By Michael H. Crawford MD FACC, Ezra A. Amsterdam MD, J. Douglas Kirk MD FACEP
Advances in know-how and supply of care in chest discomfort devices make this an important e-book for cardiologists. Articles discover acute coronary syndromes; ignored diagnoses of acute coronary syndromes within the emergency division; chest soreness unit notion; markers of cardiac damage; markers of cardiac ischemia and irritation; treadmill workout trying out; position of myocardial scintigraphy; echocardiography; cost-effectivness; administration of specific populations; reputation and administration of the sufferer with chest ache and nonobstructive coronary artery sickness; and administration of middle failure.
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Additional resources for Chest Pain Units, An Issue of Cardiology Clinics
Physical examination The physical examination is generally not helpful in diagnosing ACSs when compared with the value of historical data and ECG ﬁndings, except when it points to an alternate process. On the other hand, clinicians must not be lulled into a sense of security by chest pain that is partially or fully reproduced by palpation, because 11% may have infarction or UAP . 02), but this diﬀerence was not considered clinically signiﬁcant. Pulse rate observation in isolation appeared to be generally not helpful in ACSs identiﬁcation.
Published reports suggest that up to 5% of visits to the ED involve complaints relating to chest discomfort . The complaint of chest discomfort encompasses many varying conditions, ranging from insigniﬁcant to high-risk in terms of threat to the patient’s life, including, but not limited to, acute coronary syndromes (AMI and UAP), thromboembolic disease (pulmonary embolism), aortic dissection, pneumothorax, pneumonia, myocarditis, and pericarditis. Chest discomfort may be perceived as pain with descriptions such as crushing, vicelike constriction; a feeling equivalent to an ‘‘elephant sitting on the chest’’; tightness; pressure; heartburn; or indigestion, or as discomfort most noticeable for its radiation to an adjacent area of the body such as the neck, jaw, interscapular area, upper extremities, or epigastrium.
001) and that 29% of patients who had Q waves present on their ECGs had a ﬁnal diagnosis of AMI. 3 s duration) in two contiguous leads, not having second- or third-degree heart block, and not having a new conduction abnormality (eg, bundle branch block). These patterns are the most diﬃcult to interpret and can result in overdiagnosis (no comparison ECG available) and underdiagnosis (baseline abnormality obscuration of ischemia) . Lee and colleagues  found that emergency patients who had chest pain and nondiagnostic ECG abnormalities had a low risk for AMI but a signiﬁcant risk for ACSs.
Chest Pain Units, An Issue of Cardiology Clinics by Michael H. Crawford MD FACC, Ezra A. Amsterdam MD, J. Douglas Kirk MD FACEP