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1.
Am Heart J ; 231: 157-159, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33010246

RESUMO

During the COVID-19 pandemic there has been a reduction in hospital admissions for acute myocardial infarction. This manuscript presents the analysis of Google Trends meta-data and shows a marked spike in search volume for chest pain that is strongly correlated with COVID-19 case numbers in the United States. This raises a concern that fear of contracting COVID-19 may be leading patients to self-triage using internet searches.


Assuntos
Dor no Peito , Controle de Doenças Transmissíveis/estatística & dados numéricos , Autoavaliação Diagnóstica , Infarto do Miocárdio/epidemiologia , /epidemiologia , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/psicologia , Correlação de Dados , Medo , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Isolamento Social , Estados Unidos/epidemiologia
2.
Isr Med Assoc J ; 22(12): 775-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381951

RESUMO

BACKGROUND: Our 1600-bed teaching hospital opened the first physician-led specialist pleural service in Israel in November 2016. Thoracentesis is one of the frequently performed procedures in clinic. OBJECTIVES: To review the incidence of thoracentesis-related symptoms, complications, and risk factors in a specialist pleural clinic. METHODS: Prospective analysis was conducted of 658 ultrasound-assisted thoracenteses between November 2016 and November 2019. Data were collected on patient demographics, clinical characteristics, procedural aspects, symptoms, complications, and additional interventions required. RESULTS: Of the procedures, 24% were accompanied by a reported symptom of any intensity or duration. Cough and chest discomfort were noted in 56.4% and 52% of these cases, respectively. Large-volume drainage was associated with symptoms (P = 0.002). Ultrasound-estimated effusion volume before drainage predicted pain (P = 0.001) and pneumothorax (P = 0.021). Of 8 cases of pneumothorax, 6 were due to non-expandable lung. Two patients were hospitalized (0.3%), and one required a chest drain. CONCLUSIONS: Symptoms are a common feature of thoracentesis even when performed by experienced operators in ideal settings. Complications, however, are rare when the procedure is performed with bedside ultrasound and attention is paid to patient-reported symptoms and volume drained. Specialist pleural clinics provide a good model for a standardized approach to safe performance of this common procedure.


Assuntos
Toracentese/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Idoso , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco , Toracentese/métodos , Ultrassonografia de Intervenção/métodos
3.
Health Policy ; 124(12): 1333-1339, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33148454

RESUMO

INTRODUCTION: The increase in access to Emergency Departments (ED) worldwide causes inefficiencies, but also signals its importance. The Coronavirus (Covid-19) outbreak allows to study the reactions of patients to the news about the spreading of the infection, which may have generated the fear that ED was no longer safe. METHODS: We study access to ED of a large teaching hospital in Brescia - one of the most hit provinces in Italy by Covid-19 - during the pandemic (from the announcement of the first cases to the explosion of the pandemic, to months after end of the acute phase) to study how patients reacted to the news that ED could no longer be a safe place. We analyse triage code, mode of arrival to ED, and accesses related to chest and abdominal pain, to evaluate who was discouraged most. RESULTS: Accesses have drastically reduced immediately after the news of the first contagion. During the lockdown accesses and admissions to hospital ward have decreased; this may mean that some patients may have suffered reduced health or increased mortality risks because of this decision. At the end of June accesses to ED and admissions to hospital ward are still lower than usual. DISCUSSION: Fear of contagion and appeals not to use ED directly by Covid-19 patients may have discouraged access also for pressing health need.


Assuntos
/psicologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medo , Pandemias , Dor Abdominal/epidemiologia , Dor no Peito/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Triagem/organização & administração
4.
Med Care ; 58(10): 881-888, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32732782

