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Lumbreras-Fernández B, Vicente Bártulos A, Fernandez-Felix BM, Corres González J, Zamora J, Muriel A. Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors. Radiologia (Engl Ed) 2023; 65:423-430. [PMID: 37758333 DOI: 10.1016/j.rxeng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.
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Affiliation(s)
| | - A Vicente Bártulos
- Servicio de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Centro de Investigación Biomédica en Red Enfermedades respiratorias (CIBERES), Madrid, Spain
| | - B M Fernandez-Felix
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Corres González
- Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - A Muriel
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Departamento de Enfermería de la Universidad de Alcalá, Madrid, Spain
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Ibrahim-Achi D, Pelizzolo-Vega S, Puiguriguer J, Supervía A, Galicia M, Domínguez-Rodríguez A, Miró O, Burillo-Putze G. Chest pain secondary to drug use treated in hospital emergency departments in Spain. Rev Clin Esp 2023:S2254-8874(23)00072-3. [PMID: 37330171 DOI: 10.1016/j.rceng.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To determine the characteristics of patients with chest pain (CP) associated with recent drug use. METHODS Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. RESULTS CP accounted for 8.97% of attendances (males 82.9%, p < 0.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, p < 0.001), anxiety (42.5%, p < 0.001), hypertension (13.6%, p < 0.001) and arrhythmias (5.9%, p < 0.001). Patients with TD received more treatment (81.9% vs 74.1%; p < 0.001), although they were admitted less (7.6%, p = 0.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). CONCLUSIONS In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing.
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Affiliation(s)
- Dima Ibrahim-Achi
- School of Health Sciences, Universidad de La Laguna, Tenerife, Spain; Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Jordi Puiguriguer
- Emergency Department-Clinical Toxicology Unit, Hospital Son Espases, Palma de Mallorca, Spain
| | - August Supervía
- Emergency Department-Clinical Toxicology Unit, Hospital del Mar, Barcelona, Spain
| | | | - Alberto Domínguez-Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain; Department of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
| | - Oscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain; Primary Care Research Network on Addiction (RIAPAd)
| | - Guillermo Burillo-Putze
- Department of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain; Primary Care Research Network on Addiction (RIAPAd).
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Villanueva Campos AM, Etxano Cantera J, Patel N, Villanueva Marcos AJ. Extrapleural fat: description, incidence, and relation with body mass index. Radiologia (Engl Ed) 2023; 65:106-111. [PMID: 37059576 DOI: 10.1016/j.rxeng.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/24/2021] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIMS Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI>30) and non-obese (BMI<30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured <5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.
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Affiliation(s)
| | - J Etxano Cantera
- Departamento de Radiología, Hospital Universitario Araba, Sede Txagorritxu, Vitoria-Gasteiz, Araba/Álava, Spain
| | - N Patel
- Stanmore Road Medical Group, Stevenage, England
| | - A J Villanueva Marcos
- Department of Radiology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, England.
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León-Blanchet MF, Araiza-Garaygordobil D, Reynier-Garza V, Gopar-Nieto R, Belderrain-Morales N, Sarabia-Chao V, Martínez-Amezcua P, Cabello-López A, Sandoval-Aguilar TT, Arias-Mendoza A. Prediction of adverse cardiac outcomes in high-risk Mexican patients with chest pain in the emergency department. Arch Cardiol Mex 2023; 93:183-188. [PMID: 37037214 PMCID: PMC10161808 DOI: 10.24875/acm.22000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. METHODS A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. RESULTS A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. CONCLUSIONS The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population.
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Affiliation(s)
- María F León-Blanchet
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
| | | | - Valeria Reynier-Garza
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
| | - Rodrigo Gopar-Nieto
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
| | | | - Vianney Sarabia-Chao
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
| | - Pablo Martínez-Amezcua
- Division of General Medicine, Department of Medicine, Columbia University, Irving, Medical Center, New York, USA
| | - Alejandro Cabello-López
- Occupational Health Research Unit, National Medical Center Siglo XXI, IMSS, Mexico City, Mexico
| | | | - Alexandra Arias-Mendoza
- Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
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Dos Santos Rodrigues da Silva MJ, Ferreira MLN, Fernandez Gacio M, Miranda MLC, Agrelo A. The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:338-45. [PMID: 34140270 DOI: 10.1016/j.redare.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. METHODS A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 h, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. RESULTS 3 patients were excluded. At 24 h, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn't improve. CONCLUSION Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.
