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Coronary Risk Stratification of Chest Pain

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81. Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). Full Text available with Trip Pro

Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). Current models incompletely risk-stratify patients with acute chest pain. In this study, N-terminal pro-B-type natriuretic peptide and cystatin C were incorporated into a contemporary chest pain triage algorithm in a clinically stratified population to improve acute coronary syndrome discrimination. Adult patients with chest pain presenting without myocardial infarction (n = 382) were prospectively enrolled from (...) 2008 to 2009. After clinical risk stratification, N-terminal pro-B-type natriuretic peptide and cystatin C were measured and standard care was performed. The primary end point was the result of a clinical stress test. The secondary end point was any major adverse cardiac event at 6 months. Associations were determined through multivariate stratified analyses. In the low-risk group, 76 of 78 patients with normal levels of the 2 biomarkers had normal stress test results (negative predictive value 97

2012 American Journal of Cardiology

82. Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit. (Abstract)

Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit. The Thrombolysis in Myocardial Infarction (TIMI) score has shown use in predicting 30-day and 1-year outcomes in emergency department (ED) patients with potential acute coronary syndrome. Few studies have evaluated the TIMI score in risk stratifying patients selected for the ED observation Unit (EDOU). Risk stratification (...) (5). Risk of composite outcome increased by score: 0 (1%), 1 (2.6%), 2 (2.1%), 3 (6.9%), 4 (11.1%), and 5 (20%). Those with an intermediate risk score (3-5) were also more likely to require admission (15.4% vs 9.8%, P = .048).The TIMI risk score may serve as an effective risk stratification tool among chest pain patients selected for EDOU placement. Patients with intermediate-risk by TIMI may be considered for inpatient admission and/or more aggressive evaluation and therapy.Copyright © 2013

2012 American Journal of Emergency Medicine

83. Chest pain: coronary CT in the ER Full Text available with Trip Pro

Chest pain: coronary CT in the ER Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without (...) imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection

2016 The British journal of radiology

84. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals Full Text available with Trip Pro

and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic (...) The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain

2016 Acta Cardiologica Sinica

85. CT coronary angiographic evaluation of suspected anginal chest pain. (Abstract)

. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac (...) CT coronary angiographic evaluation of suspected anginal chest pain. Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD

2016 Heart

86. The association of electrocardiographic abnormalities and major adverse cardiac events in emergency patients with chest pain. Full Text available with Trip Pro

The association of electrocardiographic abnormalities and major adverse cardiac events in emergency patients with chest pain. The electrocardiograph (ECG) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome (ACS). A six-point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department (ED) with suspected ACS. We set out to evaluate the efficacy (...) of these criteria in identifying patients with major adverse cardiac events (MACE), Type 1 myocardial infarction (T1MI), Type 2 myocardial infarction (T2MI), and 1-year mortality in a cohort of emergency patients with chest pain.This was an analysis of data from 2,349 patients who presented to the ED with chest pain between 2008 and 2013. Data were collected as part of two prospective trials. ECGs were recorded at presentation and categorized according to the six-point criteria by local cardiologists blinded

2016 Academic Emergency Medicine

87. Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain. Full Text available with Trip Pro

classified as high risk by the ED physician, but low risk by the cardiologist.There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.Copyright © 2016 Elsevier Inc. All rights reserved. (...) concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were

2016 American Journal of Emergency Medicine

88. The HEART score with high-sensitive troponin T at presentation: ruling out patients with chest pain in the emergency room. (Abstract)

The HEART score with high-sensitive troponin T at presentation: ruling out patients with chest pain in the emergency room. The HEART score is a simple scoring system, ranging from 0 to 10, specifically developed for risk stratification of patients with undifferentiated chest pain. It has been validated for the conventional troponin, but not for high-sensitive troponin. We assess a modified version of the HEART score using a single high-sensitivity troponin T dosage at presentation, regardless (...) of symptom duration, and with different ECG criteria to evaluate if the patients with a low HEART score could be safely discharged early. The secondary aim was to confirm a statistically significant difference in each HEART score group (low 0-3, intermediate 4-6, high 7-10) in the occurrence of major adverse cardiac events at 30 and 180 days. We retrospectively analyzed the HEART score of 1597 consecutive patients admitted to the Emergency Department of our Hospital for chest pain between January 1

2016 Internal and emergency medicine

89. CCS/CTS Position Statement on Pulmonary Hypertension Full Text available with Trip Pro

features such as functional class, 6-minute walk test distance, brain natriuretic peptide levels, and cardiac index helps to prognosticate at the time of diagnosis and is essential to guide management and follow-up ( ). In this section we discuss specific issues surrounding the management of PAH followed by a brief discussion of management of PH due to left heart and lung disease. Table 3 Measures to consider in risk stratification of pulmonary arterial hypertension patients Parameter Low risk (...) . This document is targeted at clinicians and describes a framework for screening and diagnosis of PH, with recommendations for performance and interpretation of echocardiography, cardiac magnetic resonance imaging, and right heart catheterization. In addition, the current approach to PAH management in Canada including risk stratification and pharmacologic therapy aimed at achieving a low-risk profile is discussed. The rationale to avoid specific PAH therapy in patients with left heart disease and lung

