Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.906
Filtrar
3.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 19-25, feb. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-185849

RESUMEN

Objetivo. La correcta identificación en el primer contacto médico de los pacientes con un síndrome coronario agudo (SCA) es esencial. No existe ninguna escala predictiva para el diagnóstico de SCA en los centros de coordinación de emergencias (CCE) que facilite la toma de decisiones al equipo médico. El objetivo primario es construir y validar una escala de estas características. Método. Estudio prospectivo, observacional, unicéntrico, realizado durante 1 año (2016). Se incluyeron los pacientes que consultaron telefónicamente por dolor torácico no traumático en un CCE. Los pacientes incluidos se repartieron en las muestras de derivación y validación de forma aleatoria. La escala predictiva –escala SCARE– se construyó mediante regresión logística, la discriminación y calibración del modelo se realizó con el cálculo del área bajo la curva (ABC) de la característica operativa del receptor y el test de Hosmer-Lemeshow. Resultado. La muestra de derivación incluyó 902 pacientes y 7 de las variables recogidas se relacionaron con un diagnóstico final de SCA: sexo masculino, edad, tabaquismo, dolor torácico de características típicas, primer episodio de dolor torácico, diaforesis y la intuición del médico que realizó la entrevista telefónica. La utilización de la escala desarrollada en los 465 pacientes de la muestra de validación obtuvo un ABC de 0,81 (intervalo de confianza al 95% 0,76-0,87) y el test de Hosmer-Lemeshow fue de 5,18 (p = 0,74). Conclusión. La escala SCARE mostró una correcta discriminación y calibración. Es necesaria una validación externa multicéntrica antes de implementar su uso en los CCE


Background and objective. Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. Methods. Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. Results. The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher’s suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). Conclusions. The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers


Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Síndrome Coronario Agudo/diagnóstico , Servicios Médicos de Urgencia/métodos , Técnicas de Apoyo para la Decisión , Dolor en el Pecho/diagnóstico , Estudios Prospectivos , Valor Predictivo de las Pruebas , Teléfono/estadística & datos numéricos , Modelos Logísticos , Intuición , Encuestas y Cuestionarios
4.
Adv Clin Exp Med ; 29(1): 147-155, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011830

RESUMEN

BACKGROUND: Chest pain is one of the most frequent symptoms in patients seeking treatment at emergency departments (ED). These patients differ according to the cause of their reported symptoms and resultant mortality. OBJECTIVES: Evaluation of the influence of hospitalization and biochemical parameters on mortality rates in patients admitted to the ED with chest pain, in whom no cardiovascular emergencies were established. MATERIAL AND METHODS: The study group consisted of 243 patients with chest pain admitted to the ED in the Wroclaw Medical University Clinical Hospital, Poland, between January 1 and March 31, 2015, in whom no specific diagnosis was made at discharge. A retrospective analysis was carried out based on medical documentation, and 60-day and 1-year survival was assessed. RESULTS: In the study group, the 60-day mortality rate was 0.8% (2 persons) while the 1-year mortality rate was 6.6% (16 persons). The stepwise multivariable logistic regression analysis revealed that 1-year mortality was related to increased level of D-dimer (odds ratio (OR) = 8.5, 95% confidence interval (95% CI) = 21.9-37.5, p < 0.005), age (OR (per year) = 1.10, 95% CI = 1.03-1.18, p < 0.03) and lower than 12 g/dL hemoglobin concentration (OR = 18.5, 95% CI = 4.2-80.4, p < 0.001). Troponin I (TNI) levels and hospitalization were not related independently to mortality when other clinical factors were considered. CONCLUSIONS: Hospitalization of patients with chest pain who were not diagnosed with cardiac emergencies is not related with better survival than of those discharged home from the ED. The 60-day mortality is very low and occurs in older patients with numerous comorbidities. In multivariate analysis, survival of the 1-year period depends on the patient's age, hemoglobin levels and D-dimer levels. Risk of death in patients admitted to the ED due to chest pain in whom the cause of the chest pain was not due to cardiovascular emergencies depends on the presence of old age and comorbidities.