RESUMO

BACKGROUND: Many older adults (65+) present to the Emergency Department (ED) with chest pain, but do not have otherwise clear clinical indication of whether they should be admitted or discharged. This uncertainty leads to decisions that are highly variable-in addition to already being costly-which could have adverse consequences, since older adults are particularly vulnerable from hospitalization. OBJECTIVE: The objective of this study was to determine whether admitting versus discharging an older adult presenting to the ED with chest pain reduces risk of mortality and readmission. STUDY DESIGN: Electronic health records were curated from an academic hospital system between January 1, 2014, and September 27, 2018. Average effects of admission on 30-day readmission and mortality were estimated using a new causal inference approach based on a latent-variable model of the admission process. Additional analyses assessed moderators and robustness of estimates. SUBJECTS: Older patients (n=3090) presenting to University of Wisconsin Hospital ED. MEASURES: Readmission and mortality within 25, 30, and 35 days of discharge from the ED for discharged patients or the hospital for admitted patients RESULTS:: For older chest pain patients, admission is estimated to lower the 30-day risk of readmission by 42.8% (95% confidence interval: 41.0%-44.6%) but increase the 30-day risk of mortality by 0.8% (95% confidence interval: 0.4%-1.2%). Individuals with higher hierarchical conditional category scores or diabetes with complications have both lower 30-day risk of readmission and higher 30-day risk of mortality compared with their counterparts (P≤0.02). CONCLUSIONS: Our findings suggest ED admission may prevent readmission at the cost of increasing mortality risk for older chest pain patients, especially those with comorbidity. Additional studies are needed to validate these findings.


Assuntos
Dor no Peito/epidemiologia , Dor no Peito/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Complicações do Diabetes , Diabetes Mellitus/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Wisconsin
5.
Pan Afr Med J ; 36: 65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32754292

RESUMO

Spontaneous esophageal perforation is rare and is associated with high morbidity and mortality. A spectrum of various surgical modalities ranging from primary surgical repair to esophagectomy is available for its management. The optimal management of patients presenting late in a hemodynamically stable condition is not clearly defined in the literature. A retrospective review of all patients with Boerhaave syndrome managed by a single surgical team in a tertiary care center between 2008 and 2019 was performed (n = 16). Eleven patients were initially managed in the medical intensive care unit (MICU) as non-esophageal cause and 5 patients were referred after failed management (conservative/endoscopic). Demographics, clinical presentation, characteristics of perforation, initial diagnosis, and treatment were analyzed. All patients were males with a mean age of 42.2 years. A history of ethanol use was present in 6 patients. The median delay in diagnosis and referral was 16 days (range: 11-40 days). The common presenting symptoms were chest pain (n=11), dyspnoea (n=10), vomiting (n=4) and cough (n=2). The perforation was directed into right, left, and bilateral pleural cavities in 6, 8, and 2 patients respectively. The location of perforation was distal esophagus except for one patient. One patient was successfully treated with conservative management. The remaining patients underwent esophagectomy as a definitive surgical procedure. There was no significant postoperative morbidity and mortality. Esophagectomy can be done as a one-stage definitive procedure for patients with Boerhaave syndrome who present late in a hemodynamically stable condition with acceptable morbidity and good long term outcome.


Assuntos
Perfuração Esofágica/cirurgia , Esofagectomia/métodos , Doenças do Mediastino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Diagnóstico Tardio , Dispneia/etiologia , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/fisiopatologia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Vômito/epidemiologia , Vômito/etiologia , Adulto Jovem
6.
Br J Sports Med ; 54(16): 1008-1012, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32532845

RESUMO

OBJECTIVE: Current guidelines recommend precautionary disqualification from competitive sports in patients with hypertrophic cardiomyopathy (HCM). We assessed the incidence of cardiovascular events in a cohort of patients with HCM engaged in long-term exercise programmes and competitive sport. METHODS: We reviewed data on 88 consecutive athletes diagnosed with HCM, from 1997 to 2017; 92% male, 98% Caucasian, median age 31 (IQR: 19-44) years. All participated in regular exercise programmes and competitive sport at study entry.We performed follow-up evaluation after 7±5 (1-21) years. 61 (69%) of the athletes had substantially reduced or stopped exercise and sport (ie, HCM-detrained), and 27 had continued with regular training and sport competitions (HCM-trained). At baseline evaluation, both groups were similar for age, gender balance, symptoms, ECG abnormalities, extent of left ventricular hypertrophy, arrhythmias and risk profile for sudden cardiac death/arrest. RESULTS: During the follow-up period, two participants suffered sudden cardiac arrest or death (0.3% per year) both outside of sport participation. In addition, 19 (22%) reported symptoms (syncope in 3, palpitations in 10, chest pain in 4 and dyspnoea in 2). The Kaplan-Meier analyses of freedom from combined sudden cardiac arrest/death and symptoms (log-rank test p=0.264) showed no differences between HCM-trained and detrained patients. CONCLUSION: In this adult cohort of low-risk HCM athletes, voluntary decision to pursue in participation in competitive sport events was not associated with increased risk for major cardiac events or clinical worsening compared with decision to reduce or withdraw from exercise programmes and sport. Similar results may not be seen in younger or racially diverse athlete populations, or in patients with more severe HCM phenotypes.


