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1.
Cir Cir ; 89(S1): 97-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762639

RESUMO

INTRODUCTION: Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE: To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT: 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS: The delay in diagnosis contributed to the fatal outcome of the patient.


Assuntos
Perfuração Esofágica , Doenças do Mediastino , Adulto , Dor no Peito , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Feminino , Humanos , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/cirurgia , Ruptura Espontânea
2.
J Cardiothorac Surg ; 16(1): 339, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802423

RESUMO

BACKGROUND: Although not common, coronary artery aneurysms (CAAs) can develop to over 8 mm in diameter to become giant CAAs. In the context of systemic lupus erythematosus (SLE), autoantibody- and immune complex-mediated atherosclerosis is believed to be the most prevalent cause of aneurysm. CASE PRESENTATION: We report the case of a 53-year-old female SLE patient who presented to our hospital with radiating chest pain. Coronary angiography revealed a giant aneurysm in the middle segment of the left anterior descending artery (LAD) and distal subtotal occlusion in the left circumflex artery (LCX). Laboratory testing also identified risk factors such as an abnormal pulmonary enzyme profile, dyslipidemia, and nephritis parameters.To prevent thromboembolism, anticoagulation and antiplatelet therapy were administered. In addition, one stent was implanted at the distal end of the LCX and repeated coronary angiography verified restoration of TIMI grade III flow.The patient was discharged with resolved chest pain. During 6 months of follow-up, the patient is in good health. CONCLUSIONS: Our case study, together with 16 recent comparable reports, emphasizes the need for coronary aneurysm screening in SLE patients. It is necessary that thromboembolism, anticoagulation and antiplatelet therapy were administered for CAA.


Assuntos
Aneurisma Coronário , Lúpus Eritematoso Sistêmico , Dor no Peito/etiologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade
3.
Ann Card Anaesth ; 24(4): 470-472, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747756

RESUMO

Hydatid infection of the heart is rare and there is always the lethal hazard of cyst perforation. We present an 18-year-old male from Kashmir valley who was admitted to the emergency department of our hospital with fever and chest pain for the last 4 days. Using echocardiography and cardiac tomography (CT), cardiac Echinococcosis was diagnosed. The results of surgical treatment of cardiac Echinococcosis were better than the conservative strategy. Surgical excision was performed. The patient had an uneventful recovery.


Assuntos
Equinococose , Cardiopatias , Adolescente , Dor no Peito , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Ecocardiografia , Coração , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino
4.
Pneumologie ; 75(11): 901-909, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34788891

RESUMO

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


Assuntos
Dor no Peito , Eletrocardiografia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Diagnóstico Diferencial , Humanos
5.
Am J Cardiol ; 160: 31-39, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34740394

RESUMO

Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial populations are unknown. Furthermore, the contribution of noncardiac factors - such as pulmonary, gastrointestinal, and psychological - to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication. This retrospective cohort study included patients receiving PCI for any indication from 2003 to 2017 through a single integrated health-care system. Post-PCI CP-related HCU tracked through electronic medical records included (1) office visits, (2) emergency department (ED) visits, and (3) hospital admissions with CP or angina as the primary diagnosis. The strongest predictors of CP-related HCU were identified from >100 candidate variables. Among 6386 patients followed an average of 6.7 years after PCI, 73% received PCI for acute coronary syndrome (ACS), 19% for stable angina, and 8% for other indications. Post-PCI CP-related HCU was common with 26%, 16%, and 5% of patients having ≥1 office visits, ED visits, and hospital admissions for CP within 2 years of PCI. The following factors were significant predictors of all 3 CP outcomes: ACS presentation, documented CP >7 days prior to the index PCI, anxiety, depression, and syncope. In conclusion, CP-related HCU following PCI was common, especially within the first 2 years. The strongest predictors of CP-related HCU included coronary disease attributes and psychological factors.


Assuntos
Dor no Peito/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris , Angina Estável/cirurgia , Angina Instável/cirurgia , Ansiedade/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , AVC Isquêmico/epidemiologia , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores Sexuais
6.
BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753720

RESUMO

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.


