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Coronary Risk Stratification of Chest Pain

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281. Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features. (Abstract)

a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated.A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary (...) patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079-0.115%) (one of 1027 patients).Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

2014 Emergency medicine Australasia

282. Heart Rate Variability as a Predictor of Ischemic Heart Disease

of this proposal is to collect heart rate variability data on patients admitted to the emergency department with chest pain. The intent is to measure the association between heart rate variability and the various risk stratification scoring systems for chest pain. Condition or disease Intervention/treatment Acute Coronary Syndrome Other: Heart rate variability Detailed Description: Identification of patients who are at highest risk for heart attack is an important task for emergency medicine physicians (...) : Groups and Cohorts Go to Group/Cohort Intervention/treatment Chest pain patients All patients who present to the ED with chest pain. Other: Heart rate variability All patients have a 10-minute recording analyzed for indices of heart rate variability. Outcome Measures Go to Primary Outcome Measures : Major adverse cardiac events [ Time Frame: 30 days ] Secondary Outcome Measures : HEART score [ Time Frame: 1 day ] Coronary heart disease risk factors [ Time Frame: 1 day ] Eligibility Criteria Go

2016 Clinical Trials

283. Chest Pain

, Precordial Pain From Related Chapters II. Risk Factors See s See III. Epidemiology Acute and Chest Pain are the two most commonly litigated ED claims IV. Precautions No single finding is absolutely pathognomonic nor completely reassuring in Chest Pain presentation Risk stratification, evaluation and management is based on an overall analysis of all clinical data Approach should be based on combination of factors Exam, ekg and s Consider atypical presentations of coronary syndromes in atypical patients (...) (diagnosis) , chest pain , Pain chest , Pain in chest , Thoracic pain , Thorax pain , Chest pain NOS , Nonspecific chest pain , Chest Pain [Disease/Finding] , Pain;chest , pain thoracic , thoracic pain , thorax pain , Pain, Chest , [D]Chest pain (situation) , [D]Chest pain, unspecified (situation) , Chest pain NOS (finding) , [D]Chest pain NOS (situation) , Thorax painful , chest pain or discomfort reported as pain , chest pain or discomfort reported as pain (symptom) , reported chest pain , thoracodynia

2015 FP Notebook

284. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department Full Text available with Trip Pro

Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department The HEART score serves risk stratification of chest pain patients at the emergency department (ED). Quicker and more solid decisions may be taken in these patients with application of this score. An analysis of medical consumption of 122 acute chest pain patients admitted before the introduction of this score may be indicative of possible savings.Numbers (...) of cardiology investigations and clinical admission days were counted. Charged cost of medicine was divided into three categories: ED, in-hospital, and outpatient clinic.The total cost of care was 469,631, with an average of 3849 per patient. Seventy-five percent of this cost was due to hospitalisation under the initial working diagnosis of acute coronary syndrome (ACS). This diagnosis was confirmed in only 29/122 (24 %) of the patients. The low-risk group (41 patients with HEART scores 0-3

2012 Netherlands Heart Journal

285. Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography

Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached (...) the maximum number of saved studies (100). Please remove one or more studies before adding more. Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography (ESCORT) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01416532 Recruitment

2011 Clinical Trials

286. Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Full Text available with Trip Pro

Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed.To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes.Ongoing prospective population-based (...) %) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001).Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA

2015 Annals of Internal Medicine

287. Cocaine-Induced Coronary Vasospasm

Coronary Vasospasm Cocaine-Induced Coronary Vasospasm Aka: Cocaine-Induced Coronary Vasospasm , Cocaine and Chest Pain , Cocaine Abuse Cardiovascular Effects , Acute Coronary Syndrome due to Cocaine From Related Chapters II. Epidemiology contributes to nonfatal MI in 25% of patients <45 years old III. Pathophysiology increased risk MI increases to 24 fold over baseline Risk increases within first hour of use and persists for 4-7 hours Acute: Strong effects Tachyarrhythmias Coronary vasospasm (...) patients emergently to PCI lab is common -induced tends to occur in younger patients risk Concurrent substance use further increases the risk (e.g. ) may be difficult to differentiate with Aberrancy is more common, but cannot exclude VIII. Evaluation: Chest Pain See Obtain , , and labs as with typical chest Acute use and Extend rule-out period of serial , monitoring to 12 hours regardless of risk score ing is not typically needed (unless other indications) Chronic use, but did not precede current

