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1.
Adv Clin Exp Med ; 29(1): 147-155, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32011830

RESUMO

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.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/terapia , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Troponina I/sangue , Idoso , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos
2.
Am J Med Sci ; 359(2): 73-78, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32039768

RESUMO

BACKGROUND: Prevailing hospital practice dictates a protracted phase of observation for patients with chest pain to establish or exclude the diagnosis of myocardial infarction. Early diagnosis of acute myocardial infarction may improve patient care and reduce both complications and hospital costs. A study was performed to investigate the feasibility of early diagnosis of myocardial infarction within the first 9 hours of the hospital stay. METHODS: The records of all patients admitted with chest pain within one calendar year were analyzed. The timing of creatine kinase-MB (CK-MB) quantification was determined with reference to the initial phlebotomy (time 0). An enzymatic diagnosis of myocardial infarction was assigned if any determination of CK-MB exceeded the upper limit of normal, and the diagnosis of each patient at or before 9 hours (early diagnosis) was compared to the ultimate diagnosis at 14 to 24 hours (final diagnosis) beyond initial assessment. RESULTS: Of the 528 included patients, 523 patients (99.1%) had identical early and final diagnostic outcomes; 5 patients (0.9%) had conflicting results. An early diagnosis of myocardial infarction was assigned to 195 of the 528 patients (36.9%). Of these, 190 achieved the diagnosis within 9 hours (sensitivity 97.4%). The negative predictive value was 98.5%. CONCLUSION: Standard CK-MB mass measurements within 9 hours of arrival provided an accurate clinical assessment in > 99% of the cases. The high sensitivity and negative predictive values suggest that early diagnosis of myocardial infarction is feasible and reliable.


Assuntos
Dor no Peito , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/sangue , Dor no Peito/diagnóstico , Diagnóstico Precoce , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo
3.
J Med Case Rep ; 13(1): 387, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31884973

RESUMO

BACKGROUND: Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies. CASE PRESENTATION: A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features. CONCLUSIONS: Clinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.


Assuntos
Dor Abdominal/induzido quimicamente , Transtornos Induzidos por Álcool/diagnóstico por imagem , Dor no Peito/induzido quimicamente , Vasos Coronários/diagnóstico por imagem , Etanol/envenenamento , Pancreatite/diagnóstico por imagem , Dor Abdominal/sangue , Dor Abdominal/diagnóstico por imagem , Transtornos Induzidos por Álcool/sangue , Transtornos Induzidos por Álcool/terapia , Dor no Peito/sangue , Dor no Peito/diagnóstico por imagem , Angiografia Coronária , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Pancreatite/fisiopatologia , Pancreatite/terapia , Resultado do Tratamento
4.
Int J Cardiol ; 291: 168-172, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987836

RESUMO

BACKGROUND: Endothelin-1 (ET-1) is a vasoconstrictor associated with cardiovascular disease, whereas adrenomedullin (ADM) is a vasorelaxant with cardioprotective properties. We sought to determine the relationship between plasma ET-1 and ADM with coronary circulatory function and long-term major adverse cardiovascular events (MACE). METHODS: Thirty-two patients undergoing coronary angiography for chest pain were recruited. Baseline plasma ET-1 and ADM levels were measured. The index of microcirculatory resistance (IMR), coronary flow mediated dilatation (cFMD) and coronary flow reserve (CFR) were measured in a non-obstructed coronary artery. Patients were assessed for MACE over a median period of 8.8 years. RESULTS: Plasma ET-1 levels correlated with IMR (r = 0.57; p < 0.01) and ADM levels correlated with CFR (r = 0.50; p = 0.04) and cFMD (r = 0.62; p = 0.01). After adjustment for age, gender and cardiovascular risk factors, the association between ADM and cFMD (ß = 0.79; p < 0.01) and between ET-1 and IMR (ß = 5.7; p = 0.01) remained significant. IMR was higher, although not statistically significant, in patients with long-term MACE (17.9 ±â€¯5.3 vs. 13.1 ±â€¯6.0 units; p = 0.14). In patients free of MACE, cFMD (9.3 ±â€¯7.6 vs. 2.8 ±â€¯5.0%; p = 0.01) and plasma ADM levels (7.6 ±â€¯5.3 vs. 4.0 ±â€¯1.9 pmol/L; p = 0.07) were higher. CONCLUSIONS: Plasma ET-1 and ADM were associated with measures of coronary microvascular and coronary conduit vessel function, respectively. Increased cFMD and elevated plasma ADM were associated with a cardioprotective effect.