Assuntos
Cardiomiopatia Hipertrófica , Doenças Cardiovasculares/epidemiologia , Esportes/fisiologia , Adulto , Arritmias Cardíacas/epidemiologia , Dor no Peito/epidemiologia , Morte Súbita Cardíaca/epidemiologia , Dispneia/epidemiologia , Eletrocardiografia , Exercício Físico/fisiologia , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Síncope/epidemiologia , Adulto Jovem
7.
Clin Res Cardiol ; 109(12): 1469-1475, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32476041

RESUMO

BACKGROUND: We sought to determine structure and changes in organisation and bed capacities of certified German chest pain units (CPU) in response to the emergency plan set-up as a response to the SARS-CoV-2 pandemic. METHODS AND RESULTS: The study was conducted in the form of a standardised telephone interview survey in certified German CPUs. Analyses comprised the overall setting of the CPU, bed capacities, possibilities for ventilation, possible changes in organisation and resources, chest pain patient admittance, overall availability of CPUs and bail-out strategies. The response rate was 91%. Nationwide, CPU bed capacities decreased by 3% in the early phase of COVID-19 pandemic response, exhibiting differences within and between the federal states. Pre-pandemic and pandemic bed capacities stayed below 1 CPU bed per 50,000 inhabitants. 97% of CPUs were affected by internal reorganisation pandemic plans at variable extent. While we observed a decrease of CPU beds within an emergency room (ER) set-up and on intermediate care units (ICU), beds in units being separated from ER and ICU were even increased in numbers. CONCLUSIONS: Certified German CPUs are able to maintain adequate coverage for chest pain patients in COVID-19 pandemic despite structural changes. However, at this time, it appears important to add operating procedures during pandemic outbreaks to the certification criteria of forthcoming guidelines either at the individual CPU level or more centrally steered by the German Cardiac Society or the European Society of Cardiology.


Assuntos
/terapia , Serviço Hospitalar de Cardiologia/organização & administração , Dor no Peito/terapia , Serviço Hospitalar de Emergência/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Número de Leitos em Hospital , Hospitalização , Unidades de Terapia Intensiva/organização & administração , /diagnóstico , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Alemanha/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde
8.
Am J Cardiol ; 127: 36-40, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32418720

RESUMO

Acute chest pain is one of the most common presenting symptoms to the emergency department. Currently available risk scores are suboptimal in identifying low-risk patients eligible for early and safe discharge. Various, initially obtained clinical data have valuable discriminating power but are not being fully utilized. We developed a new scoring system based on 5 sets of variables; characteristics of Symptoms, history of Vascular disease,  Electrocardiography,  Age, and Troponin (SVEAT score). A total of 321 subjects presenting to the emergency department or admitted to the clinical decision unit at our institution with chest pain from May 2017 to August 2018 were prospectively recruited. The subjects were followed for 30 days for any major cardiovascular events (MACE); acute myocardial infarction, confirmed coronary artery disease requiring revascularization or medical therapy or death. A 30-day MACE occurred in 19.6% of the subjects. Predictive ability of SVEAT score for a 30-day MACE was compared with HEART and TIMI risk score using receiving-operator characteristic curve. The area under the curve of SVEAT score (0.98, 95% confidence interval [CI] 0.97 to 0.99) is higher than HEART (0.92, 95% CI 0.88 to 0.96) and TIMI score (0.88, 95% CI 083 to 0.93). Using SVEAT score of 4 as a cut off, 0.8% of the subjects developed a 30-day MACE compared with 1.4% and 1.5% of those classified as low-risk based on the HEART and TIMI score respectively. SVEAT score additionally identified larger proportion of low-risk (73.8%) than the HEART (45.2%) and TIMI risk score (40.1%), (p <0.01, for both).