2018 FP Notebook

288. Cardiac Rehabilitation

programs Dean Ornish Program for Reversing Heart Disease Pritikin Intensive Cardiac Rehab Program Benson-Henry Institute Cardiac Wellness Program Phase I Cardiac Rehabilitation (during hospitalization for acute event or procedure) Supervised, structured early Risk stratification (low level, graded, tolerance testing) Phase II Cardiac Rehabilitation (Early Outpatient) Supervised program Reassess symptom-limited tolerance Custom tailored for 30 minutes daily and 5 days weekly Monitoring of , pulse (...) have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include Chest discomfort - pressure, squeezing, or pain Shortness of breath Discomfort in the upper body - arms, shoulder, neck, back Nausea, vomiting, dizziness, lightheadedness, sweating These symptoms can sometimes be different in . What exactly is a heart attack? Most heart attacks happen when a in the coronary

2018 FP Notebook

289. Cocaine-Induced Coronary Vasospasm

Coronary Vasospasm Cocaine-Induced Coronary Vasospasm Aka: Cocaine-Induced Coronary Vasospasm , Cocaine and Chest Pain , Cocaine Abuse Cardiovascular Effects , Acute Coronary Syndrome due to Cocaine From Related Chapters II. Epidemiology contributes to nonfatal MI in 25% of patients <45 years old III. Pathophysiology increased risk MI increases to 24 fold over baseline Risk increases within first hour of use and persists for 4-7 hours Acute: Strong effects Tachyarrhythmias Coronary vasospasm (...) patients emergently to PCI lab is common -induced tends to occur in younger patients risk Concurrent substance use further increases the risk (e.g. ) may be difficult to differentiate with Aberrancy is more common, but cannot exclude VIII. Evaluation: Chest Pain See Obtain , , and labs as with typical chest Acute use and Extend rule-out period of serial , monitoring to 12 hours regardless of risk score ing is not typically needed (unless other indications) Chronic use, but did not precede current

2018 FP Notebook

290. Examining Renal Impairment as a Risk Factor for Acute Coronary Syndrome: A Prospective Observational Study. (Abstract)

after controlling for age, sex, hypertension, dyslipidemia, family history of cardiac disease, diabetes, patient history of cardiac disease, cardiac troponin level, and ECG findings.There is an independent association between eGFR and acute coronary syndrome risk in patients presenting to the ED with chest pain; this association is independent of age, traditional cardiac risk factors, medical history, troponin level, and ECG findings. Reduced eGFR should be considered an acute coronary syndrome risk (...) Examining Renal Impairment as a Risk Factor for Acute Coronary Syndrome: A Prospective Observational Study. This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain.We used prospectively collected data on adult patients presenting with suspected acute coronary syndrome to 2 EDs in Australia and New

2013 Annals of Emergency Medicine

291. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Full Text available with Trip Pro

of blood cholesterol levels to reduce ASCVD risk. For this guideline, ASCVD includes coronary heart disease (CHD), stroke, and peripheral arterial disease, all of presumed atherosclerotic origin. These recommendations are intended to provide a strong, evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men. Because RCT data were used to identify those most likely to benefit from cholesterol-lowering statin therapy (...) January 2019 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Open Access article Share on Jump to Open Access article 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines , MD, MACP, FAHA, FACC , MD, MPH, FAHA , DSc, FAHA , MD, FAHA, FACC , MD, FAHA , MD, FAHA , MD, FACP, FAHA , MD