Assuntos
Adrenomedulina/sangue , Angiografia Coronária/tendências , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária/fisiologia , Endotelina-1/sangue , Idoso , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade
6.
Hellenic J Cardiol ; 60(3): 171-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30851457

RESUMO

Cardiac troponins are pivotal in the evaluation of patients who suffer from acute chest pain, and the introduction of the high-sensitivity cardiac troponins (hs-cTn) has shown that there are differences between male and female patients. Recent recommendations from experts point out that an appropriate evaluation must take into account the patients' sex, but there is no clear evidence of the implementation of this recommendation in the clinical practice, and the matter has sparked controversy. If the same cutoff value is used for both sexes, myocardial infarction in men might be overdiagnosed, especially in the elderly, who have relatively higher values, and might be underdiagnosed in most women. The International Federation of Clinical Chemistry and Laboratory Medicine Task Force on Clinical Applications of Cardiac Bio-Markers (IFCCLM, TF-CB) 2018 and the Fourth Universal Definition of Acute Myocardial Infarction support the overall and sex-specific 99th percentile Upper Reference Limit (URL) cutoff value, but based on the definition of hs-cTn assays, the Limit of Detection (LoD) may be considered a starting point for an assessment method that does not differentiate between the levels of hs-cTn in male and female patients suspected of suffering from acute coronary syndrome (ACS). In this paper, we discuss the evidence and a novel strategy based on hs-cTn for rapidly ruling out myocardial infarction in low-risk patients who suffer from acute chest pain.


Assuntos
Dor no Peito/sangue , Infarto do Miocárdio/diagnóstico , Troponina/sangue , Biomarcadores/sangue , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Humanos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Reprodutibilidade dos Testes , Fatores Sexuais
8.
Crit Pathw Cardiol ; 18(1): 5-9, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747758

RESUMO

BACKGROUND: Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity. METHODS: A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients. Three hundred thirty-four participants with symptoms and findings indicating intermediate to high risk for acute coronary syndrome were enrolled in 3 clinical trials. Major exclusions were ST-segment elevation, initial troponin elevation, and hemodynamic instability. Participants were randomly assigned to receive usual inpatient care, or ACES. The ACES care pathway includes placement in observation for serial cardiac markers, with an expectation for stress imaging. The primary outcome was index visit objective cardiac testing, compared among AA and White participants. RESULTS: AA participants represented 111/329 (34%) of the study population, 80/220 (36%) of the ACES group and 31/109 (28%) of the usual care group. In usual care, objective testing occurred less frequently among AA (22/31, 71%) than among White (69/78, 88%, P = 0.027) participants, primarily driven by cardiac catheterization (3% vs. 24%; P = 0.012). In ACES, testing rates did not differ by race [AA 78/80 (98%) vs. White 138/140 (99%); P = 0.623]. At 90 days, death, MI, and revascularization did not differ in either group between AA and White participants. CONCLUSIONS: A care pathway with the expectation for stress imaging eliminates the racial disparity among AA and White participants with chest pain in the acquisition of index-visit cardiovascular testing.


Assuntos
Dor no Peito/diagnóstico , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Medição de Risco/métodos , Síndrome Coronariana Aguda/diagnóstico , Idoso , Dor no Peito/sangue , Diagnóstico Diferencial , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Retrospectivos , Troponina/sangue
9.
Crit Pathw Cardiol ; 18(1): 16-18, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30747760

RESUMO

The latest European Society of Cardiology guideline on the management of acute coronary syndromes without persistent ST-elevation stipulates several acceptable pathways through which patients presenting with chest pain can be assessed for unstable coronary disease. This article reviews the data behind the "rule-in and rule-out algorithm," which can exclude acute myocardial infarction within 1 hour of presentation through the use of fifth generation high-sensitivity troponin assays.


