Diagnosis Of Acute Coronary Syndrome Research Articles

A case series of falsely elevated serum troponin I in Fabry disease secondary to macrotroponin

High-sensitivity troponin is a crucial biomarker for the diagnosis of acute coronary syndrome.1 However, raised troponin has also been noted in numerous clinical conditions such as cardiomyopathy, pulmonary embolism and chronic kidney disease. In particular, troponin may be elevated in Fabry disease (FD), which is a rare X-linked lysosomal storage disorder due to alpha-galactosidase deficiency.2 This results in cellular accumulation of glycosphingolipids in various organ systems, and may lead to cardiomyopathy and chronic renal failure.

Development and evaluation of the TRIGGER score to identify patients with acute coronary syndrome in the emergency department

Background/aims Acute coronary syndrome is a serious possible cause of chest pain, but detection rates at initial triage are low. This study evaluated the TRIGGER score as a tool for identifying patients with acute coronary syndrome who present to the emergency department with chest pain. Methods Data from 100 patients who presented to the emergency department with chest pain in February 2019 (before implementation of the TRIGGER score) were compared to 100 patients who presented in February 2020 (after implementation of the TRIGGER score). The proportion of patients with a final diagnosis of acute coronary syndrome was calculated and the predictive value of the TRIGGER score for acute coronary syndrome was evaluated. Results The majority of patients with a TRIGGER score of 9 or higher (actioning urgent referral) were found to have acute coronary syndrome or another cardiac condition. Overall, 50% of patients with a score of 10, 67% of patients with a score of 11 and 75% of patients with a score over 11 were found to have acute coronary syndrome. Overall, the TRIGGER score had 84.0% sensitivity and 81.7% specificity for acute coronary syndrome. The score was also associated with a decrease in average time to specialist review from 225 minutes to 112 minutes. Challenges associated with the tool included misclassification and increased workload. Conclusions The TRIGGER score is a useful tool for the rapid identification and referral of patients presenting with chest pain who have a high likelihood of acute coronary syndrome.

TROPONIN ONLY MANCHESTER ACUTE CORONARY SYNDROME(T-MAC) SCORE AS A DIAGNOSTIC TOOL OF ACUTE CORONARY SYNDROME IN THE EMERGENCY DEPARTMENT.

Chest pain is one of the most common presenting complaints in the Emergency Department(ED).We aimed to apply Troponin only-Manchester Acute Coronary(T-MAC) Score as a diagnostic risk stratication to 'rule in' and 'rule out' Acute Coronary Syndrome(ACS) at triage. Methods: This study was undertaken in the Emergency Department of a tertiary care Hospital. A sample size of 50 patients presenting with acute chest pain were evaluated and assigned a probability of ACS using the T-MAC rule, electrocardigraphy(ECG) ndings, contemporary Troponin-I levels and clinical symptoms. As per the rule, patients were stratied into low risk, moderate risk and high risk. Results: Of the 50 patients who presented with chest pain in the ED with a male:female ratio of 2.5:1, ~22% were High Risk patients and were sent for immediate intervention to the Cardiac care unit,~70% were Moderate risk patients, they were admitted to the ward for further evaluation and intervention, ~8% were Low risk patients and were discharged after a period of 24 Hrs observation. Out of the 50 patients, 1 patient was discharged against medical advice. The ROC analysis found under AUC(Area under curve) is 0.964 with p<0.05, with cut off value for TMAC study is 4. Conclusions: With the ROC analysis found under AUC of 0.964, the TMAC Score can be applied as a good tool for evaluation of chest pain patients and as an aid in the clinical judgement for the diagnosis of Acute Coronary Syndrome in the Emergency Department

Clinical and angiographic characteristics of patients with coronary ectasia in a reference hospital

To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography. : Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined. 7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000). coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.

