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1.
Medicine (Baltimore) ; 98(39): e17195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574826

RESUMO

The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into 4 groups: ECG-/Echo- (negative ECG and Echo), ECG+/Echo- (positive ECG and negative Echo), ECG-/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.MACEs were similar between ECG-/Echo- and ECG+/Echo- groups. Compared with ECG+/Echo- group, ECG-/Echo+ group had more MACEs (adjusted hazard ratio [HR] adjusted by clinical risk factors [95% confidence interval {CI}], 3.57 [1.75-7.29], P < .001). Compared with ECG+/Echo+ group, ECG-/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs (HR, 0.49 [0.29-0.81], P = .006).Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared with exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Dor no Peito/complicações , Angiografia Coronária , Doença da Artéria Coronariana/etiologia , Exercício/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(26): e15884, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261496

RESUMO

Proton pump inhibitor (PPI)-refractory non-cardiac chest pain (NCCP) is often resolved when constipation was relieved. This study aimed to investigate the clinical features of patients with both NCCP and constipated functional bowel disorders (FBD).Among 692 consecutive patients diagnosed with functional constipation or irritable bowel syndrome with constipation and underwent anorectal manometry (ARM) in our hospital, PPI-refractory NCCP was present in 37. The clinical course of various torso symptoms including NCCP and ARM findings were retrospectively evaluated.The mean age was lower in the NCCP than in the non-NCCP group (57.4 vs 61.3 years, respectively, P = .042). Back pain (16.2% vs 2.0%, P < .001) and sharp abdominal pain (13.5% vs 0.9%, P < .001) were more common in the NCCP group. Increased resting pressure (16.2% vs 6.9%, P = .036) and squeezing pressure (62.2% vs 50.7%, P = .049) of the anal sphincter, increased urgency volume (40.5% vs 23.2%, P = .004), and maximal volume (25.7% vs 15.0%, P = .032) for rectal sensation were more frequently observed in the NCCP group. After taking laxatives for 1 to 3 months, 81.1% of patients with NCCP reported improvement.Subjects with NCCP showed decreased rectal sensation more frequently at anorectal manometry. Majority of patients with NCCP reported improvement of symptom upon relief of constipation. Constipation might be a therapeutic target in patients with NCCP related to constipated functional bowel disorders.


Assuntos
Dor no Peito/complicações , Dor no Peito/tratamento farmacológico , Constipação Intestinal/complicações , Constipação Intestinal/tratamento farmacológico , Laxantes/uso terapêutico , Fatores Etários , Canal Anal/fisiopatologia , Dor no Peito/fisiopatologia , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/fisiopatologia , Estudos Longitudinais , Masculino , Manometria , Pessoa de Meia-Idade , Fenótipo , Reto/fisiopatologia , Estudos Retrospectivos , Sensação , Resultado do Tratamento
4.
Acta Radiol ; 60(1): 45-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29742921

RESUMO

BACKGROUND: Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. PURPOSE: To evaluate the prognostic value of CCTA in patients with suspected CAD. MATERIAL AND METHODS: A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). RESULTS: Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. CONCLUSION: Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.


Assuntos
Dor no Peito/complicações , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Adulto , Idoso , Dor no Peito/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Tempo
5.
Med Princ Pract ; 28(1): 87-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30380556

RESUMO

OBJECTIVE: Acute thrombotic occlusion of > 1 major coronary arteries is very rare (2.5%). Herein, we report a patient with simultaneous anterior and inferior myocardial infarction without cardiogenic shock. CLINICAL PRESENTATION AND INTERVENTION: A 43-year-old woman was admitted with severe chest pain. Electrocardiography showed ST segment elevation in anterior and inferior derivations. There was no severe hypotension. Urgent coronary angiography showed that there were thrombotic occlusions in both left anterior descending artery and right coronary artery. Both lesions were successfully treated with coronary stenting. CONCLUSION: If there is multiple ST segment elevation on presentation electrocardiography, clinicians should be aware of possible simultaneous coronary occlusions.


Assuntos
Dor no Peito/complicações , Dor no Peito/diagnóstico por imagem , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico por imagem , Adulto , Angioplastia Coronária com Balão , Angiografia Coronária , Oclusão Coronária/cirurgia , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio , Resultado do Tratamento
6.
BMC Infect Dis ; 19(1): 1090, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888522

RESUMO

BACKGROUND: In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30-65% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities. METHODS: The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal's National Tuberculosis Program (NTP) for Xpert MTB/RIF testing. Participants' demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer's protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay. RESULT: Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, > 45(nearly 33%) with median age 42 ± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB/RIF assay, the additional case 16.5% (n = 85/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects. CONCLUSION: With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.


