Abstract:
BACKGROUND:Evaluation of chest pain accounts for millions of costly Emergency Department (ED) visits and hospital admissions annually. Of these, approximately 10-20% are myocardial infarctions (MI). HYPOTHESIS:Patients with chest pain whose initial electrocardiogram (ECG) is normal do not require hospital admission for evaluation and management of a possible myocardial infarction. METHODS:The medical records of a consecutive cohort of 250 patients who presented to the ED with chest pain and were admitted by the ED physician to a cardiology inpatient service of an academic tertiary care medical center were reviewed. Reasons for admission to hospital was to rule out an acute coronary syndrome, specifically, myocardial infarction. The initial ECG of each patient was evaluated for abnormalities and compared with the final diagnosis. RESULTS:Of the 75 patients presenting with normal ECGs (normal, upright T waves and isoelectric ST segments), 1 (1.3%) was subsequently diagnosed with a myocardial infarction by Troponin I elevation alone. Of the 55 patients presenting with abnormal ECGs but no clear evidence of ischemia [i.e., left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH)], 2 (3.6%) were diagnosed with MI. Of the 48 patients presenting with abnormal ECGs questionable for ischemia (nonspecific ST and T wave changes that were not clearly ST segment elevation or depression), 7 (14.6%) were diagnosed with an MI. Of the 72 patients who presented with abnormal ECGs showing ischemia (acute ST segment elevation and/or depression), 39 (54.2%) were shown to have evidence for MI. SUMMARY:Patients who presented with normal ECGs (category 1) were extremely low risk for acute myocardial infarction. Patients with abnormal ECGs but no evidence of definite ischemia (category 2) had a relatively low incidence of MI. Patients with abnormal ECGs questionable for ischemia (category 3) had an intermediate risk of acute myocardial infarction. The majority of patients with abnormal ECGs demonstrating ischemia (category 4) were subsequently shown to evolve an acute myocardial infarction. CONCLUSIONS:Patients with chest pain and initial ECGs with ST segment abnormalities suggestive or diagnostic for ischemia, should be admitted to the hospital for further evaluation and management. Patients with ECGs that do not display acute ST segment changes are at a lower risk for acute myocardial infarction than those with acute ST segment changes and should be admitted on the basis of cardiac risk profile. (i.e., age, gender, hypertension, diabetes, smoking, known coronary artery disease, etc.) Patients with normal ECGs (category 1) are at extremely low risk, and it may be acceptable to consider further evaluation on an outpatient basis.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Challa PK,Smith KM,Conti CRdoi
10.1002/clc.20141subject
Has Abstractpub_date
2007-11-01 00:00:00pages
558-61issue
11eissn
0160-9289issn
1932-8737journal_volume
30pub_type
杂志文章abstract::More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with C...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.21965
更新日期:2012-03-01 00:00:00
abstract::Patients with atrial fibrillation (AF) have an increased stroke risk compared with those in sinus rhythm, although the absolute risk for individual patients is modulated by the presence of various additional risk factors. Patient selection for oral anticoagulation for stroke prevention is based on risks of stroke and ...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.22122
更新日期:2013-06-01 00:00:00
abstract::The purpose of this study was to examine signal-averaged electrocardiographic (SA-ECG) late potentials to predict ventricular arrhythmias during intrinsic cardiac rhythm and during ventricular pacing in children with complete heart block (CHB). Recordings of SA-ECG were obtained from eight patients (aged 3-18 years) w...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960170610
更新日期:1994-06-01 00:00:00
abstract::A 55-year-old Caucasian woman suddenly developed substernal chest pain at rest accompanied by pallor, diaphoresis, nausea, and vomiting. Physical examination was otherwise unremarkable. The resting ECG showed T-wave inversion in all anterior leads which returned to normal 24 h after the onset of the symptoms. The pain...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960100614
更新日期:1987-06-01 00:00:00
abstract::This report describes a patient who developed acute severe exacerbation of mild rheumatic mitral regurgitation caused by ischemia in the territory of a small, non-dominant circumflex coronary artery without myocardial infarction. ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960151215
更新日期:1992-12-01 00:00:00
abstract::This work attempted to study the segmental wall motion on left ventriculograms, in terms of segmental shortening, velocity of segmental shortening, and temporal sequences of various events in systole as well as in diastole. The ability of such a method to characterize patterns of normal regional wall motion and to det...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960090201
更新日期:1986-02-01 00:00:00
abstract::Hyponatremia is common and is increasingly recognized as an independent prognostic marker that adversely affects morbidity and mortality in various disease states, including heart failure. In acute decompensated heart failure (ADHF), the degree of hyponatremia often parallels the severity of cardiac dysfunction and is...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.20822
更新日期:2010-11-01 00:00:00
abstract::Several studies have investigated the role of physical fitness in atrial fibrillation (AF), but the results remain controversial. We aimed to estimate the association between physical fitness and risk of AF. We comprehensively retrieved data from the Cochrane Library, PubMed, and Embase databases until February 29, 20...