Automated electrocardiographic diagnosis of myocardial infarction

In 2020, the Russian Society of Cardiology published the clinical guidelines for the diagnosis of acute coronary syndrome and acute myocardial infarction with the use of electrocardiography terms and symbols. Currently, a specialist in functional diagnostics often has questions when formulating an ECG diagnosis. The formulations accepted for describing ECG for coronary circulation disorders («focal myocardial changes»), and non-specifi c repolarization abnormalities stated («diff use myocardial changes») in the Russian methodology [1] are not always related to a coronary disease. The article presents an overview of currently existing ECG criteria of myocardial infraction to be used by a specialist in functional diagnostics in an automated workplace. It is suggested to prepare an ECG report for patients with acute coronary syndrome (particularly those with myocardial infarction) based on the presence of areas of myocardial ischemia, damage and necrosis.

Atypical manifestations of acute coronary syndrome — throat discomfort: a multi-center observational study

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.

Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory

IntroductionWe report an experiment using Australian paramedics (n = 64) and Australian paramedicine undergraduates (n = 44), on the processes underlying the formation of an intuitive diagnostic impression, based on limited dispatch information. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the diagnosis comes to mind (answer fluency) as important in impression formation. MethodParticipants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. Diagnostic impression, confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics. ResultsLikelihood, answer fluency, self-reported typicality and confidence predicted the impression but there was no effect of experience. Students and experienced paramedics had comparable accuracy and performance. ConclusionThe results support a role for answer fluency and confidence in forming that impression. We have shown it is possible to experimentally manipulate various factors associated with paramedic diagnostic impressions. These experimental methods can form the basis for additional studies into paramedic decision making.

The Impact of Short-Term Outdoor Air Pollution on Clinical Status and Prognosis of Hospitalized Patients with Coronary Artery Disease Treated with Percutaneous Coronary Intervention.

Background: The aim of this study was to determine the influence of acute exposure to air pollutants on patients’ profile, short- and mid-term outcomes of hospitalized patients with coronary artery disease (CAD) treated with coronary angioplasty. Methods: Out of 19,582 patients of the TERCET Registry, 7521 patients living in the Upper Silesia and Zaglebie Metropolis were included. The study population was divided into two groups according to the diagnosis of chronic (CCS) or acute coronary syndromes (ACS). Data on 24-h average concentrations of particulate matter with aerodynamic diameter <10 μm (PM10), sulfur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2), and ozone (O3) were obtained from eight environmental monitoring stations. Results: No significant association between pollutants’ concentration with baseline characteristic and in-hospital outcomes was observed. In the ACS group at 30 days, exceeding the 3rd quartile of PM10 was associated with almost 2-fold increased risk of adverse events and more than 3-fold increased risk of death. Exceeding the 3rd quartile of SO2 was connected with more than 8-fold increased risk of death at 30 days. In the CCS group, exceeding the 3rd quartile of SO2 was linked to almost 2,5-fold increased risk of 12-month death. Conclusions: The acute increase in air pollutants’ concentrations affect short- and mid-term prognosis in patients with CAD.

The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool.

Since its inception in 1902 by Willem Einthoven, the electrocardiogram (ECG) has fundamentally undergone minimal technological advances. Nevertheless, its clinical utility is critical, and it remains an essential tool to diagnose, risk stratify, and guide reperfusion and invasive strategies in patients with suspected acute coronary syndromes. ECG reading can be demanding, with many healthcare professionals lacking the necessary expertise to accurately interpret them. This is exacerbated by the need to constantly revisit old dogmas pertinent to the interpretation of ECGs. Notably, ECG leads record the global electrical activity of the heart toward and away from each electrode rather than local events. The long-held central paradigm that the various ECG leads record local events underneath specific electrodes should therefore be reassessed. For example, ST segment elevation in leads V1 and V2 usually denote antero-apical rather than septal infarction, often a misnomer utilized by the majority of clinicians. The ECG diagnosis of ST-elevation myocardial infarction (STEMI) is sometimes challenging and discerning it from non-ST-elevation myocardial infarction (NSTEMI) is of paramount importance to implement timely acute reperfusion therapy. In fact, when qualifications for emergency reperfusion therapy are based on STEMI ECG criteria, nearly one-third of cases with acute coronary occlusion are missed. Diagnostic ST elevation in the absence of left ventricular (LV) hypertrophy or left bundle-branch block (LBBB) is defined by a specific set of sex-specific criteria for new ST elevation at the J point in contiguous precordial or limb leads. However, other ECG criteria need to be kept in mind. These include, but are not limited to, new or presumably new left bundle branch block (LBBB), which is often considered as an STEMI-equivalent; ST depression in two or more precordial leads (V1-V4), denoting a true inferolateral transmural myocardial infarction; and the infrequent presentation with hyperacute T-wave changes. As our understanding of the pathology of ischemic reperfusion injury has evolved and following the introduction of new imaging modalities such as cardiac magnetic resonance imaging, we need to re-assess the old dogmas pertinent to the interpretation of ECGs and update the terms and classifications.

