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Coronary Risk Stratification of Chest Pain

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161. 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

162. 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

163. 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 (PubMed)

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 (...) to emergency departments (EDs) at high risk for ACS, such as those with ST segment elevation on their 12-lead electrocardiogram (ECG), immediate contrast coronary angiography is performed. On the other hand, chest pain observation units (OUs) are recommended for managing those with chest pain at low risk for an ACS event. In this setting, these OUs are associated with lower healthcare resource utilization and improved cost-effectiveness. Cost-effective diagnosis and treatment options are important goals

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2012 Current Treatment Options in Cardiovascular Medicine

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

in reducing the risk of cancers, III–B preventive actions? coronary artery disease, chronic obstructive airways disease and stroke. There are no risks from preventive actions Short Fagerstrom test for nicotine dependence 20 Questions Answers Score 1. How soon after waking up do you smoke your first cigarette? Within 5 minutes 3 6–30 minutes 2 31–60 minutes 1 2. How many cigarettes a day do you smoke? 10 or less 0 1 1–20 1 21–30 2 31 or more 3 Score: 0–2 very low 3 low 4 moderate 5 high 6 very highA (...) 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

2014 The Royal Australian College of General Practitioners

165. Moderate Risk Acute Coronary Syndrome Management

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 (...) 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

2015 FP Notebook

166. 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 (...) for ischemia References Orman, Mattu and Swaminathan in Herbert (2016) EM:Rap 16(10): 8-9 VII. Evaluation Initial evaluation for high risk, intermediate risk and Low Risk Chest Pain begins the same See (includes giving 325 mg) Low Risk Chest Pain protocol is only per indications listed above Approach Assess likelihood Consider differential diagnosis Decision Rules See (may be preferred for accelerated diagnostic protocols) See Precautions s are not useful in the exclusion of acute coronary disease

2015 FP Notebook

167. Inclusion of stroke in cardiovascular risk prediction instruments

on lipid management for primary and secondary prevention, including those of the NCEP, expand theuseofabsoluterisklevelsbyincludingcategoriesofCHD risk equivalents. 5 Those considered to have coronary risk equivalents include those with established CHD, as well as thosewithDM,PAD,andsymptomaticcarotidarterydisease. Risk stratification can also be performed with the Framing- ham risk prediction instruments, and patients can be divided into those with low (10%), moderate (10%–20%), or high (20%) 10-year (...) 1998 Downloaded from http://ahajournals.org by on March 27, 2019before consideration and approval by the AHA Science Advisory and Coordinating Committee. There are several reasons to consider stroke patients, and particularly patients with atherosclerotic stroke, among the groups of patients at high absolute risk of coronary and cardiovascular disease. First, evidence suggests that patients with ischemic stroke are at high absolute risk of fatal or nonfatal myocardial infarction or sudden death

2012 American Academy of Neurology

168. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

The safety of nonsteroidal anti-inflammatory agents for analgesia is controversial, with greater evidence for adverse cardiovascular events with the selective cyclooxygenase-2 inhibitors than the nonselective agents. A 2007 AHA Scien- tific statement presented a stepped-care approach to the management of musculoskeletal pain in patients with or at risk for coronary artery disease (CAD), with the goal of limiting the use of these agents to patients in whom safer therapies fail. 47 In patients hospitalized (...) 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

2011 American Heart Association

169. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

(≥50% diameter stenosis) left main coronary artery stenosis. (Level of Evidence: B) Class IIa PCI to improve survival is reasonable as an alternative to CABG in selected stable patients with significant (≥50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (eg, a low SYNTAX score [≤22], ostial or trunk left main CAD); and 2) clinical characteristics that predict (...) a significantly increased risk of adverse surgical outcomes (eg, STS-predicted risk of operative mortality ≥5%). , , , , (Level of Evidence: B) PCI to improve survival is reasonable in patients with UA/NSTEMI when an unprotected left main coronary artery is the culprit lesion and the patient is not a candidate for CABG. , , , , (Level of Evidence: B) PCI to improve survival is reasonable in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion, distal coronary flow