Assuntos
Derrame Pleural , Febre Reumática , Adulto , Dor no Peito , Ecocardiografia , Humanos , Masculino , Penicilinas/uso terapêutico , Febre Reumática/complicações , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico , Adulto Jovem
7.
West J Emerg Med ; 22(6): 1291-1294, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34787553

RESUMO

INTRODUCTION: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. METHODS: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995-September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. RESULTS: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. CONCLUSION: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST , Troponina , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Creatina Quinase , Eletrocardiografia , Humanos , Troponina T
8.
Prim Care ; 48(4): 627-643, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752274

RESUMO

In an era where cardiovascular disease continues to increase in prevalence, chest pain is a commonly encountered complaint in the outpatient setting. Clinicians are often tasked with the challenge of selecting the most appropriate screening tool in the evaluation of a patient with suspected coronary artery disease. With proper consideration of indications and contraindications, exercise electrocardiogram (ECG) stress testing is an accessible, cost-conscious, and validated outpatient diagnostic modality for predicting coronary artery disease.


Assuntos
Doença da Artéria Coronariana , Teste de Esforço , Dor no Peito/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Humanos
9.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598963

RESUMO

This case describes the first documented clinical presentation of Sweet's syndrome with unilateral swelling of the neck, severe pain and fever. The clinical and radiological manifestation resembled necrotising fasciitis and the patient underwent acute neck dissection. The patient was ultimately diagnosed with a new subtype of Sweet's syndrome called necrotising Sweet's syndrome, and quickly recovered after treatment with intravenous administration of prednisolone.


Assuntos
Síndrome de Sweet , Dor no Peito , Edema/etiologia , Feminino , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológico
10.
Aerosp Med Hum Perform ; 92(10): 815-824, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642002

RESUMO

BACKGROUND: Neck pain (NP) is common among high performance aircrew, yet evidence remains insufficient to guide examination, treatment, and prevention. The purpose of this randomized pilot study was to collect baseline data for neck function for F-15E aircrew and determine efficacy and feasibility of two separate exercise protocols in measuring short-term outcomes of subjective and objective neck function in order to inform future study design. METHODS: Randomized to either progressive (PRO) or general (GEN) exercise groups were 41 F-15E aircrew. Data collection occurred at baseline, 3 wk, and 3 mo. RESULTS: At baseline, 39% of the subjects reported current NP, 79.5% reported a history of NP attributed to flying, 12.8% reported being removed from flying duties due to NP, and 10% reported receiving medical care for NP. PRO and GEN group randomization showed similar baseline assessment data. Blinding was successful and exercise logs showed 31.6% compliance with prescribed exercise regimens. There were small but statistically significant increases in neck range of motion in both groups over the course of the study. Aircrew with current NP had significantly higher F-15E flight hours. DISCUSSION: This study supports the high prevalence of NP in aircrew, yet low frequency of seeking care for NP. Future studies to assess NP prevention and treatment in aircrew require an integrated approach that includes operational exercise policy and long-term data collection in flying units with dedicated resources for assessment and analysis. Lee MS, Briggs R, Scheirer V, Kearby G, Young BA. Exercise effects on neck function among F-15E aircrew. Aerosp Med Hum Perform. 2021; 92(10):815824.


Assuntos
Exercício Físico , Cervicalgia , Dor no Peito , Humanos , Cervicalgia/epidemiologia , Cervicalgia/prevenção & controle , Projetos Piloto , Amplitude de Movimento Articular
11.
BMC Surg ; 21(1): 364, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641847

RESUMO

BACKGROUND: Symptomatic Bochdalek hernias are found mainly in infants in respiratory distress and occur rarely in adults. CASE PRESENTATION: We report a rare case of Bochdalek hernia associated with developmental abnormalities in an adult who exhibited acute chest pain and dyspnea on exertion. CONCLUSIONS: This case highlights the importance of the differential diagnosis of acute left-sided chest pain and antenatal examination.


