takotsubo Syndrome in stress management to enhance their quality of life and reduce potential recurrence.

scholarly journals The Science Underlying COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (1) ◽  
pp. 68-78 ◽  
Author(s):  
Peter P. Liu ◽  
Alice Blet ◽  
David Smyth ◽  
Hongliang Li
Keyword(s):  
Heart Failure ◽  
Immune Response ◽  
Acute Coronary Syndrome ◽  
Angiotensin Converting Enzyme ◽  
Expectant Management ◽  
Type I ◽  
Converting Enzyme ◽  
Angiotensin Converting Enzyme 2 ◽  
Presenting Symptoms ◽  
Coronary Syndrome

The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history.

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