Spectral imaging with dual-layer spectral detector computed tomography for the detection of perfusion defects in acute coronary syndrome.

To evaluate the feasibility of spectral imaging with dual-layer spectral detector computed tomography (CT) for the diagnosis of acute coronary syndrome. We identified 30 consecutive patients who underwent cardiac CT using dual-layer spectral detector CT and were diagnosed with acute ischemic syndrome by an invasive coronary angiography. We reconstructed 120kVp images and generated virtual monochromatic images (VMIs; 40-200keV in 10keV increments), iodine concentration maps, and effective atomic number (Z) maps. We calculated the contrast and contrast-to-noise ratio (CNR) between myocardial normal and hypo-perfusion and chose the VMIs with the best CNR for quantitative analysis. We compared the image noise, contrast, and CNR of 120kVp images and the best VMIs, CT value, iodine concentration, and effective Z between myocardial normal and hypo-perfusion with the paired t test. As the X-ray energy decreased, venous attenuation, contrast, and CNR gradually increased. The 40keV image yielded the best CNR. The contrast and CNR between myocardial normal and hypo-perfusion were significantly higher in 40keV images than those in 120kVp images.The iodine concentration and the effective Z were significantly higher in normal myocardium than those in hypo-perfused myocardium. Spectral imaging with dual-layer spectral detector CT is a feasible technique to detect the hypo-perfused area of acute ischemic syndrome.

CHEST PAIN IN WOMEN. IS IT ALWAYS ATHEROSCLEROTIC?

Patients both male and female with diagnosis of Acute Coronary Syndrome (ACS) present with chest pain as presenting complaint. Lichtman JH et al. in his study with ACS showed that 93% of women presented with chest pain or discomfort.1 As compared to men women experience more associated symptoms as primary complaint. The associated symptoms are fatigue, dyspnea, backache, flue like symptoms, indigestion, palpitations and most common is anxiety &amp; feeling scarry.2 Keeping these scenarios in mind one should inquire this associated presentation along with chest pain or discomfort in evaluating ACS in women. In continuation with symptoms there is quite a debate on pathophysiology of Acute Myocardial infraction in men and women regarding coronary pathologic features.3 Type 1 plaque rupture most common in both genders with plaque erosion most common in women in non-obstructive coronary artery disease.4 Spontaneous coronary artery dissection (SCAD) having high mortality exists in the absence of risk factor of ACS.5 It was found in women up to 35% of patients with mean age of 42 to 53 years with a MACE (Major acute coronary event) of 47.4% and 10 years mortality rate of 7.7%2 SCAD seen in peripartum cases, oral contraception use, lack of exercise, connective tissue disorders and vasculidites. It is important for the physician to have in mind these disorders to avoid complications of coronary interventions. In a scientific statement from AHA, Mehte LS et al. showed a lower prevalence of atheroscrotic CAD in women.3 These are certain scoring system,6 that under present women because of vague symptoms and presentation. These scoring systems lead to decrease hospital admission and less noninvasive cardiac testing. For risk satisfaction of chest pain female gender should not be taken as sole criteria for presence or absence of coronary events in presence of other multiple factors. The last but not the least is the psychosocial stress more in women than in men. It has been found that young women who present with early onset myocardial infarction have more psychosocial risk factors in comparison to men of similar age,3 probably having high rates of poverty and trauma exposure during childhood because of various reasons.7 Different studies are endorsing relationship between depression and ischemic heart disease as prognostic factor after ACS.7 In our population where there is lack of education, poverty, awareness of disease especially in women the physician should ponder on different factors mentioned above i.e. presentation perceptions, prevalence, pathophysiology and psychosocial stress for evaluation and management of chest pain.

