Document Detail

Detection of chest pain of non-cardiac origin at the emergency room by a new non-invasive device avoiding unnecessary admission to hospital.
MedLine Citation:
PMID:  15983083     Owner:  NLM     Status:  MEDLINE    
Recent advances in the treatment of acute coronary syndromes has raised awareness that prompt presentation for chest pain may be life saving. Most patients presenting with chest discomfort have a non-ischaemic ECG on presentation, but are routinely admitted to hospital because of diagnostic uncertainty for occult MI or ischaemia. We tested a new non-invasive device that measures central aortic pressure changes (dP/dtejc): an accepted index of myocardial performance that could be added to the diagnostic triage of ischaemia in the ER avoiding unnecessary admissions. We followed 85 patients presenting at the ER with acute chest pain. In 72 patients, negative ECG and myocardial enzyme dynamics ruled out coronary origin during the first 24 h after admission. In 8 of the 72 patients, coronary catheterisation found normal coronary arteries. In this group, average dP/dtejc was 163 (range 92-232). In 35 patients in whom the new non-invasive cardiac performance index dP/dtejc was above a threshold of >150, acute MI was ruled out. In 13 patients, acute chest pain had coronary origin confirmed by ECG and/or positive enzymes. The average dP/dtejc in this group was 117 (range 61-149). The dP/dtejc values were found to be significantly higher in patients without acute MI (p<0.001). Preliminary findings suggest that nearly 40% of patients presenting with acute chest pain could be spared the risks and costs of unnecessary hospital admission and more invasive cardiac testing by simply adding a easy to use, immediately obtained, test to the diagnostic protocol, and using a threshold of dP/dtejc>150 to rule out heart attack.
M Gorenberg; A Marmor; H Rotstein
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  22     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-28     Completed Date:  2005-08-18     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  486-9     Citation Subset:  IM    
Department of Nuclear Cardiology and Nuclear Medicine, Sieff Government Hospital, Safed, Israel.
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MeSH Terms
Aged, 80 and over
Aorta / physiopathology
Blood Pressure
Blood Pressure Determination / instrumentation*
Brachial Artery / physiopathology
Chest Pain / etiology*,  physiopathology
Diagnosis, Differential
Emergency Service, Hospital*
Middle Aged
Myocardial Contraction
Myocardial Ischemia / diagnosis*,  physiopathology
Triage / methods
Unnecessary Procedures

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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