Assuntos
Algoritmos , Dor no Peito/diagnóstico , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Infarto do Miocárdio/diagnóstico , Triagem/métodos , Troponina/sangue , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/etiologia , Eletrocardiografia , Humanos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Fatores de Tempo
10.
Clin Biochem ; 66: 103-105, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30738031

RESUMO

We report a case of a heterophile antibodies interference in a new high-sensitivity troponin commercial immunoassay (cTNIH Siemens), observed in a patient with possible acute coronary syndrome (ACS). The analytical interference was investigated with standard laboratories procedures. The false positive result was found with different troponin methods and kits. We also investigated the protein sequence of cTnl and no sequence variants were detected. The discordance between clinical pictures and high concentration of cTnl, together with the collaboration between clinicians and laboratory staff avoided possible erroneous diagnosis and further invasive investigations to the patient.


Assuntos
Dor no Peito/sangue , Troponina I/sangue , Animais , Anticorpos Heterófilos/imunologia , Anticorpos Monoclonais/imunologia , Bovinos , Reações Falso-Positivas , Cabras , Humanos , Imunoensaio/métodos , Masculino , Camundongos , Pessoa de Meia-Idade , Ovinos , Troponina I/imunologia
11.
Acta Cardiol ; 74(5): 413-418, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30650021

RESUMO

Background: Red blood cell distribution width (RDW) is a measure of the degree of heterogeneity of erythrocyte volume. Higher RDW levels are associated with increased mortality among patients with acute coronary syndrome (ACS), heart failure and other cardiovascular diseases. The association between RDW levels and clinical outcomes in patients admitted for further evaluation of chest pain is not known. Methods: A retrospective analysis of patients hospitalised with chest pain 2010-2016 was conducted. Patients diagnosed with ACS in the emergency department (ED) were excluded. Patients were divided into tertiles according to baseline ED RDW levels (≤13.1%, 13.1%13.9%). Study endpoints were diagnosis of ACS during the index hospitalisation and ACS and all-cause mortality during a median follow-up of 3.3 ± 1.9 years. Results: Included were 13,018 patients (mean age 58 ± 13 years, 61% male). Increased RDW levels were associated with higher rates of ACS in the index hospitalisation (6.1%, 6.6% and 8.1% for 1st, 2nd and 3rd tertiles, respectively, p < .01), ACS during follow-up (8.6%, 10.1% and 13.4%, respectively, p < .01), and with all-cause mortality during follow-up (2.5%, 4.6% and 15.4%, respectively, p < .01). In multivariate analysis, RDW levels >13.9% (vs. ≤13.1%) were associated with ACS in the index hospitalisation (adjusted OR 1.25, 95% CI 1.04-1.51, p = .02), ACS during follow-up (adjusted OR 1.35, 95% CI 1.05-1.73, p = .02) and with all-cause mortality (adjusted HR 2.41, 95% CI 1.94-2.99, p < .01). Conclusion: In this retrospective study of patients hospitalised with chest pain, higher RDW levels were associated with future ACS and long-term mortality.


Assuntos
Dor no Peito/sangue , Hospitalização , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Dor no Peito/mortalidade , Dor no Peito/terapia , Índices de Eritrócitos , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
12.
Emerg Radiol ; 26(3): 269-275, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30631994

RESUMO

PURPOSE: It is uncertain whether patients with elevated troponin and non-classical presentation of acute coronary syndrome (ACS) should receive coronary CT angiography (CCTA). A proportion of these patients will have no coronary artery disease (CAD) and would benefit from non-invasive investigations and expedited discharge. Objectives were to determine most common diagnoses and rate of ACS among patients with positive troponin and low clinical suspicion of ACS who received CCTA. METHODS: IRB approved retrospective analysis of 491 consecutive patients in a level I trauma center ED referred for CCTA between April 4, 2015 to April 2, 2017. Patients were included if there was an elevated troponin (TnI > 0.045 µg/L) and atypical chest pain within 24 h prior to imaging. One hundred one patients met inclusion criteria; 17 excluded due to technical factors or history. Scans performed on dual-source CT. RESULTS: Eighty-four patients (47 men, 37 women) with median TnI of 0.11 ± 0.21 µg/L underwent CCTA 8.20 ± 6.41 h after first elevated Tn. Mean age was 53.2 ± 14.6 years. CCTA demonstrated absence of CAD in 39 patients (46.4%; 20 M, 19 F). CAD < 25% stenosis was observed in 24 (28.6%; 9 M, 15 F). CAD with 25-50% stenosis was observed in seven (8.3%; six M, one F). CAD > 50% stenosis was observed in 11 (13.1%; 9 M, 2 F), and non-diagnostic in three (3.6%, 3 M, 0 F). Forty-six (56.8%) were discharged directly from ED with median stay 15.82 ± 6.41 h. CONCLUSIONS: Use of CCTA in ED patients with elevated troponin and low clinical suspicion for ACS allowed obstructive CAD to be excluded in 83%.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Serviço Hospitalar de Emergência , Troponina/sangue , Síndrome Coronariana Aguda/sangue , Dor no Peito/sangue , Dor no Peito/diagnóstico por imagem , Doença da Artéria Coronariana/sangue , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos
13.
Lipids Health Dis ; 18(1): 27, 2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30684966