Assuntos
Hérnias Diafragmáticas Congênitas , Adulto , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Gravidez
13.
Adv Emerg Nurs J ; 43(4): 303-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34699420

RESUMO

This column discusses what appears to be a lead reversal in a 12-lead electrocardiogram (ECG) of a routine low-risk chest pain evaluation in a 36-year-old man. A 12-lead ECG was completed and identified ST changes suggestive of ischemia in the inferior leads. Findings in the ECG suggested arm lead reversal that created an ST-segment elevation myocardial infarction (STEMI) mimic. Repeating the ECG and correcting the arm lead mistake identified a correction of these changes and identified an ECG more suggestive of benign early repolarization or J-point elevation. This case discusses the importance of identifying ECG findings that may suggest arm lead reversal and how sometimes misplaced leads could create the appearance of an STEMI. This is a review of the case, key points to interpreting ECGs for possible lead reversal and identifying the REVERSE mnemonic.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Dor no Peito/diagnóstico , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
14.
BMJ Open ; 11(10): e049349, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663657

RESUMO

INTRODUCTION: Current evaluation of patients suspected of a non-ST-elevation acute coronary syndrome (NSTE-ACS) involves the use of algorithms that incorporate clinical information, electrocardiogram (ECG) and high-sensitivity cardiac troponins (hs-troponins). While primarily designed to rule out NSTE-ACS safely, these algorithms can also be used for rule in of NSTE-ACS in some patients. Still, in a substantial number of patients, these algorithms do not provide a conclusive work-up. These patients often present with an atypical clinical profile and low-range positive hs-troponin values without a characteristic rise or fall pattern. They represent a heterogeneous group of patients with various underlying conditions; only a fraction (30%-40%) will eventually be diagnosed with a myocardial infarction. Uncertainty exists about the optimal diagnostic strategy and their management depends on the clinical perspective of the treating physician ranging from direct discharge to admission for invasive coronary angiography. Coronary CT angiography (CCTA) is a non-invasive test that has been shown to be safe, fast and reliable in the evaluation of coronary artery disease. In this study, we will determine the usefulness of CCTA in patients with acute chest pain and low-range positive hs-troponin values. METHODS AND ANALYSIS: A prospective, double-blind, observational, multicentre study conducted in the Netherlands. Patients aged 30-80 years presenting to the emergency department with acute chest pain and a suspicion of NSTE-ACS, a normal or non-diagnostic ECG and low-range positive hs-troponins will be scheduled to undergo CCTA. The primary outcome is the diagnostic accuracy of CCTA for the diagnosis of NSTE-ACS at discharge, in terms of sensitivity and negative predictive value. ETHICS AND DISSEMINATION: This study was approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam, the Netherlands (registration number MEC-2017-506). Written informed consent to participate will be obtained from all participants. This study's findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT03129659).


Assuntos
Síndrome Coronariana Aguda , Troponina , Síndrome Coronariana Aguda/diagnóstico por imagem , Biomarcadores , Dor no Peito/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
J Prim Health Care ; 13(2): 180-185, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620300

RESUMO

INTRODUCTION Back and rib pain is a common presentation in primary care practice. Although most cases are secondary to non-specific musculoskeletal pain, it is essential for clinicians to identify patients presenting with life-threatening pathologies. AIM This case report serves as a reminder to clinicians to reconsider their initial diagnosis when a patient's pain fails to improve, while considering life-threatening pathologies. CASE HISTORY We describe a 44-year-old man from India who presents to his general practitioner with a 2-week history of rib and upper back pain. He was initially diagnosed with non-specific musculoskeletal pain. However, after representing twice 2 months later due to persistent pain and due to the uncertainty about his condition, he was investigated with different imaging modalities. It was discovered on bone scan that he had osteolytic lesions in the right 11th rib and T2 vertebrae. As the cause of his osteolytic lesions were unclear, he was referred to different specialists. Skeletal tuberculosis was suspected when one of his specialists discovered his recent visit to India, a tuberculosis-endemic country. This reminded the specialist of the possible risks of the patient's background and its association with his symptoms. Bone biopsy of his lytic lesions revealed Mycobacterium tuberculosis, consistent with skeletal tuberculosis. DISCUSSION Revisiting the diagnosis of back and rib pain while considering other obscure and urgent pathologies is essential if a patient fails to improve clinically. Clinicians should focus on aspects of their clinical assessment to explore these pathologies, enabling earlier recognition of the disease.