2011 American Heart Association

170. Troponin assay use in the emergency department for management of patients with potential acute coronary syndrome: current use and future directions (PubMed)

physicians with evaluating chest pain in the emergency department in the context of de-tection (or absence) of troponins in systemic circulation. Additionally, investigators are working to integrate data generated by hs-cTn measurements into existing and new risk-stratification scores. (...) as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays. These tests are known as high-sensitivity cardiac troponin assays. Current research is aimed at evaluating the clinical sig-nificance of troponin elevations detected by these new assays especially in management of pa-tients with suspected acute coronary syndrome. A number of risk-stratification scores exist to assist

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2016 Clinical and experimental emergency medicine

171. The clinics of acute coronary syndrome (PubMed)

The clinics of acute coronary syndrome Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations (...) such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt.

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2016 Annals of Translational Medicine

172. Factors Influencing Time-dependent Quality Indicators for Suspected Acute Coronary Syndrome Patients (PubMed)

Factors Influencing Time-dependent Quality Indicators for Suspected Acute Coronary Syndrome Patients Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non-ST elevation myocardial infarction (NSTEMI) in the emergency department (ED).A retrospective, cohort study (...) %, respectively. Cox regression models revealed that chief complaints without chest pain and the timing of stress testing and medication administration were associated with the most significant delays.Patient and system factors both significantly influenced QI times in this cohort with unstable angina/NSTEMI. These results illustrate both the complexity of diagnosing patients with NSTEMI and the competing effects of clinical and system factors on patient flow through the ED.

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2016 Journal of patient safety

173. Do gender and race make a difference in acute coronary syndrome pretest probabilities in the emergency department? (PubMed)

Do gender and race make a difference in acute coronary syndrome pretest probabilities in the emergency department? The objective was to test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90-day returns, cost, and chest radiation exposure after these stratifications.This is a secondary (...) analysis of a prospective outcomes study of ED patients with chest pain and shortness of breath. We performed two separate analyses. The data set was divided by gender for analysis 1 while the analysis 2 stratification was made by race (nonwhite vs. white). For each analysis, groups were compared on several variables: provider visual analog scales (VAS) for likelihood of ACS, PREtest Consult ACS probabilities, rates of ACS, total radiation exposure to the chest, total costs at 30 days, and 90-day

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2016 Academic Emergency Medicine

174. Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE. (PubMed)

Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE. The PROMISE (Prospective multicenter imaging study for evaluation of chest pain) trial compared the effectiveness of coronary CT angiography and functional testing as initial diagnostic test for patients with suspicion for stable coronary artery disease (CAD). With 10,003 patients randomized at 193 sites, the PROMISE trial provides a snapshot of real-world care (...) of coronary computed tomography angiography (CTA) to select patients for invasive coronary angiography (ICA) who had obstructive CAD (72 vs. 48 % for coronary CTA and functional testing, respectively). Radiation exposure was higher in the CT arm compared to all functional testing but lower than for nuclear perfusion stress testing. Improvement of patient selection for diagnostic testing and risk stratification will be keys to increase efficacy and efficiency of management of patients with suspicion

2016 Current cardiology reports Controlled trial quality: uncertain

175. Acute coronary syndromes: consensus recommendations for translating knowledge into action

leadership, education, and acceptance of the agreed clinical pathway by medical staff, on the understanding that it is not intended to replace clinical judgement; a system-wide approach to staff training to overcome barriers encountered due to mobility of the medical workforce; and including risk stratification measurement and feedback in key performance indicators (KPIs) (see priority area 6). 3. Early invasive management for high-risk NSTEACS Guidelines recommend access to coronary angiography and PCI (...) diseases, Australian facts 2004. Canberra: AIHW and National Heart Foundation of Australia, 2004. (AIHW Cat. No. CVD 27. Cardiovascular Disease Series No. 22.) Australian Bureau of Statistics. Causes of death 2007. Canberra: ABS, 2009. (ABS Cat. No. 3303.0.) Access Economics. The economic cost of heart attack and chest pain (acute coronary syndrome). Canberra: Eli Lilly, 2009. (accessed Jul 2009). Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary

2009 MJA Clinical Guidelines

176. Validation of Simple Acute Coronary Syndrome (SACS) Score

Ruppert, Cardiac Data Specialist and Cardiovascular Clinical Coordinator, Bayfront Health St Petersburg ClinicalTrials.gov Identifier: Other Study ID Numbers: 521-0 First Posted: February 6, 2015 Last Update Posted: July 19, 2016 Last Verified: July 2016 Keywords provided by Wayne Ruppert, Bayfront Health St Petersburg: Acute Coronary Syndrome Chest Pain ACS Risk Stratification Score HEART Score Modified TIMI Coronary Artery Disease Risk Factors Myocardial Infarction Additional relevant MeSH terms (...) during coronary angiography in the cardiac catheterization suite. In addition, we plan to determine if a variant of SACS, HEART, TIMI, or a hybrid score resulting from combining formulas from two or all three scores yields a new tool that exceeds the predictive performance of all three current models for determining the absence or presence of OCAD. Condition or disease Chest Pain Acute Coronary Syndrome Angina Myocardial Infarction Detailed Description: HISTORY: The Simple Acute Coronary Syndrome

2015 Clinical Trials

177. The Accuracy of the Mini RELF Device for the Diagnosis of an Acute Coronary Artery Occlusion.

on an individual basis an elevation of the ST segment that is indicative for an acute coronary occlusion. The investigators aim to evaluate the accuracy of Mini RELF device when it is self-applied on a daily basis by patients with coronary artery disease. Condition or disease Intervention/treatment Phase Chest Pain ST Elevation Myocardial Infarction Device: Diagnostic accuracy of Mini Relf Device Not Applicable Detailed Description: The increasing availability of small hand held medical devices is a novel (...) by University Ghent: RELF method Medical device Admission delay Additional relevant MeSH terms: Layout table for MeSH terms Infarction Myocardial Infarction Chest Pain ST Elevation Myocardial Infarction Coronary Occlusion Ischemia Pathologic Processes Necrosis Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Pain Neurologic Manifestations Signs and Symptoms Coronary Disease

2016 Clinical Trials

178. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. (PubMed)

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations (...) stratification of ACS; provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction; risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS; administration of antithrombotic therapies in the acute setting and considerations affecting their long term use; and implementation of an individualised secondary prevention plan that includes both pharmacotherapies

2016 Medical Journal of Australia

179. Sensitivity, Specificity, and Sex Differences in Symptoms Reported on the 13‐Item Acute Coronary Syndrome Checklist (PubMed)

Sensitivity, Specificity, and Sex Differences in Symptoms Reported on the 13‐Item Acute Coronary Syndrome Checklist Clinical symptoms are part of the risk stratification approaches used in the emergency department (ED) to evaluate patients with suspected acute coronary syndromes (ACS). The objective of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a discharge diagnosis of ACS in women and men.The sample included 736 patients admitted to 4 (...) EDs with symptoms suggestive of ACS. Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS, adjusting for age, obesity, diabetes, and functional status. Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7±14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest

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2014 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

180. Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis

for MeSH terms Infarction Myocardial Infarction Angina Pectoris Angina, Stable Angina, Unstable Coronary Stenosis Ischemia Pathologic Processes Necrosis Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Chest Pain Pain Neurologic Manifestations Signs and Symptoms Coronary Disease Aspirin Clopidogrel Ticagrelor Prasugrel Hydrochloride Sirolimus Everolimus Anti-Inflammatory Agents, Non-Steroidal Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System (...) , you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: Child, Adult, Older Adult Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Patients with de novo stenotic lesions who are suitable for coronary stenting with drug-eluting stent Exclusion Criteria: 1. High risk profiles for ischemic adverse events such as A. ST-segment elevation

2015 Clinical Trials

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