RESUMO

BACKGROUND: Chest pain is a serious symptom that is routinely investigated as a sign of coronary artery disease. Non-cardiac chest pain (NCCP) is indistinguishable from ischemic chest pain and both are considered serious and receive similar medical investigations. Although NCCP is not associated with cardiovascular diseases (CVDs), patients with NCCP may become anxious and frightened from developing coronary events. So, it will be valuable to improve modifiable cardiovascular risk factors in such subjects to reduce fear from CVDs. Because vitamin D deficiency was considered as a possible modifiable cardiovascular risk factor, our aim was to investigate association between serum vitamin D and cardiovascular risk variables in subjects with NCCP. METHODS: A cross-sectional study involved 104 subjects who underwent cardiac catheterization that did not reveal any cardiac origin for their chest pain. 25-hydroxyvitamin D was measured by electrochemiluminescence immunoassay, glucose was measured by hexokinase method, hemoglobin A1c (HbA1c) was measured by turbidimetric inhibition immunoassay and lipid profile was measured by enzymatic colorimetric assays. RESULTS: High density lipoprotein cholesterol (HDL-C) was significantly higher in subjects with sufficient vitamin D compared to those with insufficient or deficient vitamin D (p-value< 0.01). 25-hydroxyvitamin D was positively associated with HDL-C (p-value< 0.01) and inversely associated with HbA1c (p-value = 0.02). 25-hydroxyvitamin D was not significantly correlated with other cardiovascular biomarkers including blood pressure, glucose, and other components of lipid profile (p-values> 0.05). CONCLUSIONS: low serum vitamin D could be involved in reducing HDL-C and increasing HbA1c and thus it may increase cardiovascular risk in subjects with NCCP.


Assuntos
Doenças Cardiovasculares/genética , HDL-Colesterol/genética , Vitamina D/análogos & derivados , Vitamina D/genética , Idoso , Biomarcadores/sangue , Cateterismo Cardíaco , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/patologia , Dor no Peito/sangue , Dor no Peito/genética , Dor no Peito/patologia , HDL-Colesterol/sangue , Feminino , Estudos de Associação Genética , Hemoglobina A Glicada/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Vitamina D/sangue
14.
Eur Heart J Acute Cardiovasc Care ; 8(5): 395-403, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29737180

RESUMO

BACKGROUND: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. METHODS: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn. RESULTS: One hundred and forty-nine patients were diagnosed with myocardial infarction (54 Black and 95 Caucasian). The negative predictive value of copeptin at a cut-off of 14 pmol/l (as in the CHOPIN study) for myocardial infarction was higher in Blacks (98.0%, 95% confidence interval (CI) 96.2-99.1%) than Caucasians (94.1%, 95% CI 92.1-95.7%). The sensitivity at 14 pmol/l was higher in Blacks (83.3%, 95% CI 70.7-92.1%) than Caucasians (53.7%, 95% CI 43.2-64.0%). After controlling for age, hypertension, heart failure, chronic kidney disease and body mass index in a logistic regression model, the interaction term had a P value of 0.03. A cut-off of 6 pmol/l showed similar sensitivity in Caucasians as 14 pmol/l in Blacks. CONCLUSIONS: This is the first study to identify a difference in the performance of copeptin to rule out myocardial infarction between Blacks and Caucasians, with increased negative predictive value and sensitivity in the Black population at a cut-off of 14 pmol/l. This also holds true for non-ST-segment elevation myocardial infarction and, although numbers were small, similar trends exist in the normal troponin population. This may have significant implications for early rule-out strategies using copeptin.