journal_title:Clinical cardiology
pub_type: 杂志文章,meta分析,评审
doi:10.1002/clc.22552
更新日期:2016-07-01 00:00:00
abstract::A community-wide study of patients hospitalized with acute myocardial infarction in metropolitan Baltimore was conducted to examine socio-demographic and clinical characteristics in association with ventricular fibrillation and cardiac arrest (VF/CA). Multivariate analyses revealed that variables significantly associa...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960040404
更新日期:1981-07-01 00:00:00
abstract:BACKGROUND:The effect of smoking on prognosis among patients undergoing percutaneous coronary intervention (PCI) is controversial, and data on the importance of smoking cessation or reductions were lacking. HYPOTHESIS:Smoking cessation or reductions could reduce the risk of adverse outcomes in patient after PCI. METH...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22004
更新日期:2012-09-01 00:00:00
abstract::The safety of quinapril hydrochloride, a new nonsulfhydryl angiotensin-converting enzyme (ACE) inhibitor with an intermediate duration of action, has been evaluated in 3,031 patients with hypertension and congestive heart failure (CHF) and has been compared with other ACE inhibitors. A comparison of double-blind studi...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960131408
更新日期:1990-06-01 00:00:00
abstract:BACKGROUND:Internal cardioversion of atrial fibrillation with direct current energy has become an increasingly employed technique for patients who fail external cardioversion. HYPOTHESIS:The purpose of this study was to determine whether internal cardioversion could be avoided by careful attention to cardioversion tec...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960240716
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:It is unclear whether more severe coronary atherosclerosis is a prerequisite to an initial acute coronary event in women vs men. HYPOTHESIS:Women may have more severe coronary atherosclerosis than men in patients with acute coronary event. METHODS:We used intravascular optical coherence tomography (OCT) to...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22825
更新日期:2017-12-01 00:00:00
abstract::Various anatomical and functional features of hypertrophic cardiomyopathy are analyzed in view of the data provided by two-dimensional echocardiography. Measurement of septal thickness is crucial, and is best done by a combination of M-Mode and 2-D echo. Two types of systolic anterior movement of the mitral valve (SAM...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960071203
更新日期:1984-12-01 00:00:00
abstract:BACKGROUND:Ablation procedures in patients with paroxysmal atrial fibrillation (PAF) includes isolation of all pulmonary veins (PVs). We hypothesized that an approach using an algorithm to detect arrhythmogenic PVs (aPVs) might lead to shorter procedure duration (PD) and fewer proarrhythmic effects (PE). HYPOTHESIS:Is...