Assuntos
Dor no Peito/diagnóstico , Eletrocardiografia , Serviço Hospitalar de Emergência , Medição de Risco/métodos , Doença Aguda , Adulto , Idoso , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nevada/epidemiologia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Troponina/sangue
9.
Tunis Med ; 98(1): 55-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395778

RESUMO

BACKGROUND: Non-traumatic chest pain is a common cause in pre hospital emergency medicine. The objective of our study was to identify predictive factors of STEMI in patients with acute chest pain, on telephone interview. METHODS: We conducted a prospective observational study over a period of one year (december 2017 to november 2018) in the Emergency Care System of the North Est (SAMU 01) of Tunisia. We included all adults patients aged more than 18 years old, calling the emergency dispatch center for acute non traumatic chest pain (CP). The demographic and clinical data were collected and studied to identify the predictive factors for STEMI. RESULTS: We included 368 patients. The average age was 56 ± 15 years, the sex ratio was 2.7. Smoking was the most common cardiovascular risk factor (41%) followed by hypertension (31%) and coronary artery disease (20%). Half of calls were made by doctors and 43% of them were made within the first two hours of onset of the CP. Clinical examination showed cardio respiratory arrest in 10 patients, 6 of them were related to STEMI. On the arrival of our emergency mobile teams, an elevation of ST segment was identified in 118 patients (32%) of which 37% were admitted directly into the catheterization room. In multivariate analysis, the independent predictive factors of STEMI were: diabetes (OR = 5.25; CI [1.61 - 17.06]), smoking (OR = 2.78, CI [1.03 - 7.5]), typical CP (OR = 4.68, CI [1.09 - 21.67]), CP persistence of more than 30 min (OR = 63.31, CI [13.51 - 29.49]). CONCLUSION: History of diabetes, smoking, typical and persistent CP were the main factors associated with STEMI in patients calling the emergency dispatch center for an acute CP. The early identification of these factors by the emergency physician will improve the management of acute CP since the medical regulation.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/epidemiologia , Eletrocardiografia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Tunísia/epidemiologia , Adulto Jovem
12.
Minerva Med ; 111(2): 120-132, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32338841

RESUMO

BACKGROUND: The aim of this study was to describe the population of patients arriving in several Italian Emergency Departments (EDs) complaining of chest pain suggestive of acute coronary syndrome (ACS) in order to evaluate the incidence of ACS in this cohort and the association between ACS and different clinical parameters and risk factors. METHODS: This is an observational prospective study, conducted from the 1st January to the 31st December 2014 in 11 EDs in Italy. Patients presenting to ED with chest pain, suggestive of ACS, were consecutively enrolled. RESULTS: Patients with a diagnosis of ACS (N.=1800) resulted to be statistically significant older than those without ACS (NO ACS; N.=4630) (median age: 70 vs. 59, P<0.001), and with a higher prevalence of males (66.1% in ACS vs. 57.5% in NO ACS, P<0.001). ECG evaluation, obtained at ED admission, showed new onset alterations in 6.2% of NO ACS and 67.4% of ACS patients. Multiple logistic regression analysis showed that the following parameters were predictive for ACS: age, gender, to be on therapy for cardio-vascular disease (CVD), current smoke, hypertension, hypercholesterolemia, heart rate, ECG alterations, increased BMI, reduced SaO2. CONCLUSIONS: Results from this observational study strengthen the importance of the role of the EDs in ruling in and out chest pain patients for the diagnosis of ACS. The analysis put in light important clinical and risk factors that, if promptly recognized, can help Emergency Physicians to identify patients who are more likely to be suffering from ACS.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Dor no Peito/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico , Fatores Etários , Idoso , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Fatores Sexuais
13.
Indian J Tuberc ; 67(1): 38-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32192615