Assuntos
Dor no Peito/diagnóstico , Glicopeptídeos/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo , Adulto , Afro-Americanos/etnologia , Idoso , Dor no Peito/sangue , Comorbidade , Serviço Hospitalar de Emergência , Europa (Continente)/epidemiologia , Europa (Continente)/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/etnologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Sensibilidade e Especificidade , Troponina I/sangue , Estados Unidos/epidemiologia , Estados Unidos/etnologia
15.
Transfusion ; 59(2): 463-469, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30488953

RESUMO

BACKGROUND: Chest pain is a common clinical dilemma and is rarely reported as part of suspected adverse events in transfusion recipients. The aim of this study is to describe and characterize the clinical presentation of transfusion-associated chest pain and how it relates to currently defined National Healthcare Safety Network hemovigilance entities. STUDY DESIGN AND METHODS: This is a retrospective chart review at a single large academic institution of patients who reported chest pain during or after a transfusion that resulted in a transfusion reaction investigation during the period January 2004 to December 2016. RESULTS: Of approximately 500,000 transfusions occurring during the study period and 3220 suspected transfusion reactions reported, 23 (0.7%) reactions involving chest pain were identified, of which 20 had medical records available for analysis. Ninety percent of cases presented with chest pain within 2.5 hours of the start of transfusion, with a mean time of onset of 92.2 minutes. Fourteen RBC units and 6 platelet units were implicated, and all transfusions were ABO identical. All posttransfusion workups were negative for hemolysis or agglutination on direct antiglobulin testing. Twenty percent of cases showed evidence of acute coronary ischemia that was first detected during transfusion with rising troponins or electrocardiographic abnormalities, all in association with RBC transfusion for anemia. For most reactions, the signs and symptoms did not fit any hemovigilance definitions for transfusion reactions. CONCLUSION: Chest pain is an infrequently reported chief complaint for transfusion reactions. Increased circulatory volume due to transfusion may be an important contributor to myocardial demand ischemia in at-risk patients. Additional studies are necessary to determine the clinical significance of chest pain during transfusion and to elucidate potential mechanisms.


Assuntos
Anemia/terapia , Segurança do Sangue , Dor no Peito/etiologia , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Plaquetas/efeitos adversos , Reação Transfusional , Adulto , Idoso , Anemia/sangue , Dor no Peito/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Rom J Intern Med ; 57(2): 201-204, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30447150

RESUMO

Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy syndrome resulting from decrease or absence of "a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13" (ADAMTS13). TTP has been characterized by the classical pentad of thrombocytopenia, hemolysis, fever, renal injury and neurological deficits, yet the patient may present with any atypical symptom related to microthrombi formation in the microcirculation. Here we present a rare case of a young patient with retrosternal chest pain and myocardial injury as the first manifestation of TTP.


Assuntos
Dor no Peito/sangue , Púrpura Trombocitopênica Trombótica/diagnóstico , Troponina T/sangue , Dor no Peito/etiologia , Eletrocardiografia , Humanos , Masculino , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/complicações , Adulto Jovem
17.
Scott Med J ; 64(1): 10-15, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30426853

RESUMO

BACKGROUND AND AIMS: Anti-platelet and anti-thrombotic therapy are well-established treatments in acute coronary syndromes. Highly sensitive assays have diminished the positive predictive value of troponin in acute coronary syndromes and increased the importance of the clinical assessment in interpreting positive results. This cohort study sought to investigate over-treatment of non-coronary troponin rises and associated adverse outcomes. METHODS AND RESULTS: We reviewed 223 consecutive patients presenting to Queen Elizabeth University Hospital, Glasgow, with suspected acute coronary syndromes over a six-week period. Of these, 27 (12%) met our 'inappropriate therapy' criteria. This group had a low ischaemic risk (HEART score: 4.2 ± 1.4) (GRACE score: 117 ± 30.8) but an intermediate-high bleeding risk (CRUSADE score: 34 ± 14.5). Approximately half of the patients (14/27, 52%) reported chest pain, with only 4/27 (15%) having ischaemic ECG changes. There were three intracranial haemorrhages, each after the patient had received a single dose of aspirin, ticagrelor and fondaparinux. CONCLUSION: The combination of injudicious high-sensitivity troponin testing with potent anti-platelet and anti-thrombotic therapy was associated with possible over-treatment of patients and associated harm. Emphasis on interpretation of troponin in the context of clinical presentation and improved awareness of type 2 myocardial infarction are essential to limit iatrogenic pharmacological harm.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Dor no Peito/tratamento farmacológico , Sobremedicalização/estatística & dados numéricos , Medição de Risco/métodos , Troponina/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/sangue , Dor no Peito/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos , Fatores de Risco
18.
J Clin Psychol Med Settings ; 26(2): 194-199, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30151664

