scholarly journals Assessment Screening of Chest Pain in Primary Setting: A Review

2021 ◽  
pp. 82-87
Author(s):  
Faisal Suliman Algaows ◽  
Saud Saad A Albishi ◽  
Abdulrahman Dayel A. Alshahrani ◽  
Mohammad Rajab Alkhalaf ◽  
Heba Hesham Nezamadeen ◽  
...  
Keyword(s):  
Primary Care ◽  
Chest Pain ◽  
Visceral Pain ◽  
Chest Discomfort ◽  
Precise Location ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Significant Pathology ◽  
Electrocardiogram Ecg ◽  
Diffuse Distribution

Chest pain can be caused by a variety of illnesses, ranging from benign and self-limiting to significant or life-threatening. Before a doctor examines more benign reasons, a workup must focus on ruling out significant pathology. The words "dull," "deep," "pressure," and "squeezing" are commonly used to describe visceral discomfort. Visceral pain generally has a diffuse distribution pattern, making it difficult for the patient to pinpoint a precise location. chest discomfort accounts for 1.5 percent of all consultations in primary care. The age group 45 to 64 years has the highest prevalence of chest pain consultations. Patients with suspected Acute coronary syndrome (ACS)  should be diagnosed and treated as soon as feasible. While most patients are sent to the hospital, an electrocardiogram (ECG) is the sole examination necessary in primary care. In this review we will be looking at chest pain incident in primary care, and also we’ll be making overview to the etiology and diagnosis of the disease.

Assessment of chest pain

2017 ◽  
Vol 10 (10) ◽  
pp. 595-601
Author(s):  
Knut Schroeder
Keyword(s):  
Primary Care ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Assessment ◽  
Coronary Syndrome ◽  
Pain Clinics ◽  
Life Threatening ◽  
Urgent Action

Chest pain is an important presentation in primary care. Clinical assessment can be a challenge, as there are many potential causes of chest pain, ranging from benign to life-threatening. Since referring all patients to chest pain clinics is neither feasible nor appropriate, this article aims to help you differentiate between chest pain requiring urgent action, such as acute coronary syndrome or pulmonary embolism, and less serious non-cardiac chest pain that can (at least initially) be managed in the community.

PP23 Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for chest pain patients. A systematic review abstract

2021 ◽  
Vol 38 (9) ◽  
pp. A10.2-A10
Author(s):  
Ahmed Alotaibi ◽  
Abdulrhman Alghamdi ◽  
Charles Reynard ◽  
Richard Body
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Prediction Models ◽  
Meta Analysis ◽  
Final Diagnosis ◽  
Telephone Triage ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Pain Patients

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

scholarly journals Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE)

2020 ◽  
Vol 21 ◽  
Author(s):  
Amy Manten ◽  
Cuny J.J. Cuijpers ◽  
Remco Rietveld ◽  
Emma Groot ◽  
Freek van de Graaf ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Chest Pain ◽  
The Netherlands ◽  
Clinical Outcomes ◽  
Acute Chest Pain ◽  
Urgent Care ◽  
Triage System ◽  
Out Of Hours ◽  
Coronary Syndrome

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

scholarly journals Recognising and treating arrhythmias in primary care

2019 ◽  
Vol 30 (6) ◽  
pp. 270-275
Author(s):  
Dave Richley
Keyword(s):  
Primary Care ◽  
Chest Pain ◽  
Cardiac Arrhythmias ◽  
Accurate Diagnosis ◽  
Loss Of Consciousness ◽  
Specialist Care ◽  
Practice Nurses ◽  
Erroneous Diagnosis ◽  
The Uk ◽  
Electrocardiogram Ecg

As more and more people in the UK are being affected by cardiovascular conditions, it is increasingly necessary for practice nurses to keep up-to-date with the latest developments. Dave Richley explains common ECG readings that may be seen in primary care Cardiac arrhythmias may be asymptomatic or they may be responsible for a range of symptoms including palpitations, dizziness, chest pain and loss of consciousness. Accurate diagnosis, and therefore appropriate management, depends on careful interpretation of an electrocardiogram (ECG) recording of the arrhythmia, and this is often achievable in primary care. This article presents the arrhythmias most commonly encountered in primary care, as well as those seen rarely, and describes and illustrates their defining features. It will also discuss some of the pitfalls that can lead to erroneous diagnosis. While some arrhythmias can be managed appropriately in primary care, guidance is provided in regarding referral or admission to hospital for arrhythmias that may warrant further investigation or specialist care.

scholarly journals Systematic review and modeling of the investigation of acute and chronic chest pain presenting in primary care