RESUMO

BACKGROUND: "Active case finding among key populations" is one of the four main thrust areas under the National Strategic Plan for Tuberculosis (NSP) 2017-25. OBJECTIVE: This study aims to actively screen for TB symptoms and disease among migrant brick kiln workers and their care seeking behaviour for the symptoms through a private-public partnership effort. METHODS: This was a cross sectional study conducted among all migrant brick kiln workers working in the brick kilns in the field practice area of the Rural Health Centre of a medical college hospital. A pretested structured questionnaire was used for the interview. Productive Cough with or without other symptoms for 2 weeks or more was considered suggestive of TB. Sputum smear microscopy and Gene Xpert were used to diagnose TB among symptomatics. SPSS version 16.0 was used for analysis. RESULTS: Among 580 brick kiln workers, the prevalence of TB symptoms was 9.7%. Upon sputum examination, one was found to be positive for TB. Smoking was found to be associated with TB symptoms (p < 0.05). Only 50% of the symptomatics sought health care and the main reason for not seeking was low severity of symptoms. CONCLUSION: Active case finding is helpful in screening and diagnosing TB among the marginalised community of brick kiln workers.


Assuntos
Programas de Rastreamento/métodos , Fumar/epidemiologia , Migrantes/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Apetite , Dor no Peito/epidemiologia , Dor no Peito/fisiopatologia , Escolaridade , Feminino , Febre/epidemiologia , Febre/fisiopatologia , Hemoptise/epidemiologia , Hemoptise/fisiopatologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Índice de Gravidade de Doença , Fumar/fisiopatologia , Sudorese , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/fisiopatologia , Perda de Peso
14.
Acta Odontol Scand ; 78(5): 377-383, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32073330

RESUMO

Objective: To follow up 2209 individuals in a longitudinal study and assess self-reported TMD pain, painful and non-painful comorbid conditions, and pain-related disability.Material and methods: During 2012-2014, questionnaires were sent to 2209 eligible individuals who had been screened for TMD pain each year during 2000-2003. The two screening questions were (1) Do you have pain in the temple, face, jaw joint, or jaws once a week or more often? and (2) Do you have pain when you open your mouth wide or chew once a week or more often? If the patient answered 'yes' to one or both of the questions, TMD pain was recorded. Non-respondents received reminders; telephone interviews were offered a randomised group. The questionnaire queried TMD pain, and painful and non-painful comorbid conditions.Results: The overall response rate was 36.5%. Individuals were placed into one of four pain groups defined by their pain experience at baseline and at the follow-up: no TMD pain (69.0%), new TMD pain (13.0%), previous TMD pain (9.9%), and persistent TMD pain (8.1%). Based on the self-report surveys, significantly more responders with TMD pain at follow-up had had pain as adolescents than not. Of adolescents with TMD pain, 45.1% had pain at follow-up as young adults, while 15.8% had pain at follow-up without a previous history of TMD pain. Individuals with persistent TMD pain had high frequencies of comorbid pains (p < .001), 45.2% reported moderate-severe depression scores (p < .001), and 13.0% had moderate pain-related disability (GCPS).Conclusions: Based on self-report surveys, TMD pain in adolescence appears to triple the risk of TMD pain in young adulthood, and persistent pain increased comorbid pain and psychosocial distress.


Assuntos
Dor Facial/epidemiologia , Dor/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Adolescente , Adulto , Dor nas Costas/epidemiologia , Dor no Peito/epidemiologia , Comorbidade , Dor Facial/etiologia , Seguimentos , Cefaleia/epidemiologia , Humanos , Estudos Longitudinais , Cervicalgia/epidemiologia , Dor/etiologia , Medição da Dor , Questionário de Saúde do Paciente , Autorrelato , Inquéritos e Questionários , Suécia/epidemiologia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/psicologia , Adulto Jovem
16.
Am Heart J ; 222: 191-198, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32105985

