Blunt chest trauma can cause several forms of heart injuries, of which myocardial infarction (MI) is recognized as a rare complication. An unusual case of occlusion of the left anterior descending artery following a snowmobile accident, with two episodes of sustained ventricular tachycardia, is presented here. Management of the occluded ...

BACKGROUND: Blunt chest trauma is an important clinical problem leading to injury of the heart and lungs that may be fatal. Experimental models in large animals have been developed previously. This study was aimed at developing a small-animal (rat) model for the purpose of evaluating blunt chest trauma. METHODS: Blunt ...

Echocardiography is a key diagnostic tool in evaluating patients with cardiac emergencies and chest trauma. The lack of qualified real-time interpretation limits its use by emergency first responders. Early diagnosis of cardiac emergencies has the potential to facilitate triage and medical intervention to improve outcomes. We investigated the feasibility of ...

Malignant ventricular arrhythmias can result from isolated right ventricular infarction, and reports of this phenomenon in the literature are rare. We present a case of a 46-year-old man with acute onset of chest pain angiographically confirmed to be a result of isolated occlusion of a right ventricular branch artery. He ...

A short cut review was carried out to establish the incidence of acute myocardial infarction in patients presenting as emergencies with post-cocaine chest pain. Altogether 198 papers were found using the reported search, of which eight presented the best evidence to answer the clinical question. The author, date and country ...

Recent advances in biomarkers have improved the evaluation of patients with acute chest pain, but current critical care pathways may still lead to important delays in early diagnosis and, hence, treatment of acute myocardial infarction (AMI). Electrocardiographic changes may occur within seconds of an ischemic insult, but the conventional 12-lead ...

STUDY OBJECTIVES: Continuous 12-lead serial ECG monitoring has been proposed to assist in the evaluation of patients with acute coronary syndrome and nondiagnostic ECG in an emergency department chest pain unit. However, the ability of serial ECG to detect acute coronary syndrome and its benefit in addition to a standard ...

BACKGROUND: Managing chest pain in the emergency department remains a challenge with current diagnostic strategies. We hypothesized that cardiac MRI could accurately identify patients with possible or probable acute coronary syndrome. METHODS AND RESULTS: The diagnostic performance of MRI was evaluated in a prospective study of 161 consecutive patients. Enrollment ...

Studies have repeatedly shown that as many as 43% of patients undergoing coronary angiograms have no evidence of coronary heart disease (CHD). Fear of cardiac-related sensations has been posited as one explanation for complaints of chest pain in patients without CHD. The purpose of this study is to examine variables ...

We report here a case of Behçet's syndrome. The patient was suddenly affected by chest pain during the clinical course of the disease and developed abdominal pain and melena after 5 weeks. The diagnosis of acute anteroseptal myocardial infarction was made on the basis of the electrocardiography findings, and many ...

Although heart-type fatty acid-binding protein (H-FABP) can be a marker of sarcolemmal injury due to acute myocardial ischemia, the diagnostic or prognostic value is not established in patients with acute chest pain. This multicenter prospective study aimed to determine the diagnostic and prognostic values of H-FABP in 133 patients presenting ...

OBJECTIVES: In an animal model of commotio cordis, sudden death with chest-wall impact, we sought to systematically evaluate the importance of impact velocity in the generation of ventricular fibrillation (VF) with baseball chest-wall impact. BACKGROUND: Sudden cardiac death can occur with chest-wall blows in recreational and competitive sports (commotio cordis). ...

BACKGROUND: Tilmicosin phosphate is a macrolide antibiotic that is used to treat cattle for pathogens that cause Bovine Respiratory Disease. CASE REPORT: A 28-year-old man with no prior history of heart disease developed severe chest pain, inverted T waves, and intraventricular conduction delay on EKG and mild elevation of cardiac ...

The emergency physician's (EP) fast and correct diagnosis of patients with chest pain is crucial for preventing inappropriate discharge and dire consequences. To determine which factors affect admission decisions in the ED, we studied epidemiologic characteristics of both discharged and admitted patients, and the percentage of discharged patients who returned ...

An 83-year-old woman was transferred to our cardiac intensive care unit with an acute non-Q-wave myocardial infarction and pulmonary edema. Enoxaparin was one component of the treatment regimen used. Her hospital course was complicated by episodes of hypotension, as well as by recurrent left hip and left thigh pain. The ...

A 64-year-old woman presented at our institution with abdominal pain. An electrocardiogram suggested the possibility of acute anteroseptal myocardial infarction. Her medical history included esophageal reconstruction with use of a jejunal conduit in the anterior mediastinum. Echocardiography revealed a distended jejunal conduit, which was compressing the right ventricle. Once the ...

In the emergency setting, acute chest pain and shortness of breath represent common patient presentations. Cardiac biomarkers including myoglobin, creatine kinase (CK)-MB, troponin, and b-type natriuretic peptide provide diagnostic and prognostic information for patients with chest pain and shortness of breath. This article reviews the use of cardiac biomarkers in ...

