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Crea F - - 1999
BACKGROUND: It has been hypothesized that ischemic cardiac pain might be due to a spatially restricted intense stimulation of non-specific cardiac receptors. If this hypothesis is correct a strong stimulation with an adequate stimulus of a limited myocardial region should cause more pain than a weaker stimulation of a larger ...
Ornato J P - - 1999
Uncertainty and delay are common in the diagnosis of acute coronary syndromes (ACS). In the last 20 years, the need for faster, more accurate, and more cost-effective diagnosis gave rise to the concept of specialized treatment of patients with chest pain in emergency departments (EDs). The original strategy dedicated a ...
Abston, Karen Crowley.
Improving health care quality while reducing costs requires the elimination of unnecessary and unintended variation in the care process. Decision support applications already exist to foster adherence to standards that would accomplish this. The challenge resides in developing based on scientific evidence and yet consistent with local practice norms. In ...
Wu A H - - 1999
The Sixth Conference on the "Standards of Laboratory Practice Series", sponsored by the National Academy of Clinical Biochemistry (NACB), was held on August 4-5, 1998, at the Annual Meeting of the American Association for Clinical Chemistry, in Chicago, IL. An expert committee was assembled to write recommendations on the use ...
Storrow A B - - 1999
The emergency department (ED) evaluation of patients with potential acute coronary syndromes (ACS) has traditionally included initial cardiac marker testing for suspected acute myocardial infarction (AMI). While ED management decisions for patients with ACS have largely been based on history, physical examination, and a presenting 12-lead electrocardiogram (ECG), there is ...
Dalton J A JA School of Nursing, University of North Carolina at Chapel Hill, 27599-7460, - - 1999
To determine whether patterns of facial expressions of patients complaining of chest pain can aid in the diagnosis of myocardial infarctions. Exploratory. Southeastern university medical center emergency department (ED). Twenty-eight patients in the ED who presented with chest pain. Age range was 40 to 84 years, with a mean of ...
Adamek R J - - 1999
BACKGROUND/AIMS: The aim of the study was to evaluate esophageal motility patterns in patients with chest pain with and without coronary artery disease, in order to elucidate the question: Does "non-cardiac" chest pain really exist? METHODOLOGY: Patients with chest pain and normal coronary angiograms, patients with chest pain and coronarographically ...
Nakajima H H Department of Plastic and Reconstructive Surgery at the Keio University School of Medicine, Tokyo, - - 1999
We began in 1982 to use a modified Ravitch procedure that preserves the blood supply to the sternum to correct funnel chest deformities, but there were some problems such as postoperative paradoxical respiration, chest wall irregularity, and palpable heart beat. To resolve these problems, the concept of Jensen's procedure was ...
Wang Yili - - 1999
When patients present with acute onset of chest pain suggestive of myocardial ischemia, immediate clinical decisions regarding thrombolysis, percutaneous transluminal coronary angioplasty, or both are usually based on the history and abnormal electrocardiograms and confirmed by the presence of abnormally elevated cardiac enzymes. However, there are potential limitations of the ...
Jeremias A - - 1999
Chest pain following successful percutaneous coronary interventions is a common problem. Although the development of chest pain after coronary interventions may be of benign character, it is disturbing to patients, relatives and hospital staff. Such pain may be indicative of acute coronary artery closure, coronary artery spasm or myocardial infarction, ...
Lumerman J H - - 1999
BACKGROUND AND OBJECTIVE: Although renal infarction has been well studied and clearly defined, it remains greatly underdiagnosed, resulting in significant morbidity. Acute segmental renal infarction is a diagnosis even more problematic, as the problem can appear insidiously and masquerade as other entities including stone, infection, and even tumor. The clinical ...
Rangel A - - 1999
The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M ...