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6
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Villanueva Campos AM, Etxano Cantera J, Patel N, Villanueva Marcos AJ. Extrapleural fat: description, incidence, and relation with body mass index. Radiologia (Engl Ed) 2021; 65:S0033-8338(21)00087-4. [PMID: 34034900 DOI: 10.1016/j.rx.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Pleural appendages (PA) are portions of extrapleural fat that hang from the chest wall. They have been described on videothoracoscopy, however their appearance, frequency and possible relationship with the amount of patient's fat remain unknown. Our aim is to describe their appearances and prevalence on CT, and determinate whether their size and number is higher in obese patients. PATIENTS AND METHODS Axial images of 226 patients with pneumothorax on CT chest were retrospectively reviewed. Exclusion criteria included known pleural disease, previous thoracic surgery and small pneumothorax. Patients were divided in obese (BMI > 30) and non-obese (BMI < 30) groups. Presence, position, size and number of PA were recorded. Chi square and Fisher's exact test were used to evaluate differences between the two groups, considering p<0.05 as significant. RESULTS Valid CT studies were available for 101 patients. Extrapleural fat was identified in 50 (49.5%) patients. Most were solitary (n=31). Most were located in the cardiophrenic angle (n=27), and most measured < 5cm (n=39). There was no significant difference between obese and non-obese patients regarding the presence or absence of PA (p=0.315), number (p=0.458) and size (p=0.458). CONCLUSIONS Pleural appendages were seen in 49.5% patients with pneumothorax on CT. There was no significant difference between obese and non-obese patients regarding presence, number and size of pleural appendages.
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Affiliation(s)
| | - J Etxano Cantera
- Departamento de Radiología, Hospital Universitario Araba, Sede Txagorritxu, Vitoria-Gasteiz, Araba/Álava, España
| | - N Patel
- Stanmore Road Medical Group. Stevenage, England
| | - A J Villanueva Marcos
- Department of Radiology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, England.
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7
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Dos Santos Rodrigues da Silva MJ, Lousame AA, Ferreira MLN, Fernandez Gacio M, Miranda MLC. The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. ACTA ACUST UNITED AC 2021; 68:338-345. [PMID: 33627290 DOI: 10.1016/j.redar.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. METHODS A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 hours, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. RESULTS 3 patients were excluded. At 24 hours, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn't improve. CONCLUSIóN: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.
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Affiliation(s)
| | - A A Lousame
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L N Ferreira
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M Fernandez Gacio
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L C Miranda
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
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Núñez-Delgado Y, Garrido-Márquez I, Díaz-Rubia L, Milena-Muñoz A, Eisman-Hidalgo M, Valero-González MÁ. Dolor torácico y shock secundarios a perforación espontánea de esófago: síndrome de Boerhaave. CIR CIR 2020; 88:18-20. [PMID: 33284265 DOI: 10.24875/ciru.20000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La perforación esofágica es la más letal de todas las perforaciones del aparato digestivo. Se presenta el caso de un varón de 65 años que acude a urgencias por un cuadro clínico de dolor torácico, vómitos e hipotensión. Se le realizó tomografía computarizada por sospecha de síndrome aórtico agudo, con hallazgos sugerentes de perforación esofágica. El síndrome de Boerhaave consiste en la rotura longitudinal del esófago sobre una pared macroscópicamente sana. Su tratamiento definitivo se realiza con cirugía durante las primeras 24 horas. El síndrome de Boerhaave debe considerarse como complicación posible en los pacientes con dolor epigástrico y vómitos, ya que es una emergencia quirúrgica con alta morbimortalidad. Esophageal perforation is the most lethal of all perforations of the digestive system. 65-year-old male who goes to the emergency department due to clinical symptoms of chest pain, vomiting and hypotension, who underwent CT scan for suspected acute aortic syndrome, with suggestive findings of esophageal perforation. Boerhaave syndrome consists of the longitudinal rupture of the esophagus on a macroscopically healthy wall. Its definitive treatment is performed with surgery during the first 24 hours. Boerhaave syndrome should be considered as a possible complication in patients with epigastric pain and vomiting, as it is a surgical emergency with high morbidity and mortality.