Acute coronary syndrome in patients under 35 years old

Objective. To evaluate the clinical and demographic characteristics of a group of patients under 35 years old admitted with acute coronary syndrome, as well as the features of coronary bed damage and endovascular treatment.Material and methods. A retrospective analysis of the group of patients aged 30 to 35, admitted to the Regional Vascular Center with a diagnosis of acute coronary syndrome in the period from 2019 to June 2021, was carried out. The study included 72 patients with ACS, regardless of the ST segment changes on the electrocardiogram, were admitted to the hospital by the emergency medical service referral. Positive troponins were detected in all the patients by qualitative analysis. Upon admission, they were sent to a catheterization laboratory. An examination was carried out according to the recommendations of medical care, as well as selective coronary angiography and, if indicated, stenting of the coronary arteries was performed.Results. When analyzing the clinical and demographic characteristics of the group, attention has been drawn to the absolute predominance of males — 71 (98.7%), urban residents — 64 (88.9%), low frequency of bad habits: tobacco smoking in 13 (18.1%) and alcohol abuse in 2 (2.8%) patients, the absence of concomitant pathology, a signifi cant time from the onset of symptoms to calling an ambulance (165 [90; 263]). According to the results of angiography, it should be noted the possibility of acute coronary syndrome with intact coronary arteries is 9 (27.3%) among all ACS cases with ST segment elevation and 29 (74.3%) with ACS without ST segment elevation, while in one third of the above episodes (13 (34.2%)) ACS was caused by the presence of a muscle “bridge” in the basin of the anterior descending artery, a concomitant phenomenon of slowed blood fl ow. The attention has been also drawn to the almost equal proportions of acute thrombotic occlusion (19 (55.9%)) and haemodynamically signifi cant hemadostenosis (14 (41.2%)) as the cause of ACS.Conclusion. In patients under 35 years old with a typical clinical. picture, positive troponins, with a qualitative analysis, there is a high probability of pathological changes in the coronary bed, regardless of the ST segment changes, which requires X-ray endovascular methods of diagnosis and treatment. Angiographic features of the coronary artery lesion in young people are the discreteness of the lesion in the proximal or middle sections of the arteries, the high frequency of thrombotic occlusions, the predominant lesion of the anterior descending or right coronary arteries, the low frequency of calcifi cation of the coronary arteries.

An update on some atypical electrocardiographic forms of acute coronary syndrome The "STEMI equivalents"

The diagnosis of acute coronary syndrome with ST segment elevation (STEMI) is based on clinical symptoms suggestive of acute myocardial ischemia and precise ECG criteria. STEMI is due to an acute occlusion or subocclusion of a coronary artery, generating a transmural ischaemia, requiring coronary angiography with urgent coronary revascularization. However, some authors consider the current STEMI ECG criteria to be too restrictive: up to 30 % of patients who do not meet these criteria present with critical coronary artery stenosis or acute coronary occlusion. Atypical electrocardiographic patterns, known as "STEMI equivalents", can be found in some cases and justify a rapid cardiological evaluation. We present a pragmatic review of five STEMI equivalents.

The Audit Of Using Of Statins Following A Diagnosis Of Acute Coronary Syndrome (ACS) In The Royal Alexandra Hospital

The Audit Of Using Of Statins Following A Diagnosis Of Acute Coronary Syndrome (ACS) In The Royal Alexandra Hospital

Investigation of Vitamin B12 Deficiency in Patients with Acute Coronary Syndrome and its Relationship with Gensini Score.

Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score. Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system. Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554). We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.