RATIONALE AND OBJECTIVES: The objective of the present study was to compare the data regarding the ability of real-time myocardial contrast echocardiography (MCE) to assess altered myocardial blood flow produced by graded coronary stenoses between open- and closed-chest canine models. MATERIALS AND METHODS: Three grades of left anterior descending coronary ...

OBJECTIVE: To examine the characteristics, subsequent resource use and outcome of a consecutive cohort of admissions with acute chest pain not due to myocardial infarction. METHODS: Subjects (N=356) identified in the course of a epidemiological study of myocardial infarction were interviewed and completed HAD, SF-36 and other self-report information in ...

A 42-year-old man experienced chest discomfort after being struck by a low-speed flying object. Two weeks after the accident, the patient complained of severe shortness of breath accompanied by ankle edema. Chest X-ray indicated acute pulmonary edema and left ventricular enlargement. There were Q waves and flat T waves in ...

The authors present two patients in whom chronic radiodermatitis developed after repeated cardiac catheterization and coronary angioplasty procedures, with no indication of malignancy. In one patient, after other therapeutic methods were unsuccessful in alleviating his symptoms, the authors excised the lesion with wide surgical margins and skin grafted the area. ...

STUDY OBJECTIVE: Chest pain is the second most common chief complaint presented to the emergency department. Although the causes of chest pain span the clinical spectrum from the trivial to the life threatening, it is often difficult to identify which patients have the most common life-threatening cause, cardiac ischemia. Because ...

BACKGROUND: Increased rates of myocardial infarction, heart failure, arrhythmias, and death occur in patients with chronic kidney disease. We sought to evaluate the processes of care and outcomes in patients with chronic kidney disease presenting to an emergency department with chest discomfort. METHODS: We enrolled 817 consecutive patients who underwent ...

The purpose of this study was to evaluate the possibility to predict in the prehospital phase the occurrence of a life-threatening disease or death among ambulance transported patients with acute chest pain or other symptoms raising any suspicion of an acute coronary syndrome. All patients transported by ambulance during 3 ...

OBJECT: Although previous studies reported that late reperfusion might prevent left ventricular dilation after acute myocardial infarction (AMI), implication of persistent ischemic chest pain on admission remains to be investigated. This study was undertaken to assess the implication of persistent ischemic chest pain on in-hospital outcome and left ventricular function ...

OBJECTIVE: To examine the reports on cardiac Munchausen syndrome for clinical characteristics. METHODS: Cases, case series, and related articles on the subject in all languages were identified through a comprehensive literature search. RESULTS: Fifty-eight cases of cardiac Munchausen syndrome were identified. Mean +/- SD patient age was 44 +/- 12 ...

We report on a 58-year-old man with known diabetes, congestive heart failure, and need for chronic hemodialysis presenting with right lower abdominal quadrant pain, fever, and leukocytosis. Although initial clinical findings were highly suggestive of acute appendicitis, CT revealed marked circumferential wall thickening of the cecum, which was interpreted as ...

The incidence of myocardial contusion as a result of blunt chest trauma remains difficult to assess. As such the potentially lethal consequences are often difficult to mitigate against. The true incidence of myocardial contusion is not known and various authors have ascribed percentages in the very broad range of 8-71% ...

STUDY OBJECTIVE: To assess the safety and the accuracy of a 4 h stepwise diagnostic approach relying on clinical judgement in unselected patients with acute chest pain. DESIGN: Prospective cohort study. SETTING: Emergency department (ED) of a tertiary care university hospital. PATIENTS: 1288 unselected patients presenting with acute chest pain. ...

Cardiac trauma is not usually treatable in the field. EMS providers must recognize the possibility of cardiac trauma rapidly and evacuate the patient to an appropriate facility. Most therapy for cardiac trauma requires an operating room, preferably with cardiopulmonary bypass capability. Basic patient care should occur en route to the ...

Cardiac markers are presently a hot topic, with active debate on their use. They now have a major role for cost-effective management of acute chest pain and suspected acute coronary syndrome. The laboratory has a pivotal role in proper selection and interpretation of available markers, depending on the creation of ...

OBJECTIVE: To evaluate the impact of the diagnostic test setting-inpatient versus outpatient-on adverse cardiac events (ACEs) after six months in emergency department (ED) patients with chest pain who were admitted to the hospital and subsequently had a negative evaluation for acute coronary syndrome (ACS). METHODS: The authors retrospectively studied a ...

If a dental patient develops chest pain it must always be managed promptly and properly, i.e., the practitioner immediately stops the procedure and, being aware of the patient's medical history, questions the patient regarding the nature of the pain to help determine the likely diagnosis. It will most likely be ...

The case is presented of a 54 year old man who attended the emergency department with a history of central abdominal pain and electrocardiograpic changes consistent with an anteroseptal myocardial infarction. Myocardial infarction was not confirmed with serial cardiac enzymes and a subsequent laparotomy revealed a gangrenous retrocaecal appendix. This ...