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Affiliation(s)
- Yolanda Núñez-Delgado
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Irene Garrido-Márquez
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Laura Díaz-Rubia
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Ana Milena-Muñoz
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
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Guerineau A, Rozelle C, Sevestre E, Narcisse S, Laribi S, Giovannetti O. Predicting a diagnosis of acute coronary syndrome during telephone evaluation by an emergency dispatcher: the SCARE predictive scale. Emergencias 2020; 32:19-25. [PMID: 31909908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. MATERIAL AND METHODS Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. RESULTS The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher's suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). CONCLUSION The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers.
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Affiliation(s)
| | - Clément Rozelle
- Department of Emergency Medicine, CHR Orléans, Orléans, Francia
| | - Elodie Sevestre
- Department of Emergency Medicine, CHR Orléans, Orléans, Francia
| | - Sophie Narcisse
- Department of Emergency Medicine, CHR Orléans, Orléans, Francia
| | - Saïd Laribi
- Tours University, School of Medicine, and Tours University Hospital, Emergency Medicine Department, Tours, Francia
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Miró Ò, Martínez-Nadal G, Jiménez S, Gómez-Angelats E, Alonso JR, Antolín A, Salgado E, Perelló R, Gualandro DM, Strebel I, López-Ayala P, Rosselló X, Bragulat E, Sánchez M, Müller C, López-Barbeito B. Nontraumatic chest pain and suspicion of acute coronary syndrome: associated clinical and electrocardiographic findings on initial evaluation. Emergencias 2020; 32:9-18. [PMID: 31909907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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. MATERIAL AND 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. CONCLUSION 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.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España. The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italia
| | - Gemma Martínez-Nadal
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España. The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italia
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Josep R Alonso
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Albert Antolín
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Emilio Salgado
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Rafel Perelló
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Danielle M Gualandro
- The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italia. Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Suiza
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Suiza
| | - Pedro López-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Suiza
| | - Xavier Rosselló
- Centro Nacional de Investigación Cardiovascular, Madrid, España
| | - Ernest Bragulat
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Miquel Sánchez
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Christian Müller
- The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italia. Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Suiza
| | - Beatriz López-Barbeito
- Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, España. The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italia
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11
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Murga-Eizagaetxebarría N, Rodríguez-Padial L, Muñiz J, Sambola A, Gómez-Doblas JJ, Pedreira M, Alonso-Martín JJ, Beltran P, Rodríguez-Roca G, Anguita M, Roig E. The Gender Perspective Within the OFRECE Study: Differences in Health Care Among Patients Consulting for Chest Pain and/or Palpitations. Rev Esp Cardiol (Engl Ed) 2019; 72:813-819. [PMID: 30971378 DOI: 10.1016/j.rec.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. CONCLUSIONS This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.
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Affiliation(s)
- Nekane Murga-Eizagaetxebarría
- Dirección General de Planificación, Ordenación y Evaluación Sanitaria, Departamento de Salud, Gobierno Vasco, Vitoria, Álava, Spain
| | | | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud e INIBIC, Universidad de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Antonia Sambola
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Hospital Univesitari Vall d'Hebron, Institut de Recerca Hospital Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Juan José Gómez-Doblas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Milagros Pedreira
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Complexo Hospitalario Universitario Santiago de Compostela, A Coruña, Spain
| | | | - Paola Beltran
- Hospital de Viladecans, Institut Català de la Salut (ICS), Viladecans, Barcelona, Spain
| | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Eulalia Roig
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Hospital Sant Pau, Barcelona, Spain
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Kot Baixauli P, Rodriguez Gimillo P, Baldo Gosalvez J, De Andrés Ibáñez J. The erector spinae plane block (ESPB) in the management of chronic thoracic pain. Correlation of pain/analgesia areas and long term effect of the treatment in three cases. ACTA ACUST UNITED AC 2019; 66:443-6. [PMID: 31395404 DOI: 10.1016/j.redar.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 11/22/2022]
Abstract
The erector spinae plane block (ESPB) is a technique that is used both as perioperative analgesia and in the management of chronic pain. This has been described recently and is being a resource increasingly used for its easy implementation and low rate of complications. However, the correlation between pain and analgesia, as well as its long-term effect on chronic pain, should be studied. We present a series of 3 cases in which the effectiveness of the ESPB in patients with chronic chest pain was evaluated. The block was performed in all cases by depositing 20ml of 0.2% Ropivacaine in the fascial plane of the erector spinae muscle. The pain was measured using a numerical scale prior to the block, at 30minutes and a month. The areas were marked on the skin with different colours for comparison.