journal_title:Clinical cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1002/clc.22132
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND AND HYPOTHESIS:In patients with stable angina pectoris, eccentric stenoses have a greater potential for dynamic changes of caliber in response to vasoactive stimuli than concentric lesions. It is not known whether in patients with coronary artery spasm the degree of coronary vasoconstriction differs in eccen...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章
doi:10.1002/clc.4960210907
更新日期:1998-09-01 00:00:00
abstract::Sertraline is a selective serotonin reuptake inhibitor with established safety for the treatment of depression. Among the common adverse effects associated with sertraline are nausea, insomnia, diarrhea, somnolence, and dizziness. Cardiac arrest had not been reported in the literature, although tachycardia was frequen...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.20647
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Troponin I (TnI) is increasingly employed as a highly specific marker of acute myocardial ischemia. The value of this marker after cardiac surgery is unclear. HYPOTHESIS:The purpose of this study was to measure serum TnI levels prospectively at 1, 6, and 72 h after elective cardiac operations. In addition, ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960231009
更新日期:2000-10-01 00:00:00
abstract::The normal human aorta is not a stiff tube but is characterized by elastic properties with a buffering Windkessel function. Aortic stiffening may cause an increase in aortic pulse pressure, left ventricular load, and ultimately left ventricular hypertrophy. This, together with the decreased diastolic transmyocardial p...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.20252
更新日期:2008-07-01 00:00:00
abstract::In the past decade, catheter ablation techniques and implantable devices have revolutionized the treatment of ventricular arrhythmias, junctional arrhythmias, and atrial flutter. For most patients presenting with atrial fibrillation (AF), the treatment available today is similar to that used a century ago, although no...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960200416
更新日期:1997-04-01 00:00:00
abstract::We report four patients who developed severe adverse reactions to protamine sulfate following cardiac surgery. Two types of reactions were seen. First, an immediate anaphylaxis which is a complement-dependent IgG antibody-mediated reaction. In the literature, 80% of patients who had similar reactions have had previous...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960070305
更新日期:1984-03-01 00:00:00
abstract::Although optimal pharmacological therapy for heart failure with reduced ejection fraction (HFrEF) is carefully scripted by treatment guidelines, many eligible patients are not treated with guideline-directed medical therapy (GDMT) in clinical practice. We designed a strategy for remote optimization of GDMT on a popula...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.23291
更新日期:2020-01-01 00:00:00
abstract::The long-term effects of valve replacement for chronic isolated aortic regurgitation as assessed by first-pass exercise radionuclide angiography have never been reported. We studied 20 males and 5 females before, 15 months postoperatively, and from 29 to 109 (mean 62 +/- 21) months following valve replacement with exe...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960110403
更新日期:1988-04-01 00:00:00
abstract::In order to test the comparative sensitivities of first-pass radionuclide and digital subtraction ventriculography in detecting wall motion abnormalities during exercise, 29 patients referred for coronary angiography were submitted to both types of stress ventriculograms. Resting and exercise ventriculograms by both t...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960090906
更新日期:1986-09-01 00:00:00
abstract::Sinus tachycardia is the most common rhythm disturbance encountered in clinical practice. Primary sinus tachycardia without an underlying secondary cause, despite often being associated with troublesome symptoms, is often neglected leading to multiple consultations and frustration on part of both the practitioner and ...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960280603
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:For decades, fasting for 8 to 12 hours has been recommended for measurement of lipid profiles. The effect of fasting on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) has been described in healthy cohorts and those with stable disease states. Recently, guidelines suggested that fasting ma...
journal_title:Clinical cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1002/clc.22851
更新日期:2018-01-01 00:00:00
abstract::The pseudoaneurysm is a rare cardiac pathology, in which the left ventricular free wall ruptures and the pericardium surrounds the rupture in combination with thrombus and inflammation and thus prevents the development of a hemopericardium. Left ventricular pseudoaneurysm may remain silent unless it gives rise to card...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.20311
更新日期:2009-06-01 00:00:00
abstract::Type II heparin-induced thrombocytopenia (HIT) is a potentially severe adverse effect of heparin treatment triggered by an immune response. Although most cases occur in patients receiving unfractioned heparin, HIT can also arise after low-molecular-weight heparin (LMWH). We report a case of HIT in a postoperative orth...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.20546
更新日期:2010-02-01 00:00:00
abstract::A 44-year-old housewife was found to have coarctation of the abdominal aorta secondary to Takayasu's arteritis. Since she also had mitral stenosis, possible etiological relation between Takayasu's arteritis and mitral stenosis is suspected. ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960110212
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:The objective of this study was to estimate the prevalence of prehypertension and hypertension in the rural adults of Liaoning province of China. METHODS:The study was conducted in 2004-2006, using a multistage cluster sampling method to select a representative sample. A total of 45925 adults, 35 years or o...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.20073
更新日期:2007-04-01 00:00:00