Assuntos
Bioensaio/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Algoritmos , Dor no Peito/complicações , Tosse/complicações , Estudos Transversais , DNA Bacteriano/efeitos dos fármacos , DNA Bacteriano/isolamento & purificação , Países em Desenvolvimento , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitais Universitários , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Nepal , Derrame Pleural/complicações , Rifampina/efeitos adversos , Rifampina/uso terapêutico , Sensibilidade e Especificidade , Escarro/microbiologia , Adulto Jovem
7.
Medicine (Baltimore) ; 97(49): e13498, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544446

RESUMO

INTRODUCTION: Coronary computed tomography angiography (CCTA) has emerged as a valuable noninvasive imaging tool for assessing atheromatous plaque morphology and composition, and several CCTA features have been validated as reliable indicators of the plaque-associated risk. However, the role of lesion geometry as a CCTA feature of plaque vulnerability has not been investigated so far. MATERIAL AND METHODS: Here we present the study protocol of the GEOMETRY trial, a prospective, single center, cohort study in which we aim to investigate the relationship between plaque geometry (as expressed by cross-sectional and longitudinal plaque eccentricity) and the risk for major adverse cardiac events (MACE) during 2 years of follow-up, in order to validate plaque eccentricity as a new CCTA marker of coronary plaque vulnerability. One thousand patients with suspected coronary artery disease (CAD) and pretest probability of CAD between 15% and 85%, who undergo CCTA and in whom CCTA identifies the presence of at least 1 significant coronary plaque (producing a luminal narrowing of at least 50%) will be enrolled in the study. Based on the results of complex image post-processing and plaque analysis, patients will be divided into 2 groups: group 1-patients in whom CCTA analysis identifies only non-eccentric coronary plaque; and group 2-patients in whom CCTA analysis reveals the presence of at least 1 eccentric significant coronary plaque producing a significant luminal narrowing. Study outcomes will consist in the rate of major cardiovascular events and the rate of plaque progression during follow-up.The study is funded by the Romanian Ministry of European Funds, the Romanian Government and the European Union, as part of the research grant number 103544/2016 - PlaqueIMAGE (contract number 26/01.09.2016). CONCLUSION: In conclusion, GEOMETRY will be the first CCTA-based study that will investigate the impact of geometric distribution of coronary atheromatous plaque on the future risk of cardiovascular events and on the rate of plaque progression, introducing and validating a new potential feature of plaque vulnerability represented by plaque geometry.


Assuntos
Dor no Peito/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Dor no Peito/complicações , Doença da Artéria Coronariana/complicações , Progressão da Doença , Humanos , Seleção de Pacientes , Medição de Risco
8.
Echocardiography ; 35(12): 2127-2129, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30328208

RESUMO

Coronary artery fistulae are congenital cardiac abnormalities characterized by an abnormal communication between a coronary artery and a cardiac chamber, systemic or pulmonary vessel. Most of the cases are asymptomatic and are discovered incidentally during an angiography. We describe a rare case of a right coronary artery fistula draining to the right atrium, manifesting in chest pain and pulmonary arterial hypertension (PAH). The fistula was detected on transesophageal echocardiography during the workup for PAH.


Assuntos
Dor no Peito/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Hipertensão Pulmonar/diagnóstico , Fístula Vascular/diagnóstico , Adulto , Dor no Peito/complicações , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Tomografia Computadorizada Multidetectores/métodos , Fístula Vascular/complicações , Fístula Vascular/congênito
9.
Rev. Soc. Bras. Clín. Méd ; 16(2): 77-79, 20180000. ilus
Artigo em Português | LILACS | ID: biblio-913361

RESUMO

OBJETIVO: Avaliar a adesão dos plantonistas da emergência na aplicação de um protocolo de dor torácica e o impacto no índice de mortalidade por infarto agudo do miocárdio. MÉ- TODOS: Estudo retrospectivo, realizado de maio de 2016 até maio de 2017. Os dados foram obtidos por relatórios do sistema TASY e mostram todas as admissões por queixa de dor torácica, segundo a CID10. Estas admissões foram tabuladas em planilha Excel. RESULTADOS: Dos 1.657 pacientes com entrada na emergência clínica por queixa de dor torácica, 471 apresentavam síndrome coronariana. Na amostra, 67,39% dos pacientes eram do sexo masculino, com média de idade de 59,72 anos. Destes, 92 (19,96%) foram diagnosticados com infarto agudo do miocárdio, 30 (28,26%) apresentavam supradesnivelamento do segmento ST e 62 (71,74%) foram diagnosticados como infarto agudo do miocárdio sem supradesnivelamento do segmento ST. Todos os casos que necessitaram de angioplastia tiveram o procedimento executado dentro do prazo estabelecido pelas diretrizes internacionais. Receberam aspirina profilática 469 (99,57%) pacientes. A mortalidade dos pacientes internados com infarto agudo do miocárdio foi de 2,17%. CONCLUSÃO: O gerenciamento deste protocolo permite mapear o processo, bem como verificar eficácia, pontos fortes e fracos, e os riscos.(AU)


