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Chest Pain

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1. Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain (Abstract)

Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain A prospective observational study.The aim of this study was to show the effect of intra-articular (IA) thoracic facet joint (TFJ) steroid injection for the management of TFJ pain, and to compare it with the effect of therapeutic thoracic medial branch block (MBB) with a local anesthetic and steroid.Several studies have shown the effects (...) of thoracic MBB with local anesthetics with or without steroids and radiofrequency neurotomy in managing TFJ pain, but thus far, the effectiveness of IA TFJ steroid injection has not been studied.Forty patients with TFJ pain were recruited and randomly assigned to one of two groups, the IA steroid injection and the MBB group, each with 20 patients. For IA TFJ steroid injection and therapeutic MBB, we injected 0.5 mL of 0.5% bupivacaine, mixed with 10 mg (0.25 mL) of dexamethasone. We assessed the severity

2018 EvidenceUpdates

2. Assessment of chest pain

-elevation myocardial infarction, and non-ST-elevation myocardial infarction, may not be the most common aetiology in patients presenting with chest pain, but excluding ACS is vital because of the mortality associated with untreated myocardial infarction. This topic concentrates on the assessment of acute chest pain in the emergency setting. Differentials Acute coronary syndrome Stable angina Pneumonia Viral pleuritis GORD Costochondritis Anxiety or panic disorder Pulmonary embolism Pericarditis Cardiac (...) Assessment of chest pain Assessment of chest pain - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of chest pain Last reviewed: February 2019 Last updated: December 2018 Summary Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the US per year. Rui P, Kang K; Centers for Disease Control and Prevention, National Center for Health Statistics

2018 BMJ Best Practice

3. Assessment of chest pain

-elevation myocardial infarction, and non-ST-elevation myocardial infarction, may not be the most common aetiology in patients presenting with chest pain, but excluding ACS is vital because of the mortality associated with untreated myocardial infarction. This topic concentrates on the assessment of acute chest pain in the emergency setting. Differentials Acute coronary syndrome Stable angina Pneumonia Viral pleuritis GORD Costochondritis Anxiety or panic disorder Pulmonary embolism Pericarditis Cardiac (...) Assessment of chest pain Assessment of chest pain - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of chest pain Last reviewed: February 2019 Last updated: December 2018 Summary Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the US per year. Rui P, Kang K; Centers for Disease Control and Prevention, National Center for Health Statistics

2018 BMJ Best Practice

4. Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey. Full Text available with Trip Pro

Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey. Little is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa.A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all (...) possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain.Of 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified 'heart attack' as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were

2019 PLoS ONE

6. What Is the Utility of Coronary Computed Tomography Angiography Compared With Standard of Care for the Evaluation of Acute Chest Pain? (SRS diagnosis)

and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157. 3. Marwick TH, Cho I, Ó Hartaigh B, et al. Finding the gatekeeper to the cardiac catheterization laboratory: coronary CT angiography or stress testing? J Am Coll Cardiol. 2015;65:2747-2756. 4. Radecki RP. CT coronary angiography: new risks for low-risk chest pain. Emerg Med J. 2013;30:856 (...) What Is the Utility of Coronary Computed Tomography Angiography Compared With Standard of Care for the Evaluation of Acute Chest Pain? (SRS diagnosis) TAKE-HOME MESSAGE Compared with existing standards of care for the evaluation of acute chest pain, coronary computed tomography (CT) angiography is associated with similar rates of major adverse events, but higher rates of revascularization. What Is the Utility of Coronary Computed Tomography Angiography Compared With Standard of Care

2018 Annals of Emergency Medicine Systematic Review Snapshots

7. Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain. Full Text available with Trip Pro

Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain. The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain.Seventeen subjects (...) with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior.The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls

2019 Pain Medicine

8. Are beta blockers safe to use in cocaine-related chest pain?

Are beta blockers safe to use in cocaine-related chest pain? Chiefs’ Inquiry Corner – 8/26/19 – Clinical Correlations Search Chiefs’ Inquiry Corner – 8/26/19 August 26, 2019 2 min read The classic teaching that beta blockers should be avoided in patients who actively use cocaine is a subject of debate. There is the theoretical risk of “unopposed alpha effect” which is based on very small human studies, case reports, and some small animal studies. For example, there are only two prospective (...) trials that evaluated a total of 19 participants and showed conflicting results. Studies that support the safe use of beta blockers in people who use cocaine are based on several retrospective studies that are not without its flaws. As such, the use of beta blockers in people who actively use cocaine remains controversial, and dependent on local practice preferences. References: Pulmonary edema is one of several processes that widen intralobular septa and create a B-line pattern on lung ultrasound

