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BACKGROUND The persistent occlusion of pulmonary arteries resulting from 1 or more thromboembolic pulmonary disease is the origin of persistent thromboembolic pulmonary disease. This is the case of a 60-year-old woman with a 6-week history of breathlessness and intermittent chest pain due to CTEPD, which has not been detected by CTPA and confirmed by V/Q imaging. CASE REPORT A 60-year-old woman was born with a 6-week history of breathlessness, intermittent chest pain, and reduced mobility. No evidence of acute thromboembolic pulmonary disease or CTEPD was found in a CTPA exam performed on day 2 of admission. Rather, V/Q scintigraphy on day 6 revealed a perfusion mismatch in the right lung apex, consistent with CTEPD. CONCLUSIONS A negative CTPA does not automatically exclude CTEPD from consideration. Although there is a strong clinical concern for CTEPD, a positive CTPA investigation should still be conducted, but V/Q imaging should always be performed.
Source link: https://europepmc.org/article/MED/36395074
Objectives Since rapid access chest pain clinics were established to enhance stable chest pain diagnosis, CT coronary angiography has become the recommended investigation for patients without apparent coronary artery disease, with well-defined causes. Before RACPC, this single-centre retrospective review determined the tenability of GP-led CTCA before. Methods reviewed by RACPC route patients without having CAD electronic records were reviewed based on pre-existing CAD data. The feasibility evaluations included appropriateness for RACPC, referral medical findings versus the RACPC's assessment of CTCA registration and safety, as well as a comparison of current versus potential pathways, timelines, and hospital encounters. Patients screening met inclusion criteria, and the result of 106/172 patients was deemed "inclusion" by the time. Conclusion Without pre-existing CAD, a hypothetical GP-led CTCA pathway would have been safe and effective in a real-world RACPC patient cohort without pre-existing CAD. Advances in knowledge GP-led CTCA is a cost-effective and safe route for patients without pre-existing CAD, reducing hospital visits required and speed to diagnosis.
Source link: https://europepmc.org/article/MED/36377676
According to the new study of patients with chest pain or people with chronic coronary syndromes, 1,2. This report is divided into the following areas: impact of the availability of evidence in guideline development; versatility of echocardiography in the assessment of chest pain; and the inimitable role of echo Doppler echocardiography in the assessment of dyspnea; and the future role of echocardiography in assessing CP and dyspnea.
Source link: https://europepmc.org/article/MED/36375734
Case report The 52-year-old man who was attending the cardiac surgery clinic for pulmonary thromboedemectomy evaluation was sent by the cardiac surgery clinic. A filling hole was identified at the bifurcation of the main pulmonary artery. A CT pulmonary angiogram at the time showed a filling defect at the bifurcation of the main pulmonary artery. Mild mitral valve regurgitation was noted in a transthoracic echocardiogram, but otherwise, the findings were normal. A new extension has completely closed the right main pulmonary artery, despite the initial presentation a persistent filling defect at the level of the pulmonary artery bifurcation. With a mean pulmonary artery pressure of 50 mm Hg, a pulmonary angiogram revealed complete occlusion and right heart catheterization revealed pre-capillary pulmonary hypertension. The results of his lupus anticoagulant test were positive, but he did not meet the criteria for antiphospholipid syndrome because he was negative for anticardiolipin and u03b2 2 glycoprotein antibodies.
Source link: https://europepmc.org/article/MED/36344135
BACKGROUND In chest pain patients presenting to emergency departments, there are elevated levels of high-sensitivity cardiac troponin levels not related to type 1 myocardial infarction. The differentiation of these patients from those with type 1 myocardial infarction is both difficult and costly. Methods We estimated the hs-cTnI/TnI or hs-cTnT ratio in 888 chest pain patients with hs-cTnI or hs-cTnT levels above the appropriate 99th percentile at 2 hours from presentation. Conclusions The median hs-cTn I/T ratio was 3. 45 in type 1 MI patients, 1. 18 in type 2 MI patients, and 0. 67 in patients without MI. Conclusions The hs-CTn I/T ratio in chest pain patients with elevated hs-cTn may be helpful in early diagnosis of type 1 MI and its discrimination from type 2 MI in chest pain patients with elevated hs-cTn. Differences in hs-cTn I/T ratio values can indicate variations in hs-cTn release mechanisms in response to various types of myocardial disease.
Source link: https://europepmc.org/article/MED/36318533
Background Noncardiac chest pain is a medical condition that has often been ignored after cardiac specialists have failed to produce a concrete diagnosis to explain whether a single episode or recurrent episodes of chest pain can be explained. Discussion Despite its generally positive prognosis, NCCP is a cause of significant morbidity and can be responsible for significant personal expense and healthcare expenses, as well as a significant personal expense and healthcare burden. NCCP is frequently associated with digestive disorders, such as gastro-oesophageal reflux disease and oesophageal spasm.
Source link: https://europepmc.org/article/MED/36309997
Aims Patients with chest pains in the emergency department need urgent coronary syndrome evaluation. Methods and findings This report used the IMPACT and ADAPT study databases to compile a combined cohort of 3496 adults with chest pain between 2007 and 2014, with early cTn testing during ED workups. Patients in AF were less likely to have a slight rise in Type 2 myocardial infarction diagnoses, according to a relative rise in the specificity of initial cTn testing for T1MI diagnosis in comparison to those not in AF. Conclusion In the absence of AF, the specificity of serial cTn testing for the diagnosis of T1MI in patients presenting to ED with chest pain is reduced. To determine whether optimised cTn thresholds for patients with AF can improve workup and results, further research is required.
Source link: https://europepmc.org/article/MED/35925661
Background and objective An investigation of carotid artery plaque the development of a coronary artery plaque in outpatients referred to coronary angiography indicates coronary artery disease. Patients with suspected cardiac ischemia in the emergency department were expected to have high adverse cardiac events within 30 days of sonographer-performed FOVUS. Methods We conducted a prospective cohort study of patients with chest pain presenting to a tertiary care ED with an electrocardiogram and cardiac troponin testing. Conclusions The presence of a carotid plaque on sonographer-performed FOVUS is associated with 30-day MACE in ED patients presenting with chest pains. Emergency physicians' careers should investigate FOVUS in conjunction with well-established clinical decision rules for chest pain, as well as the benefits of increased training and quality enhancements in the practice of FOVUS.
Source link: https://europepmc.org/article/MED/36315347
Aims and aim To investigate the experiences of patients with non-cardiac chest pain and cardiac anxiety regarding enrollment in an internet-based cognitive behavioral therapy service. Background Non-cardiac chest pain is common and contributes to cardiac instability. A potential solution to reduce cardiac anxiety in these patients using Internet-delivered cognitive behavioral therapy may be a viable option to reduce cardiac anxiety. Despite chest pain, the second program, 'The catalyst,' described the service as a catalyst, was flexible, reliable, and helpful, and the last category, 'Learning to live with chest pain,' was described as a means for building the endurance and skills to live a healthy life. Relevance to clinical practice Implication of behavioural therapy A bespoke internet-based cognitive behavioural therapy service delivered by a nurse therapist with clinical knowledge of the patient group can be useful in alleviating cardiac distress.
Source link: https://europepmc.org/article/MED/36303332
The aim of this research was to determine various lifestyle and societal causes that influence self-rated wellbeing in non-cardiac chest pain patients. SRH was attributed to depression, pain intensity, and physical fitness in women NCCP patients. The results on the predicting factors of SRH in NCCP patients provide potential insight into more advanced clinical management of NCCP.
Source link: https://europepmc.org/article/MED/36303095
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