OBJECTIVE: To evaluate the adherence of emergency doctors to the application of the chest pain protocol, and the impact on mortality rate from acute myocardial infarction. METHODS: This is a retrospective study performed from May 2016 to May 2017. Data were obtained from TASY reports and show all admissions for chest pain complaints (ICD-10). These admissions were tabulated in Excel spreadsheet. RESULTS: Of the 1.657 patients admitted to the clinical emergency due to a complaint of chest pain, 471 had a coronary syndrome. In the sample, 67.39% of patients were male, with a mean age of 59.72 years. Of these, 92 (19.96%) were diagnosed with acute myocardial infarction, 30 (28.26%) presented ST segment elevation, and 62 (71.74%) were diagnosed as acute myocardial infarction without ST segment elevation. All cases requiring angioplasty had the procedure performed within the period established by the international guidelines. Of the patients, 469 (99.57%) received prophylactic aspirin. The mortality of patients hospitalized with acute myocardial infarction was 2.17%. CONCLUSION: The management of this protocol allows mapping the process, checking efficacy, strengths, weaknesses, and risks.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Qualidade da Assistência à Saúde , Dor no Peito/complicações , Protocolos Clínicos , Síndrome Coronariana Aguda/mortalidade , Infarto do Miocárdio/mortalidade
10.
J Immunoassay Immunochem ; 39(3): 337-347, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29985768

RESUMO

Myeloperoxidase (MPO) is an inflammatory marker, elevated in acute coronary syndromes (ACSs), especially in acute myocardial infarction (AMI) cases. This study aimed to evaluate the diagnostic power of MPO in AMI patients. MPO, creatine kinase (CK) MB, and Troponin I (cTn I) were performed for all study patients. Area under the curves (AUCs) and 95% confidence intervals (CI); P values of baseline levels of MPO for discriminating AMI patients from noncoronary chest pain (NCCP) patients, stable angina (SA) patients, and unstable angina (UA) patients were 0.91, 95% CI: 0.82-0.99; P < 0.0001, 0.87, 95% CI: 0.77-0.98; P < 0.0001, and 0.72, 95% CI: 0.58-0.85; P = 0.002, respectively. For diagnosing AMI from ACS patients, MPO was the most efficient marker than others markers with efficiency 82.5% within 0-6 hr after the onset time of chest pain. A predictive score that depends on a combination of baseline levels of three markers (MPO, CK-MB, and TnI) was correctly discriminated 91% of the AMI patients with high specificity 76%. In conclusion, the use of baseline levels of three biomarkers in combination could confer the information that is required for best available early diagnosis of AMI.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/enzimologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/enzimologia , Peroxidase/metabolismo , Doença Aguda , Adulto , Idoso , Biomarcadores/metabolismo , Dor no Peito/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. ilus
Artigo em Português | LILACS | ID: biblio-916420

RESUMO

A dissecção da aorta é uma condição grave cujo diagnóstico preciso precoce é fun-damental para a sobrevida dos pacientes. Dentro do contexto da dor torácica aguda no setor de emergência, seu diagnóstico pode passar despercebido, o que exige um alto índice de suspeição para ser realizado em tempo hábil. A disponibilidade dos métodos de imagem têm contribuído para a prontidão desse diagnóstico. Os objetivos iniciais do tratamento consistem no controle da dor e da pressão arterial através, principalmente, do uso de betabloqueadores endovenosos. Tais medidas diminuem o stress na parede da aorta, minimizando a propagação da delaminação. A identificação da localização do segmento de aorta dissecado é crucial, pois impacta no tratamento e no prognóstico. Pacientes com dissecção tipo B de Stanford e sem complicações podem receber trata-mento medicamentoso exclusivo, enquanto que a dissecção aguda tipo A de Stanford é uma emergência cirúrgica. Em relação à cirurgia, têm-se discutido o benefício da técnica do Frozen Elephant Trunk, a qual corrige uma maior extensão de aorta comprometida, po-dendo beneficiar pacientes com isquemia distal, apesar de apresentar maior complexidade e aumentar o risco de complicações neurológicas. Para as dissecções tipo B, o reparo endovascular tem sido amplamente utilizado e vários especialistas têm sugerido essa abordagem também para os casos não complicados, pois estudos recentes descrevem a influência do tratamento no remodelamento aórtico e, consequentemente, na sobrevida