2019 Clinical Correlations

9. Stressed out about stress testing? The utility of stress testing after non-ACS chest pain Full Text available with Trip Pro

Stressed out about stress testing? The utility of stress testing after non-ACS chest pain Stressed out about stress testing? The utility of stress testing after non-ACS chest pain - CanadiEM Stressed out about stress testing? The utility of stress testing after non-ACS chest pain In by Vivian Tam October 15, 2019 The Case Your next patient in the acute zone of the ED is Mr. Liu, a 53-year old man presenting with one hour of acute onset atypical chest pain. He has several risk factors (...) ​ A review of the evidence on stress testing A recent disputed the commonly cited 2% ACS miss rate after ED discharge. ​4​ In the Pope et al . study, of the 10,689 patients presenting with undifferentiated chest pain, 889 patients had acute MI. ​5​ Nineteen of the confirmed MI patients were mistakenly discharged. Therefore, of all patients presenting to the ED with undifferentiated chest pain, less than 0.2% were missed (whereas the 2% figure is derived from the 19 missed MIs of the 889 patients

2019 CandiEM

10. Chest Pain – Possible Acute Coronary Syndrome

likelihood for coronary artery disease, in the absence of cardiac enzyme elevation and ischemic ST changes. ??? X-ray chest 5 This procedure is primarily a survey for noncardiac etiologies of chest pain. ? CT chest with IV contrast 5 This procedure is primarily for noncardiac etiologies such as pulmonary embolism and aortic dissection. ??? MRI heart function with stress without and with IV contrast 5 For this procedure there is limited experience in the clinical setting and lack of availability. O MRI (...) ; Christopher M. Kramer, MD 7 ; Rajesh Krishnamurthy, MD 8 ; Archana T. Laroia, MD 9 ; Amar B. Shah, MD 10 ; Jens Vogel-Claussen, MD 11 ; Richard D. White, MD 12 ; Pamela K. Woodard, MD. 13 Summary of Literature Review Introduction/Background Acute chest pain is a frequent presenting complaint in emergency departments. Along with other important disease entities such as aortic dissection and pulmonary embolus, such patient symptoms may question the possibility of acute myocardial ischemia. Acute coronary

2019 American College of Radiology

11. Changes in spinal stiffness with chronic thoracic pain: Correlation with pain and muscle activity. Full Text available with Trip Pro

Changes in spinal stiffness with chronic thoracic pain: Correlation with pain and muscle activity. The objective was to compare thoracic spinal stiffness between healthy participants and participants with chronic thoracic pain and to explore the associations between spinal stiffness, pain and muscle activity. The reliability of spinal stiffness was also evaluated.Spinal stiffness was assessed from T5 to T8 using a mechanical device in 25 healthy participants and 50 participants with chronic (...) thoracic pain (symptoms had to be reported within the evaluated region of the back). The spinal levels for which spinal stiffness was measured were standardized (i.e. T5 to T8 for all participants) to minimize between-individual variations due to the evaluation of different spinal levels. The device load and displacement data were used to calculate the global and terminal spinal stiffness coefficients at each spinal level. Immediately after each assessment, participants were asked to rate their pain

2018 PLoS ONE

12. Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention (Abstract)

Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain.To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture (...) on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS.A randomized prospective double-blinded trial.Assiut University Hospitals, Orman Cardiology Hospital.Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough

2019 EvidenceUpdates

13. Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial Full Text available with Trip Pro

Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants (...) with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week).Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control

2019 EvidenceUpdates

14. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Full Text available with Trip Pro

Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. This review is an update of a review first published in Issue 2, 2003, which was substantially updated in Issue 7, 2010. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies (...) use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain or by minimally invasive procedures using thermal or laser interruption.To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain, including complex regional pain syndrome. Sympathectomy may be compared with placebo (sham