RESUMO

BACKGROUND: Data regarding emergency department (ED) assessment of acute chest pain (CP) and incidence of myocardial infarction (MI) among adult congenital heart disease (ACHD) patients, relative to the non-congenital population, is lacking. OBJECTIVES: To describe MI risk in ACHD patients presenting to the ED with chest pain and to compare clinical characteristics, diagnostic testing patterns, and outcomes to controls. METHODS: We retrospectively identified a cohort of ACHD patients presenting with acute CP and matched them with non-ACHD controls at a large tertiary-level ED during the period 1998-2018. RESULTS: The congenital and control cohorts comprised 297 patients respectively. While MI was less common among ACHD patients (5.2%) than controls (19.7%), P = .01, arrhythmia (14% vs 6%, P < .001) and acute heart failure (3% vs 0.3%, P = .02) were more often the cause of symptoms. Despite more often presenting with non-anginal CP (81% vs 66%, P < .001) and having fewer CAD risk factors (P = .03), ACHD patients underwent more frequent stress testing (22% vs 14%, P < .001) and underwent invasive coronary angiography with equal frequency (7% vs 8%, P = .99). The trend of greater diagnostic scrutiny for acute coronary disease, in the absence of increased risk, strongly correlated with degree of congenital complexity. Both CP character and HEART Score reliably predicted MI for ACHD patients and controls (both P < .001). CONCLUSION: MI is an uncommon cause of CP among ACHD patients presenting to the ED and occurs less frequently than seen in the general population. Established MI predictors, CP character and HEART Score, can reliably identify MI in ACHD patients.


Assuntos
Dor no Peito/etiologia , Angiografia Coronária/métodos , Eletrocardiografia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Cardiopatias Congênitas/complicações , Infarto do Miocárdio/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
17.
J Pak Med Assoc ; 70(2): 293-298, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32063623

RESUMO

Objective: To evaluate the clinical decision unit of a tertiary care health facility and to see the disease pattern. . Methodology: The cross-sectional retrospective study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from September to October 2011, and comprised data of patients admitted to the clinical decision unit from January to December 2010. The protocols were developed for 7 diseases: acute coronary syndrome, ureteric colic, abdominal pain, bronchial asthma, gastroenteritis with dehydration, headache, and minor head injury. Data-collection proforma recorded demographics, dates of admission, presenting complaints at triage, diagnosis at admission, final disposition and bounce back of the patients. Data was analysed using Microsoft Excel 2007. RESULTS: Of the 1515 patients whose data was analysed, 824(54%) were males. The overall age ranged from newborns to 93 years. Further, 904(60%) patients had presented to the triage counter as P3 category. Acute gastroenteritis was the most common complaint 240(15.84%). Of the total, 1311(87%) were sent home from the clinical decision unit; 39(2.8%) of them bounced back with the same complaint. Overall, 2(0.2%) adult patients expired. CONCLUSIONS: The unit evaluated had a productive initial year. Acute gastroenteritis was the most common protocol in use, but other protocols should also be developed to address local needs.


Assuntos
Unidades de Observação Clínica , Desidratação/terapia , Gastroenterite/terapia , Hospitalização/tendências , Tempo de Internação/tendências , Alta do Paciente/tendências , Dor Abdominal/epidemiologia , Dor Abdominal/terapia , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/epidemiologia , Asma/terapia , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Dor no Peito/terapia , Criança , Pré-Escolar , Protocolos Clínicos , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Desidratação/epidemiologia , Desidratação/etiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência , Feminino , Gastroenterite/complicações , Gastroenterite/epidemiologia , Cefaleia/epidemiologia , Cefaleia/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Readmissão do Paciente , Projetos Piloto , Cólica Renal/epidemiologia , Cólica Renal/terapia , Estudos Retrospectivos , Adulto Jovem
18.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 9-18, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185848