Aortic dissection is a dramatic condition whose early accurate diagnosis is fundamen-tal for patient survival. Within the context of acute chest pain in the emergency room, its diagnosis can be overlooked, requiring a high level of suspicion to be performed in a timely manner. The availability of imaging methods has contributed to a faster diagnosis. The initial management goal is to control pain and blood pressure, mainly through the use of intra-venous beta-blockers. This strategy decreases shear stress on the aortic wall, minimizing the progression of delamination. Identifying the location of the dissected aortic segment is crucial, as this will impact on the treatment and prognosis. Patients with uncomplicated Stanford type B dissection may receive pharmaceutical treatment alone, while acute type A dissection is a surgical emergency. In relation to surgery, the benefit of the "Frozen Ele-phant Trunk" technique has been discussed, which corrects a greater area of compromised aorta and may benefit patients with distal ischemia, despite adding greater complexity and increasing the risk of neurological complications. For type B dissections, endovascular repair has been widely used, and several experts have also suggested this approach for uncomplicated cases, as recent studies have described the influence of the treatment on aortic remodeling and consequently, on survival


Assuntos
Humanos , Masculino , Feminino , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aorta , Dissecação/métodos , Doenças da Aorta , Dor no Peito/complicações , Diagnóstico por Imagem/métodos , Ecocardiografia Transesofagiana/métodos , Procedimentos Endovasculares/métodos , Hipertensão/terapia , Obesidade , Prognóstico , Fatores de Risco , Tomografia/métodos
13.
Gen Hosp Psychiatry ; 53: 101-107, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29773309

RESUMO

OBJECTIVE: Many patients who present to the emergency department (ED) with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to the experience. Less is known about risk for PTSD in patients who rule out for ACS. Our objective was to compare the risk of developing PTSD among patients who rule out versus rule in for ACS. METHODS: We enrolled a consecutive sample of 1000 patients presenting to an emergency department (ED) with symptoms of a probable ACS. We assessed presenting ACS symptoms in the ED. We determined whether presenting symptoms were due to a confirmed ACS or another etiology by chart review. We assessed PTSD by telephone 1 month after discharge using the PTSD Checklist specific for the suspected ACS event (PCL-S). We used logistic regression to determine the association of ruling out versus ruling in for ACS with a positive PTSD screen (PCL-S ≥ 32), adjusting for demographics, comorbidities, depression, trauma history, and pre-existing PTSD. RESULTS: Approximately two-thirds of patients (68.2%) ruled out for ACS. Compared to confirmed ACS patients, patients who ruled out had similar presenting symptoms, and similar risk of screening positive for PTSD (18.9% versus 16.8%; p = 0.47; adjusted OR 1.18, 95% CI 0.69-2.00; p = 0.55). CONCLUSIONS: ED presentation with ACS symptoms was sufficient to trigger a positive PTSD screen whether the etiology was due to a life-threatening ACS or another etiology. Patients who present with ACS symptoms should be considered for interventions to prevent PTSD after hospitalization, regardless of symptom etiology.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Síndrome Coronariana Aguda/complicações , Adulto , Idoso , Dor no Peito/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/etiologia
16.
BMJ Open ; 8(3): e018391, 2018 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502085

RESUMO

OBJECTIVES: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. DESIGN: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. SETTING: Emergency and cardiology departments in the Region of Southern Denmark. SUBJECTS: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. MAIN OUTCOMES MEASURES: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. RESULTS: There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. CONCLUSION: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP. TRIAL REGISTRATION NUMBER: NCT02422316; Pre-results.


Assuntos
Dor no Peito/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Angina Instável/epidemiologia , Institutos de Cardiologia , Dor no Peito/complicações , Comorbidade , Vasos Coronários/patologia , Dinamarca/epidemiologia , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Estudos Prospectivos , Medição de Risco , Taquicardia Ventricular/epidemiologia , Tomografia Computadorizada por Raios X , Calcificação Vascular/patologia
17.
BMC Emerg Med ; 18(1): 10, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-29540151