2013 American Heart Association

292. Moderate Risk Acute Coronary Syndrome Management

based) ( ) or NSTEMI ST Depression >1 mm Symmetrical T-wave inversion in precordial leads (>0.2 mV) Dynamic ST segment and changes with pain Less interpretable EKG findings increasing risk that has cardiac origin s Paced Rhythm VI. Imaging: Echocardiogram may assist in risk stratification of a patient with active Most helpful if completely normal Helpful also if significantly abnormal with wall motion abnormality (unless prior MI in the same region) VII. Labs: Serum Troponin Serum at presentation (...) Moderate Risk Acute Coronary Syndrome Management Moderate Risk Acute Coronary Syndrome Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2015 FP Notebook

293. Low Risk Acute Coronary Syndrome Management

4 Low Risk Acute Coronary Syndrome Management Low Risk Acute Coronary Syndrome Management Aka: Low Risk Acute Coronary Syndrome Management , Non-diagnostic Electrocardiogram Protocol , Non-diagnostic EKG Protocol , Atypical Chest Pain , Low Risk Chest Pain From Related Chapters II. Indications: Electrocardiogram (EKG) suggestive of Low Risk Chest Pain Normal or unchanged ST Depression 0.5 to 1.0 mm inversion (<0.2 mV) or flattening Leads with dominant III. Contraindications: Moderate Risk (...) vigilence but may not absolutely contraindicate following the low risk protocol (especially if longstanding >10 years or uncontrolled) Typical (central, heavy, crushing, pressure or squeezing pain) Especially if associated with , diaphoresis, or Higher risk presentation than Atypical Chest Pain (sharp, localized or lateral ) IV. Labs: Cardiac Biomarkers (i.e. Troponin) Highly sensitive s sufficiently sensitive to replace all other biomarkers (e.g. , Myoglobin, CRP) Decision rules are used by accelerated

2015 FP Notebook

294. Risk stratification of patients suspected of coronary artery disease: Comparison of five different models. (Abstract)

Risk stratification of patients suspected of coronary artery disease: Comparison of five different models. To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris.Retrospective cohort for creation of CORSCORE by means of logistic regression analysis. Prospective (...) cohort for validation of the five risk models using receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Significant CAD was defined as lumen area diameter reduction ≥50% at coronary angiography. All risk models include information on age, sex, and symptoms. In addition the Duke, Morise, and CORSCORE models include information on tobacco use and hypercholesterolemia. Duke and Morise also include information

2011 Atherosclerosis

295. Adenosine Stress Cardiovascular Magnetic Resonance–Observation Unit Management of Patients at Intermediate Risk for Acute Coronary Syndrome: A Possible Strategy for Reducing Healthcare-Related Costs Full Text available with Trip Pro

) indicative of ACS. As a consequence of existing co-morbidities, their management becomes time-consuming and may require inpatient monitoring, observation, and cardiac stress testing. Cardiovascular magnetic resonance (CMR) is a powerful tool for risk stratification and prognosis determination in patients in need of stress testing at intermediate risk of ACS. For those who present with acute chest pain syndromes, the combination of CMR in an OU setting represents a potentially attractive option (...) Adenosine Stress Cardiovascular Magnetic Resonance–Observation Unit Management of Patients at Intermediate Risk for Acute Coronary Syndrome: A Possible Strategy for Reducing Healthcare-Related Costs Although clear algorithms for diagnosis and treatment of patients with chest pain at low or high risk for an acute coronary syndrome (ACS) exist, they are less well delineated for patients presenting with chest pain with an intermediate risk for ACS. In patients presenting acutely or subacutely

2012 Current Treatment Options in Cardiovascular Medicine

296. Inclusion of stroke in cardiovascular risk prediction instruments

instruments,moreover,isappropriatebecauseoftheimpactofstrokeonmorbidityandmortality,thesimilarityofmany approaches to prevention of stroke and these other forms of vascular disease, and the importance of stroke relative to coronary disease in some subpopulations. Non-US guidelines often include stroke patients among others at high cardiovascular risk and include stroke as a relevant outcome along with cardiac end points. Conclusions—Patients with atherosclerotic stroke should be included among those (...) of cardiovascular disease, because the number of patients considered to be at high risk would grow substantially. (Stroke. 2012;43:1998-2027.) Key Words: AHA Scientific Statements cardiovascular disease risk assessment risk prediction stroke vascular disease E stimation of absolute risk of coronary heart disease (CHD), and cardiovascular disease (CVD) more gener- ally, is a critical component in primary and secondary prevention of CVD and in the management of comorbid conditions. Treatment strategies