Asunto(s)
Dolor en el Pecho/diagnóstico , Dolor en el Pecho/terapia , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Mortalidad Hospitalaria , Troponina I/sangre , Anciano , Biomarcadores/sangre , Dolor en el Pecho/sangre , Dolor en el Pecho/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Polonia/epidemiología , Estudios Retrospectivos
5.
Pan Afr Med J ; 33: 275, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692844

RESUMEN

The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.


Asunto(s)
Dolor en el Pecho/diagnóstico , Infarto del Miocardio/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Dolor en el Pecho/etiología , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Ecocardiografía , Femenino , Humanos
6.
Clin Lab ; 65(9)2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31532091

RESUMEN

BACKGROUND: Pulmonary hamartoma is one of the most common benign tumors of the lung, the symptoms are often atypical, so its diagnosis is not so easy. We presented an elderly man with elevated D-dimer combined persistent acupuncture-like chest pain misdiagnosed as pulmonary embolism finally proved as lung hamartoma with secondary lung infection by bronchoscopy biopsy. METHODS: Appropriate laboratory tests were carried out. The chest computed tomography (CT) scan and bronchoscopy were performed for diagnosis. RESULTS: Laboratory tests showed D-dimer was 2,615.88 ng/mL, the chest CT scan showed the right lung portal occupying lesions accompanied by obstructive changes in the middle of the right lung and mediastinal lymphade-nopathy with partial calcification. Bronchoscopy showed the new spherical neoplasm in the middle of the right lung completely blocked the opening of the bronchus, the surface of the neoplasm was smooth and blood vessels were abundant, pathological result was lung hamartoma. CONCLUSIONS: Elevated D-dimer is not a specific index of pulmonary embolism. When a patient's D-dimer rise combined with severe chest pain, the physician should be wary of pulmonary embolism, myocardial infarction, aortic dissection, and other emergencies, and should also take into account serious infections, tumors, and other diseases. Diagnosis needs further related examination. Chest CT scan has guidance function, and when the chest CT scan suggests the occupying lesion, the pathology examination is the key to identify the benign tumor.


Asunto(s)
Dolor en el Pecho/diagnóstico , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hamartoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Embolia Pulmonar/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Anciano , Broncoscopía , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , Masculino
7.
Acute Med ; 18(3): 165-170, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31536054

RESUMEN

Non-cardiac chest pain (NCCP) is a common presenting complaint which can be better managed. This requires the recognition of clinical sub-groups with investigation and treatment tailored accordingly. The aim of this paper is to encourage more accurate diagnoses and the better recognition of the source of chest pain. We discuss the appropriate investigations and management of each clinical sub-group.


Asunto(s)
Instituciones de Atención Ambulatoria , Dolor en el Pecho , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Humanos
8.
Int Heart J ; 60(5): 1184-1188, 2019 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-31484860

RESUMEN

We report the case of a 79-year-old man with acute myocardial infarction caused by left main trunk lesion, who experienced cardiogenic shock during percutaneous coronary intervention (PCI). To reverse the cardiogenic shock, we initiated veno-arterial extra corporeal membrane oxygenation (VA-ECMO) without an intra-aortic balloon pump (IABP) due to the severe tortuosity of the left external iliac artery. Although PCI was successful, arterial pressure monitoring revealed that the pulse pressure was too low to recover from the cardiogenic shock of decreased cardiac contraction function (the left ventricular ejection fraction was 30%). Thus, we decided to use IABP from the brachial artery to improve the hemodynamics. Immediately after the deployment of a 6-Fr IABP system (Takumi) from the left brachial artery, the pulse pressure was restored and finally VA-ECMO was withdrawn from the patient without complications. Although using IABP in combination with VA-ECMO is a reasonable strategy for cardiogenic shock, the effectiveness of this combination remains controversial. In this case, IABP added to VA-ECMO clearly achieved an improvement of pulse pressure and vital signs. Based on this result, monitoring of the pulse waveform is an effective tool to determine whether the concomitant use of IABP with VA-ECMO is indicated. Moreover, when it is difficult to insert IABP from the femoral arteries, the use of a 6-Fr IABP system (Takumi) approaching from the brachial artery should be considered.


Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Contrapulsador Intraaórtico/métodos , Infarto del Miocardio/complicaciones , Intervención Coronaria Percutánea/efectos adversos , Choque Cardiogénico/terapia , Anciano , Presión Sanguínea/fisiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Terapia Combinada , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/métodos , Medición de Riesgo , Choque Cardiogénico/etiología , Resultado del Tratamiento
10.
Clin Cardiol ; 42(10): 982-987, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31432542

RESUMEN

BACKGROUND: Approximately 1% to 2% of patients with stable atypical chest pain (SACP) experienced a major coronary event, even after a negative functional or anatomical test. METHODS: Over the past 15 years, 1706 patients with SACP evaluated in our clinics underwent functional stress testing or coronary computed tomographic angiography (CTA). In these patients, we also assessed the presence of three major modifiable lifestyle-related risk factors (cigarette smoking, low intake of fruit and vegetables, and physical inactivity). Patients were stratified according to the presence of at least one risky lifestyle factor or no risky lifestyle factors. Functional or anatomical tests were positive in 170 patients (10%). We followed the remaining 1536 patients with negative tests for 1 year to evaluate the incidence of major coronary events. RESULTS: The percentage of patients reporting major coronary events was 1.2% in the group with risky lifestyles and 0.2% in the non-risky lifestyle group (P < .01). Events were more common in smokers. CONCLUSIONS: Patients with SACP, when functional or anatomical tests are negative, have a residual risk of fatal and non-fatal cardiovascular events of 1% at 1 year of follow-up. People with incorrect lifestyles, especially smokers, have a higher risk of events. We think that in this population, a more effective intervention on lifestyles could be the key to reduce major cardiovascular events.


Asunto(s)
Dolor en el Pecho/diagnóstico , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Ecocardiografía de Estrés/métodos , Predicción , Medición de Riesgo/métodos , Dolor en el Pecho/epidemiología , Dolor en el Pecho/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/prevención & control , Diagnóstico Diferencial , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias
11.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-31451468

RESUMEN

Electrical injuries are a common occurrence and can be minor or even fatal depending on the voltage to which an individual has been exposed to. Electrical current causes tissue damage by producing heat due to local tissue resistance. Serious electrocution may manifest with cutaneous burns, visceral injuries, organ perforation, and cardiac and respiratory effects. Pneumothorax as a complication of electrical injury is a very rare entity. We report one such case of electrical burn injury with right-sided pneumothorax as an immediate complication.


Asunto(s)
Quemaduras por Electricidad/complicaciones , Neumotórax , Toracocentesis/métodos , Adulto , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Tos/diagnóstico , Tos/etiología , Disnea/diagnóstico , Disnea/etiología , Humanos , Masculino , Neumotórax/diagnóstico , Neumotórax/etiología , Neumotórax/fisiopatología , Neumotórax/terapia , Radiografía Torácica/métodos , Cavidad Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
12.
Cardiol Young ; 29(10): 1268-1271, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466543