RISK FACTORS FOR WOMEN’S CARDIOVASCULAR DISEASE

Risk factors specific to women such as hypertension in pregnancy, premature births, gestational diabetes and menopause are among the unique aspects of cardiovascular health in women.Objective: Women of childbearing age were considered protected and CVD were considered male diseases. A report from the European Heart Health Strategy (EuroHeart) finds that women are less likely to receive the same preventive advice as men and that women are still underrepresented in cardiovascular researchRisk factors are important for both men and women, but differ their impact was stronger in men and women. Especially in women, the presence of diabetes, hypertension and smoking is associated with a higher risk than in men. Female sex-specific risk factors related to hormonal and reproductive status that affect the risk of cardiovascular disease in women. These risk factors are related to hormonal status, pregnancy, some non-cardiac diseases with a higher prevalence in women and their treatment.Conclusions. To improve the care of women with cardiovascular disease, it is necessary to realize that the diagnosis of acute coronary syndromes can be problematic in women due to differences in symptoms. and presenting symptoms. At the same time, it is necessary to understand the importance of specific approaches in the diagnosis, treatment and prevention of CVD in women.

Assessing the Feasibility and Accuracy of Wearable 12-Lead ECG in The&amp;nbsp; Diagnosis of Acute Coronary Syndromes

Assessing the Feasibility and Accuracy of Wearable 12-Lead ECG in The&amp;nbsp; Diagnosis of Acute Coronary Syndromes

Прогностическая ценность D-димера у больных, перенесших инфаркт миокарда в условиях пандемии новой коронавирусной инфекции

In conditions of new coronavirus pandemic and high prevalence of myocarditis, myopericarditis, the issues of differential diagnosis, especially in patients who had previously undergone myocardial infarction, appear to be relevant. Against the background of COVID-19 both recurrent acute coronary disease and myocarditis, or myopericarditis are possible, and the differential diagnosis is significantly complicated by the similarity of clinical picture (pain in the heart area (not always typical), increased titers of cardiac troponins). Particular difficulties in diagnosis arise in patients who have undergone myocardial infarction, are in a coma and have unstable hemodynamics, since the detection of zones of local hypo- or akinesis on EchoCG has no proper diagnostic value; changes on ECG can be ambiguous; and the absolute majority of hospitals that provide care to COVID-19 patients have no possibilities of making MRI with gadolinium. In such cases, additional diagnostic methods may be helpful in making a definitive diagnosis. In such cases, additional diagnostic methods may be helpful in making a definitive diagnosis. The most available and well-studied laboratory indicator is D-dimer, which is a marker of hypercoagulation syndrome, however, some scientists also considered it as a marker of necrosis in myocardial infarction. This review shows the advantages and disadvantages of D-dimer in the diagnosis of acute coronary syndrome; the possibility of its use in patients with coronavirus infection, who had previously undergone myocardial infarction; the prospects for further research on this issue are outlined. The combined use of D-dimer test with electrocardiography, echocardiography, and clinical manifestations in patients with coronavirus infection to diagnose recurrent myocardial infarction was substantiated.

Acute Coronary Syndrome Diagnosis &amp;amp; Management Approach in Emergency Department: Literature Review

Acute coronary syndromes are brought on by a sudden occlusion of a coronary artery. Depending on the severity and location of the obstruction, the effects can range from unstable angina to non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and sudden cardiac death. Except for sudden death, each syndrome shares similar symptoms, such as nausea, diaphoresis, and discomfort in the chest with or without dyspnea. Electrocardiography and serolo

Evidence-based nursing care of patient with acute myocardial infarction: Case report

To achieve high-quality nursing care and management of acute myocardial infarction patients must be in accordance with evidence-based nursing practice and nurses&#39; willingness to modify nursing practice when new evidence emerges. The framework for the comprehensive care and management of a patient with acute myocardial infarction includes a comprehensive nursing assessment, diagnosis, planning, intervention, and assessment process. This case study aims to explain and illustrate how to care for patients with acute myocardial infarction based on the rationale and nursing practice evidence underlying the holistic approach. Nurses have been shown to have an essential role in the diagnosis, management, and treatment of acute coronary syndromes. This is because nurses provide care directly to patients and can identify problems early.