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González-Del-Hoyo M, Cediel G, Carrasquer A, Bonet G, Consuegra-Sánchez L, Bardají A. Diagnostic and prognostic implications of troponin elevation without chest pain in the emergency department. Emergencias 2019; 30:77-83. [PMID: 29547229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To analyze the prognostic implications of the absence of chest pain in emergency department patients with elevated troponin I levels. MATERIAL AND METHODS Observational retrospective study of patients for whom troponin I level was analyzed at least once between January 2012 and December 2013. Patient characteristics were recorded and survival was modeled. RESULTS A total of 3629 patients were distributed in 4 groups according to troponin I level and chest pain as follows: chest pain without troponin I elevation (n = 1379), no chest pain and no troponin I elevation (n = 1196), chest pain with troponin I elevation (n = 517), and troponin I elevation but no chest pain (n = 537). The patients with troponin I elevation but no chest pain were older and had more chronic conditions as well as more alternative diagnoses to consider other than acute coronary syndrome. Mortality was also higher at 12 months (log rank test < 0.001) in these patients. Multivariate analysis showed that absence of chest pain accompanying troponin I elevation was an independent predictor of mortality (hazard ratio, 5.130; 95% CI, 3.291-7.996; P<.001) vs patients with chest pain but no troponin I elevation. CONCLUSION The absence of chest pain in the presence of troponin I elevation identifies a heterogeneous group of patients with a worse 12-month prognosis.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII. IISPV. Universidad Rovira Virgili, Tarragona, España
| | - Germán Cediel
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII. IISPV. Universidad Rovira Virgili, Tarragona, España
| | - Anna Carrasquer
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII. IISPV. Universidad Rovira Virgili, Tarragona, España
| | - Gil Bonet
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII. IISPV. Universidad Rovira Virgili, Tarragona, España
| | | | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII. IISPV. Universidad Rovira Virgili, Tarragona, España
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Coll-Vinent B, Martí G, Calderón S, Martínez B, Céspedes F, Fuenzalida C. [Domestic violence against women patients seen with chest pain in the emergency department]. Semergen 2018; 45:23-29. [PMID: 30268361 DOI: 10.1016/j.semerg.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/17/2018] [Accepted: 04/09/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES 1) To determine the prevalence of intimate partner violence (IPV) in patients seen in the emergency department with chest pain. 2)To analyse the possible association between IPV and presence/control of vascular risk factors (VRF), psychic manifestations of stress, delay in requesting care, care received, and prognosis. METHODS The study was conducted on 125 women, and included a targeted interview, the Partner Violence Screen (PVS) test, a 30-day follow-up telephone interview, and a one-year follow-up clinical history review. RESULTS A total of 27 patients (21.6%) had a history of IPV, which was present in 4 of them. Women with a history of IPV were younger (53.7±15.0 vs. 64.0±18.4; P=.020), had more anxiety or a depressive syndrome (57.7% vs 13.5%; P<0.001), and consulted later (35.0±65.2days vs 7.9±25.0days; P=.047). Among older women (≥65years), there was more dyslipidaemia (100% vs 60.4%; P=.039) and worse blood pressure control (good control 20% vs 78.4%; P=.007) in those with a history of IPV. There were no differences in the diagnoses, tests, length of stay, admissions or prognosis among patients with or without a history of IPV, and there were no differences according to chronology of IPV. CONCLUSIONS The current or previous existence of IPV in patients who consult for chest pain in the emergency department is high. The existence of IPV is associated with a delay in consultation and greater anxiety, and may contribute to poor control of VRF, but does not affect the prognosis in the medium term.