2005 ◽  
Vol 21 (1) ◽  
pp. 148-149
Author(s):  
J. Mant ◽  
R. J. McManus ◽  
R. A. L. Oakes ◽  
B. C. Delaney ◽  
P. M. Barton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Early Management ◽  
Coronary Syndrome ◽  
Pain Clinics ◽  
Exertional Angina ◽  
Suspected Acute Myocardial Infarction

Objectives: The objectives were to ascertain the value of a range of methods—including clinical features, resting and exercise electrocardiography, and rapid access chest pain clinics (RACPCs)—used in the diagnosis and early management of acute coronary syndrome (ACS), suspected acute myocardial infarction (MI), and exertional angina.

Chest Pain

2014 ◽  
Vol 25 (3) ◽  
pp. 279-283
Author(s):  
Joan E. King ◽  
Kathy S. Magdic
Keyword(s):  
Chest Pain ◽  
Treatment Plan ◽  
Tension Pneumothorax ◽  
Differential Diagnoses ◽  
Coronary Syndrome ◽  
Satisfaction Of Search ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Valvular Diseases ◽  
Gastric Reflux

When a patient complains of chest pain, the first priority is to establish whether the situation is life threatening. Life-threatening differential diagnoses that clinicians must consider include acute coronary syndrome, cardiac tamponade, pulmonary embolus, aortic dissection, and tension pneumothorax. Nonthreatening causes of chest pain that should be considered include spontaneous pneumothorax, pleural effusion, pneumonia, valvular diseases, gastric reflux, and costochondritis. The challenge for clinicians is not to be limited by “satisfaction of search” and fail to consider important differential diagnoses. The challenge, however, can be met by developing a systematic method to assess chest pain that will lead to the appropriate diagnosis and appropriate treatment plan.

3298Prehospital assessment of the one-hour rule-in/rule-out algorithm using a high-sensitivity cardiac troponin t assay in a low-prevalence population for acute coronary syndrome (OUT-ACS)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T R Johannessen ◽  
D Atar ◽  
S Halvorsen ◽  
A C Larstorp ◽  
I Mdala ◽  
...  
Keyword(s):  
Primary Care ◽  
Chest Pain ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Emergency Setting ◽  
Coronary Syndrome ◽  
Rule Out

Abstract Background The majority of patients with chest pain in Norway initially present to the primary health care system, which serves to triage them to the specialist health care services including hospitals. In some emergency primary care institutions, patients who are not hospitalised directly undergo further diagnostic testing to rule out acute myocardial infarction (AMI). Purpose Several studies have shown the advantage of using high-sensitivity assays for fast interpretation of cardiac troponins. The majority of these studies included patient populations from hospital emergency departments. In contrast, we aimed to investigate whether the 1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) is safe and useful for implementation in a primary care emergency setting where the patients have a much lower pre-test probability for an acute coronary syndrome. Methods In this prospective cohort study, we included 1672 patients with acute non-specific chest pain from November 2016 to October 2018 at a primary care emergency outpatient clinic in Norway. Serial hs-cTnT samples were analysed after 0, 1 and 4 hours on the Cobas 8000 e602 analyzer. We divided the results into one of three groups (rule-out, rule-in, or further observation), according to the 0/1-hour algorithm for hs-cTn from the current ESC guidelines on non-ST-elevation myocardial infarction. In the rule-out group, the 0/1-hour results were compared to the standard 4-hour hs-cTnT. Final hospital diagnoses were collected as a gold standard for the patients in the rule-in group. Results A total of 44 (2.6%) of 1672 patients were diagnosed with AMI. By applying the algorithm, 1274 (76.2%) patients were assigned to the rule-out group. One of the rule-out patients had a significant increase in hs-cTnT in the 4-hour sample. This results in a sensitivity for AMI of 97.7% (95% confidence interval [CI] 88.0–99.9) and negative predictive value of 99.9% (95% CI 99.6–100.0). There were 50 (3.0%) patients in the rule-in group, amongst whom 35 had a verified AMI. This gives a specificity for AMI of 99.1% (95% CI 98.5–99.5) and a positive predictive value at 70.0% (95% CI 55.4–82.1). Among the 348 (20.8%) patients assigned to further observation, eight patients had an AMI. The 15 rule-in patients who did not have an AMI, had other acute illnesses that required further diagnostic work-up at the hospital. Conclusions With a negative predictive value at 99.9%, the 1-hour algorithm for hs-cTnT seems safe and applicable for a faster assessment of patients with non-specific chest pain in a primary care emergency setting. Prehospital implementation of this algorithm may reduce the need for hospitalisation of these patients and hence may probably lower the costs. ClinicalTrial.gov identifier: NCT02983123 Acknowledgement/Funding Norwegian Research Fund for General Practice, The Norwegian Physicians' Association Fund for Quality Improvement and Patient Safety

