Abstract:
BACKGROUND:The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. METHODS:In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. RESULTS:The sample was predominantly male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); Stress Symptoms (shortness of breath, sweating, nausea, indigestion, dread, anxiety); and Diffuse Symptoms, with a low frequency of most symptoms. Those in the Diffuse Symptoms cluster tended to be older (P = .08) and the Pain Symptoms group was most likely to have a history of angina (P = .01). After adjusting for differences, the Diffuse Symptoms cluster demonstrated higher mortality at 2 years (17%) than the other 3 clusters (2%-5%, P < .001), although prehospital delay time did not differ significantly. CONCLUSION:Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Riegel B,Hanlon AL,McKinley S,Moser DK,Meischke H,Doering LV,Davidson P,Pelter MM,Dracup Kdoi
10.1016/j.ahj.2010.01.003subject
Has Abstractpub_date
2010-03-01 00:00:00pages
392-8issue
3eissn
0002-8703issn
1097-6744pii
S0002-8703(10)00057-8journal_volume
159pub_type
杂志文章,多中心研究,随机对照试验abstract::Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 8 to 36 years; mean, 19.1 +/- 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 +/...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90967-z
更新日期:1992-10-01 00:00:00
abstract::Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acu...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2006.06.001
更新日期:2006-10-01 00:00:00
abstract::The extent and time course of recovery of left ventricular function were investigated in 29 patients with no previous symptoms who had acute nonischemic congestive cardiomyopathy and left ventricular ejection fraction of 0.22 +/- 0.07. Improvement in left ventricular ejection fraction by at least 0.05 was observed in ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90038-1
更新日期:1995-01-01 00:00:00
abstract::In a study of GTN absorption during exercise and high ambient temperature, 12 healthy volunteers carried 10 mg glyceryl trinitrate (GTN, nitroglycerin) transdermal patches for 6 hours during each of 3 days. During a control day the mean plasma GTN concentration ranged from 1.0 nmol/L (SD +/- 0.8 nmol/L) to 1.5 nmol/L ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(86)90518-1
更新日期:1986-09-01 00:00:00
abstract:BACKGROUND:Sirolimus-eluting stents (SES) prevent restenosis and repeat percutaneous coronary intervention (PCI), but safety data in unselected patients are limited, especially for intermediate-term follow-up. METHODS:All patients undergoing SES implantation at 4 Italian centers were enrolled into a dedicated database...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2008.06.030
更新日期:2008-11-01 00:00:00
abstract::In 14 patients with severe congestive heart failure, the effects of captopril on the forearm circulation were evaluated with strain gauge plethysmography. Changes in plasma renin activity, angiotensin II, norepinephrine, epinephrine, bradykinin, prostaglandin E2, and 6-keto-prostaglandin F1 alpha concentrations were a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90662-5
更新日期:1989-01-01 00:00:00
abstract::The addition of IAC to otherwise standard CPR provides for the application of external pressure over the abdomen in counterpoint to the rhythm of chest compression. Interposed abdominal compression is a simple manual technique that can supplement the use of adrenergic drugs to increase both coronary perfusion pressure...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(94)90132-5
更新日期:1994-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究
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abstract:OBJECTIVES:To define the incidence and cumulative risk of atrial fibrillation (AF) in a population-based cohort of whites and African Americans. BACKGROUND:African-Americans reportedly have a lower risk of AF than whites despite their higher exposure to AF risk factors. However, precise estimates of AF incidence in Af...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.05.010
更新日期:2009-07-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2010.03.032
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Inflammation is an important feature of atherosclerotic lesions, and the vulnerability of coronary lesions in acute myocardial infarction (AMI) at the time of onset may be related to blood levels of C-reactive protein (CRP) on admission, before CRP levels are affected by myocardial damage. METHODS:A total o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2000.108244
更新日期:2000-08-01 00:00:00
abstract:BACKGROUND:Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2014.11.010
更新日期:2015-02-01 00:00:00
abstract::To assess the effects of chronic left ventricular (LV) dysfunction on intravascular pulmonary blood volume (PBV) and extravascular lung water (EVLW) lung fluid volumes, 56 dogs were evaluated by means of double-indicator dilution techniques. PBV and EVLW were measured in seven control dogs, in eight dogs 4 hours after...
journal_title:American heart journal
pub_type: 杂志文章,收录出版
doi:10.1016/0002-8703(84)90421-6
更新日期:1984-09-01 00:00:00
abstract:BACKGROUND:Coronary artery disease in women appears 10 to 15 years later than in men. To test the hypothesis that the effects of estrogen may manifest themselves as histologic differences in coronary plaques, we examined the hearts of premenopausal and postmenopausal women who died suddenly from coronary artery disease...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.109946
更新日期:2001-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70463-1
更新日期:1999-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(90)90056-4
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Limited information is available on the health behavior profile of patients with premature acute coronary syndrome (ACS). The purpose of this study is to desribe the health bahvior of young patients with ACS at the baseline and 1 year post-ACS and examine sex differences. METHODS:GENESIS-PRAXY is a prospect...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2015.04.016
更新日期:2015-08-01 00:00:00
abstract::A population of 2955 patients admitted to the hospital with acute myocardial infarction (AMI) was followed for 1 year after AMI or until death. Smokers as compared to nonsmokers were over 10 years younger (p less than 0.001) and had a lower prevalence of hypertension (p less than 0.01), congestive heart failure (p les...
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pub_type: 杂志文章
doi:10.1016/0002-8703(85)90071-7
更新日期:1985-09-01 00:00:00
abstract:BACKGROUND:Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to patients on oral anticoagulant, who are transferred to their physician once they are stabilized. This may be as effective as and less expensive than long-term PMAS follow-up. METHODS:Once PMAS patients were stabilized and r...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2008.02.009
更新日期:2008-07-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:1996-03-01 00:00:00
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pub_type: 杂志文章
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更新日期:1989-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2014-01-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-8703(99)70152-3
更新日期:1999-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90219-9
更新日期:1979-08-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.03.010
更新日期:2010-06-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-8703(99)70262-0
更新日期:1999-07-01 00:00:00
abstract::The effect of beta-blockade on heart-rate variability was assessed at different heart rates in 52 patients with heart failure included in the randomized, placebo-controlled, Cardiac Insufficiency Bisoprolol Study (CIBIS). Scatterplots of R-R intervals display beat-to-beat variability by plotting each R-R interval agai...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1996-08-01 00:00:00
abstract::This study examines the electrophysiologic effects of an intravenous bolus of lidocaine in the normal canine ventricle. In 14 open-chest dogs, left ventricular effective refractory period, ventricular repolarization time, and activation time were measured continuously during ventricular pacing (150/min) before, during...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90559-9
更新日期:1985-03-01 00:00:00
abstract::To evaluate regional differences in thickness and systolic function of human myocardium perfused by angiographically normal coronary arteries in valvular and ischemic heart disease, we performed intraoperative epicardial M-mode mapping of ventriculographically normal wall regions (perfused by normal coronary arteries)...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90273-5
更新日期:1986-08-01 00:00:00
abstract::The purpose of this investigation was to identify early left ventricular (LV) cineangiographic signs of myocardial damage and to study the evolution of the characteristic lesions in 126 chronic chagasic patients, divided into three groups. Group I patients had no clinical, ECG, or radiologic evidences of heart disease...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90232-0
更新日期:1982-09-01 00:00:00