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Affiliation(s)
- B Coll-Vinent
- Àrea d'Urgències, Hospital Clínic, Barcelona, España; Grup de Recerca «Urgències: processos i patologies», Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - G Martí
- Grup de Recerca «Urgències: processos i patologies», Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - S Calderón
- Àrea d'Urgències, Hospital Clínic, Barcelona, España
| | - B Martínez
- Àrea d'Urgències, Hospital Clínic, Barcelona, España
| | - F Céspedes
- Àrea d'Urgències, Hospital Clínic, Barcelona, España
| | - C Fuenzalida
- Àrea d'Urgències, Hospital Clínic, Barcelona, España; Grup de Recerca «Urgències: processos i patologies», Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
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Calmarza P, Lapresta C, Martínez M, Lahoz R, Povar J. Utility of myeloperoxidase in the differential diagnosis of acute coronary syndrome. Arch Cardiol Mex 2017; 88:391-396. [PMID: 29233491 DOI: 10.1016/j.acmx.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To determine the usefulness of myeloperoxidase in discriminating between patients with acute coronary syndrome and patients with chest pain by other causes. METHODS The study included all patients over 18 years of age who come consecutively to the emergency department from September 2015 to December 2015 with chest pain of non-traumatic origin. The initial patient evaluation was performed according to the study protocol for patients with suspected acute coronary syndrome (ACS) in our Emergency Department. This included the serial measurement of troponin, and in this case myeloperoxidase, with serialization on admission and at 6h. For the determination of myeloperoxidase (MPO), a single step sandwich enzyme immunoassay by Siemens, automated on a Dimension analyser, was used. RESULTS Statistically significant differences were observed in the concentration of myeloperoxidase at time 0 among patients diagnosed with ACS: 505 (413)pmol/L, and non-ACS patients: 388 (195)pmol/L (p<.001), as well as at 6h (p<.001). An area under the curve ROC of 0.824 was obtained at 6h for ACS patients, with a confidence interval of 95% from 0.715 to 0.933 and a level of significance of p<.001. Statistically significant differences were also found in the concentration of myeloperoxidase at time 0 and at 6h among patients with ACS and patients with heart disease other than coronary artery disease. CONCLUSIONS The concentration of MPO helps to differentiate between ACS and non-ACS patients, as well as between ACS patients and patients with heart diseases other than coronary artery disease.
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Affiliation(s)
- Pilar Calmarza
- Department of Clinical Biochemistry, Universitary Hospital Miguel Servet, Zaragoza, Spain.
| | - Carlos Lapresta
- Department of Preventive Medicine, Barbastro Hospital, Huesca, Spain
| | - María Martínez
- Department of Endocrinology, University Hospital Miguel Servet, Zaragoza, Spain
| | - Raquel Lahoz
- Department of Clinical Biochemistry, Universitary Hospital Miguel Servet, Zaragoza, Spain
| | - Javier Povar
- Department of Urgences, University Hospital Miguel Servet, Zaragoza, Spain
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Montero-Pérez FJ, Quero-Espinosa FDB, Clemente-Millán MJ, Castro-Giménez JA, de Burgos-Marín J, Romero-Moreno MÁ. Diagnostic validity of hand gestures in chest pain of coronary origin. Rev Clin Esp 2017; 217:252-259. [PMID: 28410822 DOI: 10.1016/j.rce.2017.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/08/2017] [Accepted: 02/23/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the frequency of 3 hand gestures by patients with chest pain and determine the diagnostic validity of the gestures in acute coronary syndrome. PATIENTS AND METHODS A prospective study was conducted on 383 adult patients treated for chest pain in an emergency department. We observed certain hand gestures, previously referred to in the medical literature as characteristic of coronary pain (gesture 1: a clenched fist held over the sternal area or Levine's sign; gesture 2: open hand located over the same area; gesture 3: both hands placed in the centre of the chest), as well as other gestures. We analysed their association with the coronary origin of the pain. RESULTS We confirmed the coronary origin of the pain in 164 (43%) patients (ACS group). The other 219 patients (57%) did not have a coronary origin for the pain (nonACS group). Eighty-nine percent of the patients identified their pain with one of the 3 classical gestures. The most frequent gesture was number 2, both overall (59%) and by group (60% ACS group; 57.5% nonACS group). There was no significant association between the type of gesture and the final diagnosis (P=.172). The greater specificity corresponded to Levine's sign (90%), followed by other gestures (86%) and gesture 3 (81%). CONCLUSIONS Although 89% of the patients expressed their chest pain with one of the 3 manual gestures classically associated with coronary pain, none achieved sufficient diagnostic accuracy to be used as indicative of this type of pain.