2013 Cochrane

15. Does This Patient With Chest Pain Have Acute Coronary Syndrome? Full Text available with Trip Pro

Does This Patient With Chest Pain Have Acute Coronary Syndrome? Does This Patient With Chest Pain Have Acute Coronary Syndrome? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 70, Issue 1, Pages 44–45 Does This Patient With Chest Pain Have Acute Coronary Syndrome? x Sameer Sharif , MD (EBEM Commentator) , x Suneel Upadhye , MD, MSc (EBEM Commentator) Department of Medicine, McMaster University (...) /CSANZ rule Low to intermediate risk 0.24 (0.19–0.31) 10 Low CI , Confidence interval; HFA/CSANZ, Heart Foundation of Australia/Cardiac Society of Australia and New Zealand. Summary LR from studies that report original data at each threshold without combining across clinical decision rule thresholds. Table 2 Performance of select cardiac risk factors, chest pain characteristics, physical examination elements, and ECG findings in diagnosing acute coronary syndrome. Test No. of Studies No. of Patients

2017 Annals of Emergency Medicine Systematic Review Snapshots

16. Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease

Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Revised 2018 ACR Appropriateness Criteria ® 1 Chronic Chest Pain–Noncardiac Etiology Unlikely American College of Radiology ACR Appropriateness Criteria ® Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Variant 1: Chronic chest pain, noncardiac etiology unlikely: low to intermediate probability of coronary artery disease. Initial (...) chest without and with IV contrast Usually Not Appropriate ??? CT chest without IV contrast Usually Not Appropriate ??? Tc-99m SPECT/CT MPI rest only Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 Chronic Chest Pain–Noncardiac Etiology Unlikely CHRONIC CHEST PAIN-NONCARDIAC ETIOLOGY UNLIKELY: LOW TO INTERMEDIATE PROBABILITY OF CORONARY ARTERY DISEASE Expert Panel on Cardiac Imaging: Amar B. Shah, MD a ; Jacobo Kirsch, MD b ; Michael A. Bolen, MD c ; Juan C. Batlle, MD d ; Richard K. J

2018 American College of Radiology

17. Interventional Pain Treatments in the Management of Oncologic Patients With Thoracic Spinal Tumor-Related Pain: A Case Series. (Abstract)

Interventional Pain Treatments in the Management of Oncologic Patients With Thoracic Spinal Tumor-Related Pain: A Case Series. Advanced tumors of the thoracic spine are difficult to treat and can lead to complex pain syndromes. Following conventional oncologic treatments, pharmacologic therapy may be insufficient to manage pain. Minimally invasive interventional procedures offer alternatives to treat malignant thoracic spinal pain.Thirteen patients with metastatic disease and poorly controlled (...) thoracic axial and/or radicular pain were identified via a retrospective chart review. Patients were either treated with radiation, surgery, chemotherapy, or a combination of these. Then, the patients were organized into groups based on their diagnoses, anatomical disease locations, symptoms, prior treatments, and interventional pain procedures offered.All cases of intercostal nerve, costotransverse junction, erector spinae plane, and paravertebral blocks resulted in pain relief without any reported

2019 Pain Practice

18. ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain. Full Text available with Trip Pro

ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain. Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing (...) equity.A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients. Three hundred thirty-four participants with symptoms and findings indicating intermediate to high risk for acute coronary syndrome were enrolled in 3 clinical trials. Major

2019 Critical Pathways in Cardiology Controlled trial quality: uncertain

19. The Effectiveness of an Evidence-Based Pain Management Program on Pain Intensity and Chest Rehabilitation Improvement Among Chest Trauma Patients in a Thai Hospital. (Abstract)

The Effectiveness of an Evidence-Based Pain Management Program on Pain Intensity and Chest Rehabilitation Improvement Among Chest Trauma Patients in a Thai Hospital. Pain after thoracic injury has further profound impacts on patients resulting in increased length of hospital stay and hospital care cost, and decreased quality of life. Utilization of the cutting-edge evidence on pain management that fits with the individual care context is therefore important.To examine the effects (...) of an evidenced-based pain management program on the worst pain intensity and lung vital capacity among acutely ill hospitalized chest trauma patients.A two-group repeated measures design.trauma unit, a university hospital in southern Thailand.42 chest trauma patients.The study population included 42 chest trauma patients admitted to the trauma unit. Twenty-one eligible chest trauma patients were consecutively assigned into intervention and control groups. The impacts of the intervention on the level

2019 Pain management nursing : official journal of the American Society of Pain Management Nurses Controlled trial quality: uncertain

20. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) Full Text available with Trip Pro

Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing.In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation (...) of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA). Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. The primary end point was death, myocardial infarction, or unstable angina hospitalizations over

2017 EvidenceUpdates

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