Assuntos
Dor Musculoesquelética , Adulto , Dor no Peito , Humanos , Índia , Masculino , Dor Musculoesquelética/etiologia , Costelas/diagnóstico por imagem
18.
BMC Emerg Med ; 21(1): 112, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620086

RESUMO

BACKGROUND: Currently, the risk stratification of critically ill patient with chest pain is a challenge. We aimed to use machine learning approach to predict the critical care outcomes in patients with chest pain, and simultaneously compare its performance with HEART, GRACE, and TIMI scores. METHODS: This was a retrospective, case-control study in patients with acute non-traumatic chest pain who presented to the emergency department (ED) between January 2017 and December 2019. The outcomes included cardiac arrest, transfer to ICU, and death during treatment in ED. In the randomly sampled training set (70%), a LASSO regression model was developed, and presented with nomogram. The performance was measured in both training set (70% participants) and testing set (30% participants), and findings were compared with the three widely used scores. RESULTS: We proposed a LASSO regression model incorporating mode of arrival, reperfusion therapy, Killip class, systolic BP, serum creatinine, creatine kinase-MB, and brain natriuretic peptide as independent predictors of critical care outcomes in patients with chest pain. Our model significantly outperformed the HEART, GRACE, TIMI score with AUC of 0.953 (95%CI: 0.922-0.984), 0.754 (95%CI: 0.675-0.832), 0.747 (95%CI: 0.664-0.829), 0.735 (95%CI: 0.655-0.815), respectively. Consistently, our model demonstrated better outcomes regarding the metrics of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Similarly, the decision curve analysis elucidated a greater net benefit of our model over the full ranges of clinical thresholds. CONCLUSION: We present an accurate model for predicting the critical care outcomes in patients with chest pain, and provide substantial support to its application as a decision-making tool in ED.


Assuntos
Dor no Peito , Resultados de Cuidados Críticos , Aprendizado de Máquina , Idoso , Estudos de Casos e Controles , Dor no Peito/terapia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Triagem
20.
Scand J Trauma Resusc Emerg Med ; 29(1): 157, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717716

RESUMO

BACKGROUND: The emergency medical services (EMS) use guidelines to describe optimal patient care for a wide range of clinical conditions and symptoms. The intent is to guide personnel to provide patient care in line with best practice. The aim of this study is to describe adherence to such guidelines among prehospital emergency nurses (PENs) when caring for patients with chest pain. OBJECTIVE: To describe guideline adherence among PENs when caring for patients with chest pain. To investigate whether guideline adherence is associated with patient age, sex or final diagnosis of acute myocardial infarction on hospital discharge. METHODS: Guideline adherence in terms of patient examination and pharmaceutical treatment was analysed in a cohort of 2092 EMS missions carried out in 2018 in Region Halland, Sweden. Multivariate regression was used to describe how guideline adherence is associated with patient age, sex and diagnosis on hospital discharge. RESULTS: Guideline adherence was high regarding examination of vital signs (93%) and electrocardiogram (ECG) registration (96%) but lower in terms of pharmaceutical treatment (ranging from 28 to 90%). Adherence was increased in cases in which the patient ended up with acute myocardial infarction (AMI) as diagnosis on discharge. Patients with AMI were given acetylsalicylic acid by PENs in 50% of cases. Women were less likely than men to receive treatment with acetylsalicylic acid and oxycodone. CONCLUSIONS: Guideline adherence among PENs when caring for patients with chest pain is satisfactory in terms vital signs and ECG registration. Regarding pharmaceutical treatment guideline adherence is defective. Improved adherence is mainly associated with male sex in patients and a diagnosis of AMI on hospital discharge. Defective adherence excludes measures known to improve patients' prognoses such as treatment with acetylsalicylic acid.


Assuntos
Serviços Médicos de Emergência , Enfermeiras e Enfermeiros , Dor no Peito/diagnóstico , Estudos de Coortes , Eletrocardiografia , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Estudos Prospectivos
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