Assessment of prehospital chest pain using telecardiology

2002 ◽  
Vol 8 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Simonetta Scalvini ◽  
Emanuela Zanelli ◽  
Claudia Conti ◽  
Maurizio Volterrani ◽  
Riccardo Pollina ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Chest Pain ◽  
General Practitioners ◽  
Diagnostic Tests ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Telephone Line ◽  
Group A ◽  
Electrocardiogram Ecg

Two hundred general practitioners were equipped with a portable electrocardiograph which could transmit a 12-lead electrocardiogram (ECG) via a telephone line. A cardiologist was available 24 h a day for an interactive teleconsultation. In a 13-month period there were 5073 calls to the telecardiology service and 952 subjects with chest pain were identified. The telecardiology service allowed the general practitioners to manage 700 cases (74%) themselves; further diagnostic tests were requested for 162 patients (17%) and 83 patients (9%) were sent to the hospital emergency department. In the last group a cardiological diagnosis was confirmed in 60 patients and refuted in 23. Seven patients in whom the telecardiology service failed to detect a cardiac problem were hospitalized in the subsequent 48 h. The telecardiology service showed a sensitivity of 97.4%, a specificity of 89.5% and a diagnostic accuracy of 86.9% for chest pain. Telemedicine could be a useful tool in the diagnosis of chest pain in primary care.

scholarly journals Mellkasi panasz ritka oka

2016 ◽  
Vol 157 (36) ◽  
pp. 1445-1448
Author(s):  
Beáta Bodócsi ◽  
István Koncz ◽  
Zsigmond Hum ◽  
Orsolya Serfőző ◽  
József Pap-Szekeres ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Thoracic Aorta ◽  
Common Symptom ◽  
Main Task ◽  
Chest Computed Tomography ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Pulmonary Embolization

Chest pain is a common symptom in patients who visit Emergency Departments. The main task is to exclude life-threatening diseases such as acute coronary syndrome, pulmonary embolization and dissection of thoracic aorta. The authors present the history of a patient, who had an intense chest pain for 7 hours. In accordance with the diagnostic algorithm of chest pain, ECG, blood collection, chest X-ray and chest computed tomography angiography were performed. Acute coronary syndrome, pulmonary embolization and dissection of the thoracic aorta were excluded, however, chest computed tomography CT revealed a huge hiatal hernia as an incidental finding. An emergency surgical repair was performed and the patient recovered without any complications. The authors emphasize that the diagnostic algorithms focus on the confirmation or rejection of possible life threatening diseases in case of chest pain. However, it should be kept in mind that rarer causes may occur, which may require involvement of the relevant disciplines and multidisciplinary thinking. Orv. Hetil., 2016, 157(36), 1445–1448.

Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin

2012 ◽  
Vol 50 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani ◽  
Salvatore Di Somma ◽  
Valter Monzani ◽  
Marco Tubaro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Decision Making ◽  
Current Evidence ◽  
Emergency Physicians ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Rule Out

AbstractThe evaluation of patients admitted at the emergency department (ED) for chest pain is challenging and involves many different clinical specialists including emergency physicians, laboratory professionals and cardiologists. The preferable approach to deal with this issue is to develop joint protocols that will assist the clinical decision-making to quickly and accurately rule-out patients with non life-threatening conditions that can be considered for early and safe discharge or further outpatient follow-up, rule-in patients with acute coronary syndrome and raise the degree of alert of the emergency physicians on non-cardiac life-threatening emergencies. The introduction of novel biomarkers alongside the well-established troponins might support this process and also provide prognostic information about acute short-term or chronic long-term risk and severity. Among the various biomarkers, copeptin measurement holds appealing perspectives. The utility of combining troponin with copeptin might be cost-effective due to the high negative predictive value of the latter biomarker in the rule-out of an acute coronary syndrome. Moreover, in the presence of a remarkably increased concentration (e.g., more than 10 times the upper limit of the reference range), to reveal the presence of acute life-threatening conditions that may not necessarily be identified with the use of troponin alone. The aim of this article is to review current evidence about the clinical significance of copeptin testing in the ED as well as its appropriate placing within diagnostic protocols.

Sign in / Sign up

Export Citation Format

Share Document