2020 Canadian Cardiovascular Society

90. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui Full Text available with Trip Pro

Heart failure ACCF/AHA 2017 2016, and 2013 Valvular heart disease AHA/ACC 2017 and 2014 Supraventricular tachycardia ACC/AHA/HRS 2015 Ventricular arrhythmias and the prevention of sudden cardiac death ESC 2015 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care AHA 2015 Atrial fibrillation AHA/ACC/HRS 2014 Non–ST-elevation acute coronary syndromes AHA/ACC 2014 Assessment of cardiovascular risk ACC/AHA 2013 ST-elevation myocardial infarction ACCF/AHA 2013 Acute myocardial (...) -effectiveness ratio; QALY, quality-adjusted life-years; and WHO-CHOICE, World Health Organization Choosing Interventions that are Cost-Effective. Reproduced from Anderson, et al. 1.2. Organization of the Writing Committee The writing committee consisted of cardiac electrophysiologists (including those specialized in pediatrics), general adult and pediatric cardiologists (including those specialized in critical care and acute coronary syndromes [ACS], genetic cardiology, heart failure, and cost-effectiveness

2017 American Heart Association

91. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

factors can be targeted for preventive intervention. A s survival to adulthood in individuals with congenital heart disease (CHD) has improved, adults with CHD are increasingly at risk for noncardiac com- plications. 1,2 The median age of adults with CHD has increased to 40 years, and the number of adults with CHD >65 years of age is steadily growing. 3–5 As pa- tients age, common adult comorbidities such as diabetes mellitus (DM), coronary artery disease, and hypertension may have an impact on long (...) conditions with congestive heart failure states (im- paired cardiac output and increased central venous pressure) but also likely causes the same neurohor- monal dysregulation that has untoward effects on the kidney. 36,37 Patients with CHD also have unique risk fac- tors for developing renal dysfunction that occur with cardiac surgery and cardiopulmonary bypass. 38–40 Car- diovascular surgery and cardiopulmonary bypass may limit renal blood flow, causing hypoxemic-ischemic injury, and are known

2017 American Heart Association

92. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

Cardiac Arrest . . . . . . . . . . . . . . e468 19. Subclinical Atherosclerosis . . . . . . . . . . . . e487 20. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris. . . . . . . . . . e505 21. Cardiomyopathy and Heart Failure . . . . . . . . e523 22. Valvular Diseases . . . . . . . . . . . . . . . . e539 23. Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension. . . e548 24. Peripheral Artery Disease and Aortic (...) Cardiac Arrest (Chapter 18) • In the 2015 CARES (Cardiac Arrest Registry to Enhance Survival) National Survival Report for emergency medical services–treated nontrau- matic cardiac arrest, the survival rate to hospital discharge was 10.6% for adults >18 years old, 23.5% for children 13 to 18 years old, 16.6% for children >1 to 12 years old, and 6.2% for children 0. • Coronary artery calcium scores >400 versus 0 are associated with an increased risk for can- cer, chronic kidney disease, pneumonia

2017 American Heart Association

93. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society Full Text available with Trip Pro

dissection, stroke/TIA, cerebral hemorrhage, or significant anemia requiring blood transfusion. AVB indicates atrioventricular block; BBB, bundle-branch block; BP, blood pressure; ECG, electrocardiogram; ED, emergency department; HF, heart failure; MI, myocardial infarction; N/A, not available; NPV, negative predictive value; O 2 Sat, oxygen saturation; OESIL, Osservatorio Epidemiologico sulla Sincope nel Lazio; ROSE, Risk Stratification of Syncope in the ED; SCD, sudden cardiac death; SFSR, San (...) Heart Disease: Recommendations e41 10.3. Geriatric Patients: Recommendations e41 10.4. Driving and Syncope: Recommendation e41 10.5. Athletes: Recommendations e41 11. Quality of Life and Healthcare Cost of Syncope e42 11.1. Impact of Syncope on Quality of Life e42 11.2. Healthcare Costs Associated with Syncope e42 12. Emerging Technology, Evidence Gaps, and Future Directions e42 12.1. Definition, Classification, and Epidemiology e42 12.2. Risk Stratification and Clinical Outcomes e43 12.3