RESUMO

This study was performed to check the hypothesis that low serum vitamin D and reduced calcium intake may contribute to the comorbidity of psychological symptoms (anxiety and depression) and non-cardiac chest pain (NCCP). The design was a case-control study that involved 40 subjects with NCCP and 40 age and gender-matched healthy controls. Serum vitamin D was assessed using electrochemiluminescence immunoassay; anxiety and depression symptoms were assessed using Hospital Anxiety and Depression Scale, and dietary calcium intake was assessed by self-reporting. Subjects with NCCP had higher anxiety and depression scores and lower vitamin D and dietary calcium intake compared to healthy controls (p < .05). NCCP was associated with anxiety score (odds ratio = 1.40, p < .01). Prevalence of abnormal anxiety score was much higher in subjects with NCCP (47.5%) compared to healthy controls (7.5%). Anxiety score was inversely correlated with vitamin D level and dietary calcium intake (p < .01). Anxiety score was inversely associated with vitamin D level (R2 = .32, p < .05). In conclusion, development of NCCP can be predicted from increased anxiety score which in turn can be predicted from low vitamin D levels. This suggests physicians to consider anxiety and vitamin D deficiency as possible causes for NCCP.


Assuntos
Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/complicações , Cálcio na Dieta/sangue , Dor no Peito/complicações , Dor no Peito/psicologia , Vitamina D/sangue , Adulto , Transtornos de Ansiedade/psicologia , Cálcio na Dieta/administração & dosagem , Estudos de Casos e Controles , Dor no Peito/sangue , Feminino , Humanos , Masculino , Autorrelato
19.
Eur Heart J Acute Cardiovasc Care ; 8(5): 412-420, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29350536

RESUMO

BACKGROUND: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. METHODS: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. RESULTS: Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79-0.94) and 0.84 (0.74-0.9) vs 0.89 (0.78-0.94) and 0.83 (0.70-0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81-0.98) and specificity 0.90 (0.93-0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77-0.91) and specificity 0.92 (0.83-0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. CONCLUSIONS: Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.


Assuntos
Síndrome Coronariana Aguda/sangue , Dor no Peito/sangue , Vasos Coronários/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Síndrome Coronariana Aguda/diagnóstico por imagem , Biomarcadores/sangue , Dor no Peito/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Serviço Hospitalar de Emergência , Teste de Esforço/métodos , Feminino , Glicopeptídeos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia/métodos , Sensibilidade e Especificidade , Troponina T/sangue
20.
Ned Tijdschr Geneeskd ; 1622018 12 05.
Artigo em Holandês | MEDLINE | ID: mdl-30570937

RESUMO

BACKGROUND: Normal high sensitivity cardiac troponin (hs-cTn) assays rule out acute myocardial infarction (AMI) with great accuracy, but additional non-invasive testing is frequently ordered. This observational study evaluates whether clinical characteristics can contribute to risk stratification and could guide referral for additional testing. METHODS: This observational study included 918 patients with acute chest pain and normal hs-cTnT values. Major adverse cardiac events (MACE) and non-invasive test results were assessed during one-year follow-up. Patients were classified as low and high risk based on clinical characteristics. RESULTS: In total, 6,4% of patients experienced MACE during follow-up and mainly comprised revascularisations (86%). Absence of both recent abnormal stress test and suspicious history identified 86% of patients. These patients were at very low risk for MACE (0,4% in 30-days). Despite this, the majority (287/345=83%) of additional tests were performed in low risk patients, with 8% abnormal test findings (positive predictive value for MACE was 17%). The diagnostic yield was significantly higher in the remaining higher risk patients, 40% abnormal test findings and a positive predictive value of 70% for MACE. CONCLUSION: Clinical characteristics can be used to identify low risk patients with acute chest pain and normal hs-cTnT levels. Current strategies in the emergency department result in numerous additional tests, which are mostly ordered in patients at very low risk and have a low diagnostic yield.


Assuntos
Dor no Peito/sangue , Dor no Peito/etiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Troponina T/sangue , Idoso , Tomada de Decisão Clínica , Testes Diagnósticos de Rotina/métodos , Serviço Hospitalar de Emergência , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Revascularização Miocárdica , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Procedimentos Desnecessários
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