Ladwig Kh - - 1999
OBJECTIVES: The amount of perceived anginal pain in patients after infarction deserves the attention of the physician. This study sought to identify the modulating influence of extracardiac factors on persistent angina pectoris after myocardial infarction. METHODS AND RESULTS: A total of 552 male survivors of acute myocardial infarction (age 29 ...
Colon A J - - 1999
We retrospectively evaluated the significance of making a chest X-ray in the acute stage of a stroke. Forty percent of the chest X-rays were of suboptimal quality. Abnormal chest X-rays were, in part, the reason for consultation of chest specialists in 5%. A chest X-ray in patients with acute stroke ...
Muttreja Manoj R. - - 1999
We searched the medical literature for articles containing markers of cardiac ischemia and echocardiography in the evaluation of patients presenting to the emergency department to determine their combined clinical use. Several published articles indicate two-dimensional echocardiography is a useful and cost-effective imaging technique for the evaluation of patients with chest ...
Fu M - - 1999
Myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac pain is commonly attributed to contused myocardium or the traumatic injuries in the local chest wall. There are only scattered reports on the coronary pathology associated with MI secondary to blunt chest trauma. Because differentiation of ...
Banzo I - - 1999
Myocardial infarction is a rare complication that can occur after blunt chest trauma. The authors describe a 30-year-old man who experienced a fatal anterolateral myocardial infarction after chest trauma in a motorcycle accident. The electrocardiogram and creatine phosphokinase-MB isoenzymes levels suggested myocardial necrosis. Tc-99m phosphate myocardial scintigraphy identified an extensive ...
Kontos Michael C. - - 1999
Echocardiography is a valuable, noninvasive diagnostic tool that can provide information on systolic function and valvular abnormalities and can provide alternative explanations for causes of chest pain. Experimental as well as clinical studies have shown that wall motion abnormalities have a high sensitivity for predicting myocardial infarction. More recent studies, ...
Währborg P - - 1999
Calcitonin gene-related peptide (CGRP) and substance P co-exist in capsaicin-sensitive primary sensory neurons and are released from the myocardium after activation of sensory nerve fibres as well as by ischemia in animals. This study was undertaken to try to clarify the potential involvement of immunoreactive (ir) CGRP in anginal pain ...
Laudon D A DA Division of Emergency Medical Services and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, - - 1999
We sought to determine whether electron-beam computed tomography (EBCT) could be used as a triage tool in the emergency department for patients with angina-like chest pain, no known history of coronary disease, normal or indeterminate ECG findings, and normal initial cardiac enzyme concentrations. We conducted a prospective observational study of ...
Maron B J - - 1999
Not particularly well recognized are athletic field catastrophes in which virtually instantaneous cardiac arrest is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart (commotio cordis). To better characterize the clinical profile of this syndrome, we have assembled ...
Innami R - - 1999
A young Japanese woman who appeared to be free from any coronary risk factors was admitted to a local hospital with chest pain. Serological tests showed no evidence of inflammation; however, an electrocardiogram revealed diffuse myocardial ischemia and a coronary angiogram demonstrated isolated bilateral coronary ostial stenoses. Moreover, her serum ...
Azzopardi C - - 1999
The Churg-Strauss syndrome is characterised by a history of asthma and paranasal sinus disease, eosinophilia of more than 10 per cent, non-fixed pulmonary infiltrates on chest radiography and vasculitis which may affect multiple organ systems. The condition usually manifests in the 4th decade. We present a 21-year old female with ...
Sevre K - - 1999
Cardiovascular hyperreactivity to stress may be a risk factor for future cardiovascular events. In this study we hypothesized increased cardiovascular responses to a cold pressor test (CPT) in coronary patients admitted to hospital due to chest pain compared with patients admitted with chest pain with suspected, but not later confirmed, ...
Pitts W R - - 1998
Patients with left ventricular systolic dysfunction without chest pain or previous myocardial infarction are unlikely to have 3-vessel coronary artery disease and are very unlikely to have coronary anatomy suitable for bypass grafting. Of our 108 subjects, only 3 (3%) had 3-vessel coronary artery disease thought to be suitable for ...