2017 American Heart Association

94. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea Full Text available with Trip Pro

al. 1.2. Organization of the Writing Committee The writing committee consisted of cardiac electrophysiologists (including those specialized in pediatrics), general adult and pediatric cardiologists (including those specialized in critical care and acute coronary syndromes [ACS], genetic cardiology, heart failure, and cost-effectiveness analyses), a geriatrician with expertise in terminal care and shared decision-making, and a lay representative, in addition to representatives from the ACC, AHA (...) arrhythmias and the prevention of sudden cardiac death ESC 2015 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care AHA 2015 Atrial fibrillation AHA/ACC/HRS 2014 Non–ST-elevation acute coronary syndromes AHA/ACC 2014 Assessment of cardiovascular risk ACC/AHA 2013 ST-elevation myocardial infarction ACCF/AHA 2013 Acute myocardial infarction in patients presenting with ST-segment elevation ESC 2012 Device-based therapies for cardiac rhythm abnormalities ACCF/AHA/HRS 2012 Coronary

2017 American Heart Association

95. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

or to determine the presence of pulmonary hypertension. If there is doubt about the presence or absence of pulmonary hypertension, cardiac catheterization should be performed. Estimating Maternal and Fetal Risk Maternal risk in pregnancy is dependent not only on the complexity of the primary cardiac lesion but also on the presence of residual lesions and clinical sequelae such as heart failure, arrhythmias, or cerebrovascular events that contribute to overall risk. Maternal Risk Several risk stratification (...) scores have significant limitations, however, because they are highly population dependent. For example, Canadian Cardiac Disease in Pregnancy included 22% of patients with acquired heart disease, and 4% of the population were included because of arrhythmias. Therefore, in an effort to prevent high-risk patients from becoming pregnant, including those with severe pulmonary hypertension and severely dilated aortas and those who are not represented in these studies, a prepregnancy counseling session

2017 American Heart Association

96. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. Neuromuscular diseases (NMDs) encompass a broad spectrum of diagnoses with overlapping but distinct (...) Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search March 2019 March 2019 March 2019 March 2019 March 2019 February 2019 February 2019 February 2019 February 2019 January 2019 January 2019

2017 American Heart Association

97. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease Full Text available with Trip Pro

Figure 1 AUC Development Process 2217 3. Assumptions 2218 General Assumptions 2218 Assumptions for Rating Multiple Treatment Options 2219 4. Definitions 2219 Table A. Revascularization to Improve Survival Compared With Medical Therapy 2220 Table B. Noninvasive Risk Stratification 2222 5. Abbreviations 2223 6. Coronary Revascularization in Patients With Stable Ischemic Heart Disease: Appropriate Use Criteria (By Indication) 2223 Section 1. SIHD Without Prior CABG 2223 Table 1.1 One-Vessel Disease 2224 (...) /ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons

2017 Society for Cardiovascular Angiography and Interventions

98. Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

of CHD predispose to arrhythmias even without any surgical intervention due to abnormalities of the conduction system, intrinsic structural pathology, and impact of pre- or post- operative cyanosis and volume-/pressure-overload. In general, surgery for congenital heart defects may result in sinus node dys- function, atrioventricular (AV) block and a variety of supraventric- ular and ventricular tachyarrhythmias including the risk of sudden cardiac death (SCD). Arrhythmia treatment in patients (...) Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy; 14 Center for Electrophysiology at Heart Center Bremen, Bremen, Germany; 15 2nd Faculty of Medicine, Children’s Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; 16 Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany; 17 SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad

2017 Heart Rhythm Society

99. High Sensitivity Cardiac Troponin in the Emergency Department

cardiac catheterizations as a result? And can you still use this new assay with previously developed clinical decision rules like the HEART score? As you mull over these questions, you decide to use your detective skills to go online and do a little digging into the medical literature, hoping to \igure out how you will incorporate this assay into your current practice… PI C O Question Population : Adult ED patients with chest pain concerning for possible ACS Intervention : Using high sensitivity (...) involves ordering a troponin to evaluate for a myocardial infarction, you remember that your institution has recently adopted a new “high sensitivity” troponin I assay. You wonder how this change will effect your management of patients with chest pain. Will a single negative troponin be enough to discharge low-risk patients? Should you expect a high rate of “false positives” given that this assay is less specific? How should you handle these “false positives?” Will there be an increase in unnecessary

2020 Washington University Emergency Medicine Journal Club

100. 2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines Full Text available with Trip Pro

with cardiomyocyte injury (= cardiac troponin elevation) 13 Table 5 Assay specific cut-off levels in ng/l within the 0 h/1 h and 0 h/2 h algorithms 15 Table 6 Differential diagnoses of acute coronary syndromes in the setting of acute chest pain 18 Table 7 Major andminor criteria for high bleeding risk according to the Academic Research Consortium for High Bleeding Risk at the time of percutaneous coronary intervention (bleeding risk is high if at least one major or two minor criteria aremet) 21 Table 8 Dose (...) without cell damage (unstable angina). A small proportion of patients may present with ongoing myocardial ischaemia, characterized by one or more of the following: recurrent or ongoing chest pain, marked ST-segment depression on 12-lead ECG, heart failure, and haemodynamic or electrical instability. Due to the amount of myocardium in jeopardy and the risk of developing CS and/or malignant ventricular arrhythmias, immediate coronary angiography and, if appropriate, revascularization are indicated (see

2020 European Society of Cardiology

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