Rapid assessment of patients with non–ST-segment elevation acute chest pain: Troponins, inflammatory markers, or perfusion imaging?

2002 ◽  
Vol 9 (5) ◽  
pp. 491-499 ◽  
Author(s):  
J SWINBURN ◽  
P STUBBS ◽  
P SOMAN ◽  
P COLLINSON ◽  
U RAVAL ◽  
...  
Keyword(s):  
Chest Pain ◽  
Perfusion Imaging ◽  
Inflammatory Markers ◽  
Rapid Assessment ◽  
Acute Chest Pain ◽  
St Segment Elevation ◽  
St Segment

Predictors of short-term outcome in acute chest pain without ST-segment elevation

2003 ◽  
Vol 92 (2-3) ◽  
pp. 193-199 ◽  
Author(s):  
Juan Sanchis ◽  
Vicent Bodı́ ◽  
Ángel Llácer ◽  
Lorenzo Facila ◽  
Julio Núñez ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Short Term ◽  
Term Outcome ◽  
St Segment Elevation ◽  
Short Term Outcome ◽  
St Segment

Abstract 15848: Impact of the Covid-19 Pandemic on D2B Activations in a Single, Tertiary Care, Urban Medical Center in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Philip Lavenburg ◽  
Michael Gannon ◽  
Brian O'Murchu ◽  
Vladimir Lakhter ◽  
Deborah L Crabbe ◽  
...  
Keyword(s):  
Chest Pain ◽  
Symptom Onset ◽  
Mechanical Circulatory Support ◽  
Medical Center ◽  
Acute Chest Pain ◽  
Fluoroscopy Time ◽  
Medical Attention ◽  
Circulatory Support ◽  
St Segment Elevation ◽  
St Segment

Introduction: Initial reports suggest that patients may delay seeking medical attention during the Coronavirus Disease 2019 (COVID-19) pandemic. Our aim was to determine if the COVID-19 outbreak is associated with a higher incidence of late presentations for patients with STEMI, greater need for mechanical circulatory support and PCI. Methods: We retrospectively evaluated consecutive patients that presented to a single, academic medical center with acute chest pain and ST-segment elevation on ECG from March 15 through June 17 in years 2019 and 2020. All patients were referred for emergent coronary angiography and the final cohort consisted of 32 patients. Medical records were reviewed to determine time between symptom onset and hospital arrival, need for PCI and/or mechanical circulatory support, total fluoroscopy time and volume of contrast administration during catheterization. Results: There was no significant difference in age, gender, cardiac risk factors or history of CAD between the cohorts that presented in 2019 compared with 2020 (Table 1). The mean time from symptom onset to arrival in the ED was 6.5 ± 8 and 9.2 ± 17 hours in 2019 and 2020 (p=0.55), respectively. PCI was performed during the index catheterization in 5 (50%) and 21 (95%) patients in 2019 and 2020 (p=0.01), respectively. Mean volume of contrast media used per case was 142 ± 65 ml in 2019 and 237 ± 104 ml in 2020 (p=0.017). There was a trend towards greater need for mechanical circulatory support and total fluoroscopy time during cases in 2020 (Table 1). Conclusions: In patients with suspected STEMI during the COVID-19 pandemic, there was a trend towards longer duration between symptom onset and arrival to the ED. More patients presenting with ST-segment elevation required PCI and there was a trend towards greater utilization of mechanical circulatory support. These findings may reflect a decline in access to outpatient services and/or delays in patients seeking care for acute chest pain.

scholarly journals Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

2016 ◽  
Vol 43 (3) ◽  
pp. 258-260 ◽  
Author(s):  
Jonathan Winkler ◽  
Sunit-Preet Chaudhry ◽  
Philip H. Stockwell
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Cardiac Catheterization ◽  
Acute Chest Pain ◽  
Initial Presentation ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Septic Embolization ◽  
St Segment

Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myocardial infarction.

scholarly journals Pneumopericarditis: A Case of Acute Chest Pain with ST Segment Elevation

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Erwin E. Argueta ◽  
Menfil A. Orellana-Barrios ◽  
Teerapat Nantsupawat ◽  
Alvaro Rosales ◽  
Scott Shurmur
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Surgical Interventions ◽  
St Segment Elevation ◽  
Surgical Closure ◽  
Pericardial Space ◽  
Coronary Vascular Disease ◽  
St Segment ◽  
History Of ◽  
Upper Gastrointestinal

Pneumopericarditis describes a clinical scenario where fluid and air are found within the pericardial space. Although infrequent, pneumopericarditis should be considered in patients presenting with acute chest pain as a differential diagnosis. This is relevant in patients with history of upper gastrointestinal (GI) surgery, as this may lead to a fistula communicating the GI tract and the pericardium. We report a 42-year-old man with history of numerous surgical interventions related to a Nissen fundoplication that presented with acute chest pain and inferior lead ST segment elevations. Emergent coronary angiography was negative for coronary vascular disease but fluoroscopy revealed air in the pericardial space. Subsequent radiographic studies helped confirm air in the pericardial space with a fistulous communication to the stomach. Ultimate treatment for this defect was surgical closure.

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 75-83 ◽  
Author(s):  
Frank Breuckmann ◽  
Matthias Hochadel ◽  
Thomas Voigtländer ◽  
Michael Haude ◽  
Claus Schmitt ◽  
...  
Keyword(s):  
Chest Pain ◽  
Systolic Function ◽  
Clinical Signs ◽  
Acute Chest Pain ◽  
Final Diagnosis ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Invasive Management

Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). Methods: A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. Results: TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. Conclusions: About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.

Percutaneous coronary interventions in acute coronary syndromes

2021 ◽  
pp. 549-564
Author(s):  
Andreas Mitsis ◽  
Marco Valgimigli
Keyword(s):  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
Haemodynamic Instability ◽  
Dramatic Improvement ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Acute coronary syndromes (ACS) remain the most common disease in acute cardiovascular care. Historically, two groups of patients should be differentiated based on initial ECG features: patients with ongoing chest pain and persistent ST-segment elevation and patients with acute chest pain but no persistent ST-segment elevation. The first condition is defined as STEMI and requires immediate reperfusion by primary angioplasty or fibrinolytic therapy. The second condition is defined as NSTE-ACS and consists a big spectrum of cases range from patients free of symptoms at presentation to individuals with ongoing ischaemia, electrical or haemodynamic instability or cardiac arrest. The different types of ACS must be differentiated as their prognosis and therapeutic strategy varies. However, over the last years, the early and broad use of percutaneous coronary intervention (PCI) as well as innovations in the adjunctive antithrombotic medication, including more effective P2Y12-Inhibitors and new generation DES resulted to a dramatic improvement of the prognosis across the whole spectrum of ACS patients.

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