Khan I A - - 1998
A young pre-menopausal non-drug-addict woman without risk factors for coronary artery disease suffered from a non-Q-wave acute myocardial infarction. She presented with epigastric pain and vomiting. Diagnosis of acute myocardial infarction was not suspected at first because of her young age and lack of risk factors. She was treated for ...
Panju A A AA Department of Medicine, McMaster University, Hamilton, Ontario, Canada. - - 1998
When faced with a patient with acute chest pain, clinicians must distinguish myocardial infarction (MI) from all other causes of acute chest pain. If MI is suspected, current therapeutic practice includes deciding whether to administer thrombolysis or primary percutaneous transluminal coronary angioplasty and whether to admit patients to a coronary ...
Dahlöf C G - - 1998
We investigate whether symptoms of pressure, tightness, and/or pain in the chest, neck, and/or throat after administration of the 5HT1B/1D agonist avitriptan were associated with objective impairment of the myocardial function on 12-lead electrocardiogram (ECG), continuous ECG (Holter) monitoring, and echocardiography. Migraine sufferers who in two-thirds of all attacks treated ...
Golby A J - - 1998
OBJECTIVE AND CLINICAL IMPORTANCE: We present a case of trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve. This is the first reported case of an unusual cause of trigeminal neuralgia. A 71-year-old man presented with severe lancinating pain in the left V1 and V2 ...
Nall K S - - 1998
A 28-year-old woman presented to the emergency department for evaluation of acute chest pain. She lacked risk factors for coronary artery disease and her initial electrocardiogram (ECG) was nondiagnostic. Within 45 minutes of presentation she developed nausea, vomiting, restrosternal chest pain, and ECG changes compatible with an acute inferoposterior myocardial ...
Komukai K - - 1998
A 72-year-old woman was admitted to our hospital for evaluation of chest pain. Coronary angiography showed a left coronary artery-left ventricle fistula. An acetylcholine provocation test induced vasoconstriction of the right but not the left coronary artery. Her chest pain was not relieved by combined therapy with isosorbide dinitrate, diltiazem ...
Tresch D D - - 1998
The majority of persons sustaining acute myocardial infarction are older, and in these older persons morbidity and mortality are high. Clinical presentations and characteristics are significantly different between older and younger infarction patients. Older infarction patients are more likely to be female and to have a history of heart failure, ...
Sakurai A - - 1998
A total of 502 patients presenting in Utsunomiya city and its suburbs during a 10-year period were studied to determine the clinical features of ischemic heart disease and to identify coronary risk factors. The male/female ratio was 1.21, but the ratio decreased with increasing age. The duration of chest pain ...
Vilke G M - - 1998
A 34-year-old woman presented to the emergency department 12 weeks postpartum with chest pain. An ECG indicated an acute myocardial infarction. The patient underwent cardiac catheterization with findings suggestive of coronary artery dissection later confirmed on intravascular ultrasonography. She underwent emergency coronary artery bypass grafting and has subsequently done well.
Char D M - - 1998
Biochemical markers of myocardial injury have evolved so that the diagnosis or exclusion of acute myocardial infarction can be determined within a short time with a high degree of sensitivity and specificity. The use of these markers in patients complaining of chest pain allows for medically appropriate and cost-effective triage ...
Chun J H - - 1998
Coronary artery injury after blunt chest trauma is very rare, but this can result in a serious acute myocardial infarction. Coronary artery dissection is an uncommon complication of thoracic injuries. We report a case of a 17-year-old male who was presented with an anterior myocardial infarction following blunt chest trauma ...
Chan W K - - 1998
Because acute myocardial infarction causes significant morbidity and mortality, a correct diagnosis in the accident and emergency department is important so that early treatment including thrombolytic therapy can be given. The aim of this study was to evaluate the reasons for missed diagnosis of acute myocardial infarction in the accident ...
