scholarly journals Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-Analysis

2013 ◽  
Vol 20 (9) ◽  
pp. 861-871 ◽  
Author(s):  
David Ayaram ◽  
M. Fernanda Bellolio ◽  
M. Hassan Murad ◽  
Torrey A. Laack ◽  
Annie T. Sadosty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chest Pain ◽  
Meta Analysis ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Triple Rule Out ◽  
Tomographic Angiography ◽  
Rule Out

Computed Tomographic Angiography for Risk Stratification in Patients with Acute Chest Pain - The Triple Rule-out Concept in the Emergency Department

2020 ◽  
Vol 16 (2) ◽  
pp. 98-110
Author(s):  
Marton-Popovici Monica ◽  
Béla Merkely ◽  
Bálint Szilveszter ◽  
Zsófia Dora Drobni ◽  
Pál Maurovich-Horvat
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Risk Stratification ◽  
Acute Chest Pain ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Acute Aortic Syndromes ◽  
Triple Rule Out ◽  
Tomographic Angiography ◽  
Rule Out

Background: Acute chest pain is one of the most common reasons for Emergency Department (ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening condition, urgent identification of the etiology of chest pain is of utmost importance in emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes (AAS). Discussion: The concept of Triple Rule-out Computed Tomographic Angiography (TRO-CTA) for patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic angiography as a single imaging technique, able to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical evaluation and outcomes of these patients. Conclusion: This review aims to summarize the main indications and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest pain.

scholarly journals Takotsubo Cardiomyopathy in a 22-Year-Old Single-Ventricle Patient

2016 ◽  
Vol 43 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Gwendolyn Rose Derk ◽  
Jamil Aboulhosn ◽  
Leigh C. Reardon
Keyword(s):  
Chest Pain ◽  
Takotsubo Cardiomyopathy ◽  
Single Ventricle ◽  
Computed Tomographic Angiography ◽  
Coronary Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
History Of ◽  
Tomographic Angiography ◽  
Invasive Evaluation ◽  
Rule Out

We report a highly unusual case of a 22-year-old woman with single-ventricle anatomy and a history of Fontan palliation who developed takotsubo cardiomyopathy. To our knowledge, takotsubo cardiomyopathy has not previously been described in a patient with single-ventricle anatomy, or more generally in any patient with congenital heart disease. The patient presented at our clinic for urgent examination after a 2-day history of chest pain that had begun upon the death of her dog. Invasive evaluation was refused by the patient; instead, she underwent electrocardiogram-gated coronary computed tomographic angiography, to rule out obstructive coronary disease. A physician who suspects takotsubo cardiomyopathy in a patient should look for new-onset chest pain and dyspnea coupled with these features: immediate onset of segmental akinesia in the midventricular or apical aspects of the heart, elevation of brain natriuretic peptide level 12 to 24 hours after onset of akinesia, elevation of troponin level 24 to 48 hours after onset, and disappearance of the segmental akinesia a few days after onset.

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