RESUMO

Objetivos. Analizar qué características clínicas y del ECG de la primera valoración de pacientes con dolor torácico no traumático (DNT) se asocian con una clasificación inicial de sospecha de síndrome coronario agudo (SCA) y con el diagnóstico final de SCA, e identificar cuáles resultan sobre o infravaloradas durante la clasificación inicial. Método. Se incluyeron las consultas consecutivas por DTNT en una unidad de dolor torácico durante 10 años (2008-2017) en las que se disponía de los diagnósticos inicial de sospecha (SCA/no SCA) y final de alta de urgencias (SCA/no SCA). Se incluyeron 33 variables independientes (2 demográficas, 5 comorbilidad cardiovascular, 22 dolor torácico, 4 datos ECG). Se calcularon las odds ratio (OR) para la clasificación (inicial y final) como SCA para cada variable independiente, crudas y ajustadas en modelos globales que incluían todas ellas. En estos modelos ajustados se comparó si las OR para la clasificación inicial y final como SCA eran significativamente diferentes. Resultados. Se incluyeron 34.552 visitas. Las 33 variables analizadas mostraron asociación significativa para la clasificación inicial y final del DTNT como SCA, y en muchos casos esta asociación se mantuvo en el modelo ajustado. Diecinueve variables mostraron OR significativamente diferentes para la sospecha inicial de SCA que para el diagnóstico final de SCA: 10 sobrestimaban la asociación final y 9 la subestimaban. Conclusión. Los datos clínicos iniciales clásicamente utilizados para sospechar SCA pacientes con DTNT en urgencias identifican todos ellos individualmente a pacientes con riesgo incrementado de ser clasificado inicial y finalmente como SCA; sin embargo, algunos de ellos sobreestiman y otros subestiman inicialmente el riesgo final. Los urgenciólogos debieran sensibilizarse más con estos datos subestimados


Objectives. To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. Methods. Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008–2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. Results. A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. Conclusions. The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Análise de Dados , Ficha Clínica , Eletrocardiografia/estatística & dados numéricos , Dor no Peito/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Indicadores Básicos de Saúde , Razão de Chances , Modelos Logísticos , Análise Multivariada
19.
Eur Heart J Acute Cardiovasc Care ; 9(1): 76-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31958018
20.
Tunis Med ; 97(6): 789-794, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31872410

RESUMO

BACKGROUND: Acute myocarditis is an inflammation of the heart muscle. Its unpredictable evolution justifies the importance of its early recognition. The clinical polymorphism associated with the lack of sensitivity of conventional diagnostic means make diagnosis a challenge for the clinician. However, the magnetic resonance imaging has been of great interest for the differential diagnosis as well as for the evolutionary follow-up of this pathology. AIM: Determine the clinical profile of acute myocarditis and the contribution of multimodal imaging in its diagnosis. METHODS: This was a descriptive, retrospective study, including 31 patients hospitalized for acute myocarditis at the cardiology department of the Internal Security Forces Hospital-La Marsa between 2011 and 2017. RESULTS: The mean age of our patients was 36.5 ± 13.3 years [17-63] with a clear male predominance (sex ratio = 6.75). Smoking was the most common cardiovascular risk factor (60%). Fifty percent of the population had only two cardiovascular risk factors. The most common clinical picture was acute chest pain (84%) preceded by influenza-like illness (53%). The electrocardiogram was pathological in 97% of cases. Hyperleukocytosis was objectified in 33% of cases. Elevation of C-reactive protein was present in 80% of cases. As for troponins, they were high in 94% of cases. Overall myocardial contractility was conserved in 84% of cases with segmental kinetic disorders in 45%. Cardiac magnetic resonance imaging showed pericardial effusion (10%), spontaneous myocardial hypersignal in triple-reversal-T2 recovery (42%) and which corresponded to the zones of late enhancement. Late contrast enhancement was predominant at the lateral wall (39%), with epicardial involvement occurring in 100% of cases.28 patients had a favorable outcome after a follow-up of 24 months. However, there was only one case of death at 3 months and two cases that progressed to dilated cardiomyopathy. CONCLUSION: Acute myocarditis is mainly a disease of the young male subject. Cardiac magnetic resonance imaging is of crucial interest for positive diagnosis.


Assuntos
Dor no Peito/epidemiologia , Imagem por Ressonância Magnética , Miocardite/diagnóstico , Doença Aguda , Adolescente , Adulto , Cardiomiopatia Dilatada/epidemiologia , Dor no Peito/etiologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Troponina/metabolismo , Adulto Jovem
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