RESUMO

BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique. The survey was administered to a convenience sample of ED providers attending the 2016 American College of Emergency Physicians Scientific Assembly in Las Vegas. RESULTS: Surveys were completed by 409 emergency medicine providers from 46 states and 7 countries with a wide range of years of experience and primary practice environment (academic versus community centers). Respondents estimated that 30% of patients presenting to the ED with chest pain thought to be low risk for ACS have anxiety or panic as the primary cause but they directly communicate this belief to only 42% of these patients and provide discharge instructions to 48%. Only 39% of respondents reported adequate hospital resources to ensure follow-up. Community-based providers reported more adequate follow-up for these patients than their academic center colleagues (46% vs. 34%; p = 0.015). Most providers (82%) indicated that they wanted to have referral resources available to a specific clinic for further outpatient evaluation. CONCLUSION: Emergency Department providers believe approximately 30% of patients seeking emergency care for chest pain at low risk for ACS have anxiety as a primary problem, yet fewer than half discuss this concern or provide information to help the patient manage anxiety. This highlights an opportunity for patient centered communication.


Assuntos
Ansiedade/etiologia , Ansiedade/psicologia , Dor no Peito/complicações , Dor no Peito/psicologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ansiolíticos/administração & dosagem , Ansiedade/diagnóstico , Ansiedade/tratamento farmacológico , Técnica Delfos , Feminino , Humanos , Masculino , Padrões de Prática Médica
18.
Curr Cardiol Rep ; 20(5): 30, 2018 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-29574581

RESUMO

PURPOSE OF REVIEW: To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing. RECENT FINDINGS: There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models. The CAD Consortium models demonstrated that DF and DCS models overestimate the probability of CAD. All CAD Consortium models performed well in the contemporary population. PROMISE trial secondary data results showed that a clinical tool using readily available ten very low-risk pre-test variables could discriminate low-risk patients to defer further testing safely. In the contemporary population, CAD Consortium Basic or Clinical model could be used with more confidence. Our proposed simple algorithm would guide the physicians in selecting low risk patients who can be managed conservatively with deferred testing strategy. Future research is needed to validate our proposed algorithm to identify the low-risk patients with stable chest pain for whom further testing may not be warranted.


Assuntos
Algoritmos , Dor no Peito/complicações , Dor no Peito/diagnóstico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Dor no Peito/fisiopatologia , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/prevenção & controle , Humanos , Valor Preditivo dos Testes , Curva ROC , Medição de Risco , Fatores de Risco
19.
Int. j. cardiovasc. sci. (Impr.) ; 31(2): f:107-l:113, mar.-abr. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-881957

RESUMO

Background: Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital


Fundamentos: O infarto agudo do miocárdio se configura como uma das principais causas de morbimortalidade no mundo, e um dos fatores de maior impacto prognóstico é o atendimento especializado precoce, porém ainda existem inúmeros fatores que retardam a chegada do paciente até o hospital. Objetivo: Correlacionar fatores sociais, educacionais, cognitivos e clínicos com o tempo para a chegada no hospital após os primeiros sintomas de infarto agudo do miocárdio. Métodos: O tempo para a busca de atendimento médico foi mensurado entre o início dos primeiros sintomas de infarto relatado pelo paciente e o registro da admissão hospitalar em prontuário eletrônico do serviço de emergência. A correlação entre o delta T e outras variáveis foi verificada por meio da correlação de Kendall. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Não houve correlação entre delta T e escolaridade, e nem entre delta T e desempenho no Mini-Exame do Estado Mental, assim como não houve associação entre a presença de hipertensão arterial sistêmica, diabetes melito, dislipidemia, sedentarismo, história familiar ou tabagismo com o tempo de chegada no hospital. Comparações entre delta T e estado civil também não foram estatisticamente significativas. A transferência de outro serviço de saúde e a região de procedência foram os fatores que mais determinaram atraso no atendimento especializado de nossa população. Conclusão: Fatores educacionais, sociais e cognitivos não estiveram diretamente relacionados ao atraso na chegada ao hospital


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio/complicações , Fatores de Risco , Angina Pectoris/complicações , Dor no Peito/complicações , Diabetes Mellitus/diagnóstico , Mortalidade Hospitalar , Hipertensão/complicações , Indicadores de Morbimortalidade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Estudos Prospectivos , Comportamento Sedentário , Análise Estatística
20.
Int. j. cardiovasc. sci. (Impr.) ; 31(2): 107-113, mar.-abr. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-954091

RESUMO

Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital


Assuntos
Fatores de Risco , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio/complicações , Dor no Peito/complicações , Indicadores de Morbimortalidade , Análise Estatística , Estudos Prospectivos , Mortalidade Hospitalar , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Diabetes Mellitus , Comportamento Sedentário , Hipertensão/complicações , Angina Pectoris/complicações
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