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Affiliation(s)
- F J Montero-Pérez
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España.
| | - F de Borja Quero-Espinosa
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - M J Clemente-Millán
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - J A Castro-Giménez
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - J de Burgos-Marín
- Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - M Á Romero-Moreno
- Unidad de Gestión Clínica de Cardiología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
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Durán-Cambra A, Rosselló X, Sans-Roselló J, Vila M, Hidalgo A, Rodríguez ID, Leta R, Pons-Lladó G, Ordóñez-Llanos J, Sionis A. [High-sensitivity troponin T testing and coronary computed tomography angiography for rapid diagnosis of chest pain in the emergency department]. Emergencias 2016; 28:9-15. [PMID: 29094820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the probability of finding significant coronary lesions, the time to diagnosis, and the safety of a new diagnostic approach based on high-sensitivity cardiac troponin T (hsTnT) testing followed by coronary computed tomography angiography (CCTA) in patients with chest pain of possible coronary origin. The method was compared with our hospital emergency department's standard practice. MATERIAL AND METHODS Unblinded randomized controlled trial in a tertiary level university hospital between February 2011 and April 2013. We included emergency patients with chest pain and nondiagnostic electrocardiographic findings. Patients were assigned randomly to the new approach (hsTnT assay, followed by CCTA if the assay findings were negative) or the conventional approach (fourth generation TnT assay and, if negative, followed by an exercise stress test). Invasive coronary angiography was ordered in all patients if the results of either troponin assay, the CCTA, or the stress test were positive. We recorded the results of angiography, time until diagnosis, and all-cause mortality, new myocardial infarction, new unstable angina, or need for revascularization within the next 3 months. RESULTS Of 102 patients randomized, 7 were excluded; 50 of the remaining 95 patients were assigned to the new strategy, and 45 to the conventional approach. Coronary angiography demonstrated significant lesions in 92.9% of the patients treated with the new strategy and 66.7% of those diagnosed conventionally. A higher percentage of patients were diagnosed within 6 hours with the new approach (20.0% vs 4.4% of conventional-approach patients, P = .023). During the 3 months following diagnosis, 1 death occurred in the intervention group and none in the conventional-approach group. CONCLUSION The new strategy could accelerate diagnosis and increase the probability of finding significant coronary lesions, but we found no significant differences in adverse events in the 3 months following diagnosis. These findings should be confirmed in studies with larger numbers of patients.
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Affiliation(s)
- Albert Durán-Cambra
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Xavier Rosselló
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Jordi Sans-Roselló
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Montserrat Vila
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Alberto Hidalgo
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Iván Díaz- Rodríguez
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Rubén Leta
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Guillem Pons-Lladó
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
| | - Jordi Ordóñez-Llanos
- Servicio de Bioquímica, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España. Departamento de Bioquímica y Biología Molecular, Universitat Autònoma, Barcelona, España
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, España
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Sánchez Ramón S, Moya de la Calle M, Álvarez Hodel AE, Del Pozo Vegas C. [Myocardial bridging, or milking, as a cause of chest pain: report of 4 cases]. Emergencias 2016; 28:117-120. [PMID: 29105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Myocardial bridging of epicardial coronary arteries can cause a compression effect during systole. The anterior descending artery is the most commonly affected. This phenomenon is also known as milking. The clinical spectrum is varied. The patient may be symptom-free or experience varying degrees of chest pain during exercise or rest. We describe 4 patients treated for myocardial bridging in a hospital emergency department. Physicians should become familiar with this phenomenon in order to understand its management and implications.
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Córdoba-Soriano JG, Hidalgo-Olivares V, Cambronero-Cortinas E, Fernández-Anguita M. [Differential diagnosis of chest pain: a case of acute aortic syndrome]. Semergen 2014; 40:e37-42. [PMID: 24655911 DOI: 10.1016/j.semerg.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/29/2012] [Accepted: 12/06/2012] [Indexed: 11/30/2022]
Abstract
Chest pain is one of the most frequent reasons for consulting in any healthcare setting, however its diagnosis remains a challenge for both Primary Care and Emergency Department physicians. We report a case of an Acute Aortic Syndrome which was diagnosed late after an insidious course of chest pain, repetitive syncope, and in which the delay in diagnosis and treatment could be fatal. We also describe the definition, diagnosis, treatment, and outcome of this condition.
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Affiliation(s)
- J G Córdoba-Soriano
- Servicio de Cardiología, Hospital General Universitario, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - V Hidalgo-Olivares
- Servicio de Cardiología, Hospital General Universitario, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - E Cambronero-Cortinas
- Servicio de Cardiología, Hospital General Universitario, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Fernández-Anguita
- Servicio de Cardiología, Hospital General Universitario, Complejo Hospitalario Universitario de Albacete, Albacete, España
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