BACKGROUND: Hydatids of Morgagni are benign, pedunculated, cystic structures arising from müllerian vestiges below the fallopian tube near the fimbria. They usually are of no clinical significance unless the pedicle becomes twisted and infarction occurs. CASE: A 39-year-old primigravida at 41 weeks and 5 days' gestation underwent primary cesarean delivery ...

BACKGROUND: Cardiac health services researchers frequently use cohorts derived from administrative hospital discharge abstract data to study the outcomes and treatment of coronary artery disease. However, relatively limited data exist on the accuracy of the coding of cardiac diagnoses in discharge abstract data. The goal of this study was to ...

AIMS: To prospectively evaluate the efficacy and safety of a chest pain pathway at Green Lane Hospital. METHODS: Between August 1999 and March 2000, patients with non-traumatic chest discomfort considered to be possibly ischaemic were assessed by history, physical examination, baseline electrocardiographic findings and point of care troponin T tests. ...

A 14-year-old boy with mid-ventricular hypertrophic obstructive cardiomyopathy (MVHOCM) first presented at the age of 10 years with severe chest pain. Two-dimensional echocardiography disclosed marked hypertrophy at the mid-portion of the ventricular septum, and left ventriculography showed an hourglass appearance at systole. He was initially treated with propranolol, but the ...

OBJECTIVE: To determine whether collateral recruitment is involved in the preconditioning effect on the electrocardiogram, chest symptoms, and lactate metabolism during coronary angioplasty in patients with stable angina pectoris. METHODS AND PATIENTS: Sixteen patients with stable angina pectoris underwent three consecutive 2-min balloon inflations 5-min apart. The greatest ST elevation ...

The patient in this case was diagnosed as having a myocardial infarction, exacerbated over time. It has been reported in medical literature that women in such cases may have atypical symptoms that mimic those of other medical conditions and deceive providers into misdiagnosis. A few women present with the classical ...

BACKGROUND: Atherosclerosis is an inflammatory process in which adhesion molecules play an intimate role in both the initiation and progression of lesions. It is postulated that they also play a role in the presentation of acute coronary syndromes and that plasma levels thereafter may be of potential prognostic significance. The ...

OBJECTIVE: Inhalation of helium, which produces a change in the voice, is frequently used among young rock singers to improve their performance. DESIGN: A case report. SETTINGS: Adult medical intensive care unit in a university hospital. PATIENT: A 23-yr-old singer, who accidentally inhaled helium from a high pressurized tank without ...

In this report we present a case of a 28-year-old woman who was admitted to our emergency room complaining of chest pain. Her clinical ECG and biochemical evaluation was consistent with acute nonatherogenic myocardial infarction. Subsequent work is revealed that she was suffering from ulcerative colitis with acute exacerbation since ...

BACKGROUND: Previous studies have demonstrated the high sensitivity and specificity of technetium 99m sestamibi scintigraphy during acute chest pain myocardial perfusion imaging. However, no study has shown that this technique would alter clinical management in practice. METHODS AND RESULTS: One hundred twenty consecutive patients were injected with Tc-99m sestamibi (22 ...

Advances over the past few years have led to the use of hand-held point-of-care diagnostic tests to expedite testing for cardiac enzymes indicative of acute myocardial infarction. Although cardiac enzymes such as troponin I and CKMB are reliable markers of acute myocardial infarction, they cannot be detected until several hours ...

BACKGROUND: The present study was undertaken to test the effectiveness of an established equation for estimating the probability of acute cardiac ischaemia, but in an environment different from that in which it was developed. METHODS AND RESULTS: A total of 255 patients who presented to the accident and emergency department ...

STUDY OBJECTIVE: Accurate identification of the presence of acute myocardial infarction in adult patients who present to the emergency department with anterior chest pain remains elusive. The artificial neural network is a powerful nonlinear statistical paradigm for the recognition of complex patterns, with the ability to maintain accuracy when some ...

We report a case of cerebral arteriovenous malformation in a 34 year-old male patient presenting with chest pain. Electrocardiographic findings showed ST elevations in the precordial leads. However, a coronary angiogram showed no coronary lesions. Laboratory tests suggested that troponin and cardiac enzymes were within normal limits. Further investigation led ...

In this study, we screened a total of 6723 consecutive patients with chest pain and ECG non-diagnostic for acute myocardial infarction (AMI) on presentation to the emergency department (ED). The aim of the study was to avoid missed AMI, improve safe early discharge and reduce inappropriate coronary care unit (CCU) ...

We report a case of acute myocardial infarction in a nephrotic child. A 7-year-old boy with a 4-year history of steroid-unresponsive nephrotic syndrome due to mesangial proliferation disease presented with acute vomiting and chest pain. An electrocardiogram showed ST elevation and pathological Q waves in leads consistent with anterior and ...