RESUMEN

INTRODUCTION: Chest pain is the second most common reason for referral to paediatric cardiologists after benign heart murmurs. Aetiology frequently depends on non-cardiac reasons. In addition, individuals may experience non-cardiac chest pain which is idiopathic or of unknown origin. The aim of this study is to examine psychological symptoms in children and adolescents with medically unexplained chest pain. METHODS: A total of 76 patients (ages 8-18 years) were included in the study, who were referred to the paediatric cardiology department with the complaint of chest pain but did not have any detected cardiac aetiology or any other organic causes of chest pain. The control group was composed of 51 healthy volunteers. Self-evaluation scales were given to both groups which included Beck Anxiety Inventory and Children's Depression Inventory. Also parents of both groups completed the Conner's Parent Rating Scale for assessment of Attention-deficit/hyperactivity disorder. RESULTS: Anxiety scores of the non-cardiac chest pain group were significantly higher compared to controls. No significant differences were found between patients and controls in terms of attention-deficit/hyperactivity disorder and depression scores. In patient group, patterns were similar for boys and girls and for children and adolescents; except girls scored significantly higher than boys in children's depression inventory. CONCLUSIONS: In children and adolescents, non-cardiac chest pain is associated with increased levels of anxiety. These results show the importance of psychiatric evaluation in non-cardiac chest pain patients. Larger controlled studies are needed to determine the prevalence and impact of attention-deficit/hyperactivity disorder and depression in children and adolescents with non-cardiac chest pain.


Asunto(s)
Ansiedad/complicaciones , Dolor en el Pecho/etiología , Conducta Infantil , Depresión/complicaciones , Calidad de Vida , Adolescente , Ansiedad/psicología , Dolor en el Pecho/diagnóstico , Niño , Depresión/psicología , Electrocardiografía , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
13.
Dtsch Med Wochenschr ; 144(17): 1223-1228, 2019 08.
Artículo en Alemán | MEDLINE | ID: mdl-31454846

RESUMEN

Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.


Asunto(s)
Dolor en el Pecho/diagnóstico , Enfermedad Aguda , Dolor en el Pecho/fisiopatología , Diagnóstico Diferencial , Electrocardiografía , Pruebas de Función Cardíaca , Humanos
14.
Cardiol Young ; 29(9): 1217-1218, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31378212

RESUMEN

A 14-year-old girl suddenly developed ventricular tachycardia and severe chest pain during hospitalisation for trauma surgery. CT revealed a needle in the pericardium. Careful interview elicited that she had inserted the needle by herself, and Munchausen syndrome was diagnosed. This is the first report of ventricular tachycardia caused by a foreign body in a patient with Munchausen syndrome.


Asunto(s)
Dolor en el Pecho/etiología , Cuerpos Extraños/complicaciones , Lesiones Cardíacas/complicaciones , Pericardio/lesiones , Conducta Autodestructiva/complicaciones , Taquicardia Ventricular/etiología , Heridas Penetrantes/complicaciones , Adolescente , Procedimientos Quirúrgicos Cardíacos/métodos , Dolor en el Pecho/diagnóstico , Electrocardiografía , Femenino , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/cirugía , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Humanos , Pericardio/diagnóstico por imagen , Pericardio/cirugía , Taquicardia Ventricular/diagnóstico , Tomografía Computarizada por Rayos X , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugía
15.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31340942

RESUMEN

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.


Asunto(s)
Toma de Decisiones Clínicas , Paro Cardíaco/mortalidad , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombosis/diagnóstico por imagen , Trombosis/terapia , Anciano de 80 o más Años , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Progresión de la Enfermedad , Disnea/diagnóstico , Disnea/etiología , Ecocardiografía/métodos , Embolectomía/métodos , Servicio de Urgencia en Hospital , Resultado Fatal , Femenino , Paro Cardíaco/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Hemodinámica/fisiología , Heparina/uso terapéutico , Humanos , Embolia Pulmonar/diagnóstico por imagen
16.
Rev Gastroenterol Mex ; 84(3): 372-397, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31213326

RESUMEN

INTRODUCTION: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.