Chambers J - - 1998
Gastroesophageal reflux is frequently found in patients with chest pain despite normal coronary anatomy, but little data on the effect of specific medication exist. After performing 24 h ambulatory pH monitoring and the Bernstein test on 23 patients with normal coronary anatomy, we gave omeprazole, 40 mg nocte, for six ...
Foussas S G - - 1998
The authors identified 160 men and women from all 3,700 patients with anginal pain between 1990 and 1994 who were subsequently found to have normal coronary arteries at diagnostic cardiac catheterization with follow-up to the present (mean follow-up 2.5 years). The group comprised 50 women and 110 men. Mean age ...
Mansour V M - - 1998
Patients with panic disorder often complain of angina-like chest pain during panic attacks, but this is not usually considered life-threatening. We describe three patients with panic disorder and documented cardiac ischaemia during episodes of chest pain. In two, it progressed to myocardial infarction. As none had atherosclerosis evident at coronary ...
Sarko J - - 1998
On a daily basis the emergency physician is faced with the difficult task of determining whether or not a patient with acute chest pain is sustaining an acute myocardial infarction. In most cases this is not a straightforward decision. Although observation units are being used more often for chest pain ...
Herlitz J - - 1998
AIM: To describe the mortality and mode of death over 5 years, and factors associated with death amongst patients with acute chest pain. PATIENTS: All patients who came to the emergency department at Sahlgrenska Hospital in Göteborg with acute chest pain or other symptoms raising suspicion of acute myocardial infarction ...
Babian M - - 1998
We report a case of combined small and large intestinal infarction caused by rheumatoid vasculitis in a 60-yr-old man who had a long history of rheumatoid arthritis and presented with abdominal pain and constipation. Eventually, he developed signs of peritonitis and underwent exploratory laparotomy and was found to have sigmoid ...
Miller T D - - 1998
BACKGROUND: There are limited data addressing the outcome of patients with normal or near normal myocardial perfusion during chest pain at rest. The purpose of this study was to determine the prognosis of patients with spontaneous chest pain, a normal or nondiagnostic electrocardiogram, no enzymatic evidence of myocardial infarction, and ...
Gregoratos Gabriel - - 1998
CHD is the major cause of morbidity and mortality in the elderly in the U.S. In this age group, the clinical presentation of CHD can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common whereas dyspnea as an anginal equivalent symptom ...
Miura J - - 1998
A 34-year-old female IDDM patient complained of chest oppression in hypoglycemic episodes and electrocardiograms revealed reversible ischemic changes occurring concomitantly with hypoglycemia. The ECG changes improved and the chest oppression disappeared following increasing blood glucose level by glucose intake. Master's double load test and treadmill load test were positive for ...
Lampe F C - - 1998
OBJECTIVE: To examine the prediction of major ischaemic heart disease events by questionnaire-assessed chest pain and other symptoms. DESIGN: Population-based prospective study. SUBJECTS: 7735 randomly selected men, aged 40-59 years at entry. METHODS: Symptoms and history of diagnosed ischaemic heart disease were ascertained by administered questionnaire at baseline. Follow-up was ...
Fesmire F M - - 1998
STUDY OBJECTIVE: To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain. METHODS: A ...
Svedjeholm R - - 1997
Here we report an unexpected and possibly overlooked cause of postoperative myocardial ischemia: a chest tube compressing a vein graft. After the position of the chest tube was adjusted, graft flow was reestablished, right ventricular contractility returned, and myocardial infarction was probably prevented. The literature on chest tube complications is ...
Perry R F - - 1997
Chest pain in the pediatric age group is a common presentation to the emergency department and rarely signifies underlying cardiopulmonary pathology. However, when chest pain occurs in association with symptoms such as dyspnea, diaphoresis, or syncope/near-syncope, a cardiac etiology must be urgently considered. We present the case of an otherwise ...
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