2012 American Academy of Neurology

297. SNAP: a population health guide to behavioural risk factors in general practice

of height in metres. BMI on its own may be misleading especially in older people and muscular individuals and classifications may need to be adjusted for some ethnic groups. 29 People who are overweight have a higher risk of disease including coronary heart disease (CHD), diabetes, dyslipidaemia, hypertension, and bone and joint disorders. The presence of excess fat in the abdomen is an independent predictor of morbidity. The patient’s motivation to lose weight should be assessed to better target advice (...) . 43 The health risks of moderate intensity physical activity are low. Physical activity reduces morbidity and mortality from diabetes even without weight reduction. 45 However, certain conditions place patients at higher risk and require clinical assessment and supervision. These include: • unstable angina • recent complicated myocardial infarction (within 3 months) • untreated heart failure or cardiomyopathy • resting heart rate >100 • symptoms such as chest discomfort or shortness of breath

2014 The Royal Australian College of General Practitioners

298. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease Full Text available with Trip Pro

, asymptomatic patients, cardiac magnetic resonance (CMR), cardiac rehabilitation, chest pain, chronic angina, chronic coronary occlusions, chronic ischemic heart disease (IHD), chronic total occlusion, connective tissue disease, coronary artery bypass graft (CABG) versus medical therapy, coronary artery disease (CAD) and exercise, coronary calcium scanning, cardiac/coronary computed tomography angiography (CCTA), CMR angiography, CMR imaging, coronary stenosis, death, depression, detection of CAD (...) stable angina or low-risk UA are addressed in the present guideline. When patients with documented IHD develop recurrent chest pain, the symptoms still could be attributable to another condition. Such patients are included in this guideline if there is sufficient suspicion that their heart disease is a likely source of symptoms to warrant cardiac evaluation. If the evaluation demonstrates that IHD is unlikely to cause the symptoms, the evaluation of noncardiac causes is beyond the scope

2011 American Heart Association

299. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention Full Text available with Trip Pro

, stable ischemic heart disease; STEMI, ST-elevation myocardial infarction; STS, Society of Thoracic Surgeons; SYNTAX, Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery; TIMI, Thrombolysis in Myocardial Infarction; UA/NSTEMI, unstable angina/non–ST-elevation myocardial infarction; UPLM, unprotected left main disease; and VT, ventricular tachycardia. Table 3. Revascularization to Improve Symptoms With Significant Anatomic (≥50% Left Main or ≥70% Non–Left Main CAD (...) used in RCTs , often involves a multidisciplinary approach referred to as the Heart Team. Composed of an interventional cardiologist and a cardiac surgeon, the Heart Team 1) reviews the patient's medical condition and coronary anatomy, 2) determines that PCI and/or CABG are technically feasible and reasonable, and 3) discusses revascularization options with the patient before a treatment strategy is selected. Support for using a Heart Team approach comes from reports that patients with complex CAD

2011 American Heart Association

300. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery ACCF/AHA Practice Guideline 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons WRITING COMMITTEE MEMBERS* L. David Hillis, MD, FACC, Chair (...) : Recommendations .e696 6.5. Patients With Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency: Recommendations .e696 6.6. Patients With End-Stage Renal Disease on Dialysis: Recommendations .e697 6.7. Patients With Concomitant Valvular Disease: Recommendations .e697 6.8. Patients With Previous Cardiac Surgery: Recommendation .e697 6.8.1. Indications for Repeat CABG .e697 6.8.2. Operative Risk .e698 6.8.3. Long-Term Outcomes .e698 6.9. Patients With Previous Stroke .e698 6.10. Patients With PAD .e698

2011 American Heart Association

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