Asunto(s)
Dolor en el Pecho/terapia , Dolor en el Pecho/diagnóstico , Consenso , Humanos , México
17.
Sao Paulo Med J ; 137(1): 54-59, 2019 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-31116271

RESUMEN

BACKGROUND: The chest pain classifications that are currently in use are based on studies that are several decades old. Various studies have indicated that these classifications are not sufficient for determining the origin of chest pain without additional diagnostic tests or tools. We describe a new chest pain scoring system that examines the relationship between chest pain and ischemic heart disease (IHD). DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level university hospital and two public hospitals. METHODS: Chest pain scores were assigned to 484 patients. These patients then underwent a treadmill stress test, followed by myocardial perfusion scintigraphy if necessary. Coronary angiography was then carried out on the patients whose tests had been interpreted as positive for ischemia. Afterwards, the relationship between myocardial ischemia and the test score results was investigated. RESULTS: The median chest pain score was 2 (range: 0-7) among the patients without IHD and 6 (1-8) among those with IHD. The median score of patients with IHD was significantly higher than that of patients without IHD (P = 0.001). Receiver operating characteristic analysis showed that the score had sensitivity of 97% and specificity of 87.5% for detecting IHD. CONCLUSION: We developed a pre-test chest pain score that uses a digital scoring system to assess whether or not the pain was caused by IHD. This scoring system can be applied easily and swiftly by healthcare professionals and can prevent the confusion that is caused by other classification and scoring systems.


Asunto(s)
Dolor en el Pecho/diagnóstico , Isquemia Miocárdica/diagnóstico , Dimensión del Dolor/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Dolor en el Pecho/fisiopatología , Estudios Transversales , Femenino , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/fisiopatología , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Centros de Atención Terciaria , Adulto Joven
19.
Dtsch Med Wochenschr ; 144(10): 659-664, 2019 05.
Artículo en Alemán | MEDLINE | ID: mdl-31083734

RESUMEN

Acute chest pain is a frequent reason for encounter in primary care. In contrast to hospital/emergency departments serious diseases like acute coronary syndrome or a pulmonary embolism are relative rare in primary care. This overview presents the diagnostic work up and decisions for transfer to the hospital setting in patients with acute chest pain.


Asunto(s)
Dolor en el Pecho , Enfermedad Aguda , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Dolor en el Pecho/terapia , Humanos
20.
Clin Imaging ; 57: 7-14, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31078917

RESUMEN

PURPOSE: Quantitative computed tomography (QCT) may be useful in detecting high-risk patients with coronary atherosclerosis. Assessment of plaque composition using fixed Hounsfield unit (HU) thresholds is influenced by luminal contrast density. A method using adaptive HU thresholds has therefore been developed. This study investigates agreement between plaque volumes derived using fixed and adaptive HU thresholds and the influence of luminal contrast density on the determination of plaque composition. METHODS: We performed QCT in 260 patients with recent acute-onset chest pain without acute coronary syndrome. Plaque volumes of necrotic core (NC), fibrous fatty (FF), fibrous (FI) and dense calcium (DC) tissue were measured in 1161 coronary segments. Agreement between plaque volumes using fixed and adaptive HU thresholds was tested using the Bland-Altman method. Additionally, patients were stratified into tertiles of ascending aortic luminal contrast density and plaque volumes were compared. RESULTS: Bland-Altman plots revealed that fixed HU thresholds underestimated FI and FF plaque volumes and overestimated NC and DC plaque volumes compared to adaptive HU thresholds. Volumes of dense calcium plaque differed with increasing tertiles of luminal contrast density when using fixed HU thresholds but not when using adaptive HU thresholds: DC for fixed HU thresholds (mm3, median (95%CI)): 7.73 (5.17;12.31), 9.83 (6.55;13.57), 12.02 (8.26;16.24); DC for adaptive HU thresholds (mm3, median (95%CI)): 7.34 (5.12;12.03), 7.78 (5.40;12.61), 8.56 (5.22;12.69). CONCLUSIONS: Plaque volumes by fixed and adaptive HU thresholds differed. Plaque volumes by adaptive HU thresholds were more independent of luminal contrast density for higher attenuation tissues compared to fixed HU thresholds.


Asunto(s)
Enfermedad de la Arteria Coronaria/patología , Placa Aterosclerótica/patología , Tomografía Computarizada por Rayos X , Anciano , Dolor en el Pecho/diagnóstico , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA