Identification and Management of Intermediate Risk Patients in the Chest Pain Unit.

OBJECTIVE: We examined low risk (LR) patients admitted to our chest pain unit (CPU) with negative cardiac injury markers, normal electrocardiogram, and clinical stability. We hypothesized that there is a sub-group of intermediate risk (IR) patients within the larger LR population. METHODS: Criteria for IR were the aforementioned 3 indicators of LR and ≥1 of the following: (1) known coronary artery disease (CAD), (2) men ≥45 yo, women ≥55 yo, and (3) ≥3 cardiac risk factors. We compared patient characteristics, use of pre-discharge testing (PDT), and major adverse cardiac events (MACE). RESULTS: IR patients numbered 371, whereas LR patients totaled 70. IR patients were older (61 vs 46 years), more had known CAD (28 vs. 0%), had a higher median number of risk factors (2 vs. 1) and were less likely to be women (49 vs. 81%), all P < 0.0001. IR patients received a greater median number of tests compared with LR patients (1 vs. 0, P < 0.0001). CONCLUSIONS: Among the IR group, 16 patients (4%) had a cardiac event at the index CPU visit, 2 (0.5%) experienced MACE at 30-day follow-up, and 2 (0.5%) had MACE at 6 months follow-up. No LR patients had MACE at any point in the study. Thus, the majority of CPU patients are IR, have more risk factors than LR group, and are more likely to receive PDT. IR patients were managed safely in a CPU, while maintaining low rates of MACE post-discharge.

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience.

Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the abdominal aorta, as it can have adverse consequences if it goes unnoticed or untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently emerged as a treatment modality for AAA. It does have a few inherent complications that include endoleak, endograft migration, bleeding, ischemia, and compartment syndrome. This case report discusses a patient who came in with abdominal pain and a pulsatile mass, which raised concerns regarding endoleak. The patient had a 9.9-cm AAA, which was repaired in the past, as was made evident by computed tomography findings of the stent graft in the aneurysmal segment. This case stands out because it highlights the importance of comparing the size of the AAA at the time of the EVAR to the current scenario where the patient presents with abdominal pain of unknown etiology. Also, this case report highlights the importance of computed tomography and other imaging forms in following-up with patients who have EVAR for AAAs.