急诊胸痛患者86例诊疗体会

目的提高对急诊胸痛病因的认识，并总结诊断及治疗经验。方法总结86例以胸痛为主要症状的患者的临床资料，进行病因、症状、体征、辅助检查、诊断以及治疗资料的统计和分析。结果以胸痛为主要表现的内科疾病病因以心源性胸痛为主（占62．7％），其中以心绞痛和心肌梗死常见，非心源性胸痛（占37．2％）中以支气管炎为主。结论在临床急诊工作中，导致急性胸痛的病因比较复杂，临床表现呈多样化，急诊医生应高度重视其筛查诊断，使不同病因的患者尽早得到适当治疗。     

316例胸痛患者急诊护理体会

总结了316例以胸痛为主要表现的内科疾病患者的临床资料,进行病因、症状、体征、辕助检查、诊断、治疗及护理资料的统计和分析.以胸痛为主要表现的内科疾病病因以心源性胸痛为主(69.8％),其中尤以心绞痛(53.6％)和心肌梗死(11.6％)常见,非心源性胸痛中以支气管肺炎为主(13.6％).认为在急诊患者中,导致急性胸痛的病因比较复杂,临床表现呈多样化,急诊工作中应高度重视,提高分诊的准确性,使不同病因的患者尽早得到适当治疗和相应的护理.     

胸痛中心对患者诊疗的影响

在临床工作中每天都能遇到急性胸痛的患者,因急性胸痛至门诊就诊的患者接近1/3.胸痛的病种多且复杂,大致可分为心源性胸痛和非心源性胸痛.胸痛中心(CPC)的建立对于快速鉴别胸痛类别和尽快再灌注治疗起到了重要的作用.CPC是通过多学科合作,为胸痛患者提供迅速和准确的诊断、危险评估和恰当治疗手段的综合类科室,它可以提高胸痛在...     

“胸痛中心”建设中国专家共识

“胸痛”是急诊科或心内科常见的就诊症状,涉及多个器官系统,与之相关的致命性疾病包括急性冠状动脉综合征（ACS）、肺栓塞、主动脉夹层和张力性气胸等,快速、准确地鉴别诊断心源性和非心源性胸痛是急诊处理的难点和重点。为了优化、简化、规范我国胸痛救治流程,提高我国胸痛诊断、鉴别诊断与治疗水平,减少漏诊和误诊,改善患者预后,节约医疗资源,     

改良HEART评分在心源性胸痛早期诊断中的价值

目的:研究改良HEART评分在急诊心源性胸痛早期诊断中的价值。方法:以2010年10月至2013年6月收治的以胸痛为主诉的339例急诊患者为研究对象,分别使用传统HEART评分和改良HEART评分对心源性胸痛组和非心源性胸痛组、急性心肌梗死(AMI)组和心绞痛组进行病情预后的评估和对照分析。结果:与传统HEART评分比较,改良HEART评分在心源性胸痛组和AMI组在病情及预后评估方面均有显著性差异(P0.01)。结论:改良HEART评分能快速、准确地对心源性胸痛和AMI进行病情及预后评估,可作为鉴别心源性胸痛和AMI患者生存预测和治疗决策选择的量化指标,对急诊心源性胸痛和AMI患者快速的疾病诊断和病情评估具有重要的应用价值。     

急性心源性胸痛的快速筛查

目的探讨急性心源性胸痛的快速筛查方法。方法对2005～2010年收治的413例急性胸痛患者临床表现进行分析。结果 95%的急性心源性胸痛患者通过询问病史、体格检查、辅助心肌酶、肌钙蛋白、心电图、超声心动图等检查在3小时左右可明确诊断,其中心电图检查是所有检查的关键。需要急诊医生警惕的是心肌梗死、胸腹主动脉瘤、严重心律失常、肺栓塞等引起的急性胸痛可以在问诊、体检、检查等过程中突然心跳呼吸停止,尤其要引起注意。结论心电图检查可作为筛查急性心源性胸痛流程的首选检查,简单、方便、客观。     

即时床旁超声心动图在诊断急性高危胸痛病人中的应用

目的:总结即时床旁经胸超声心动图(TTE)在急性高危胸痛患者诊断中的应用。方法:回顾性分析2019年3月至2021年5月广东省河源市人民医院诊治的244例急性胸痛患者的临床资料,并分为急性高危胸痛组63例,非急性高危胸痛组181例(对照组),比较TTE的诊断率及其在不同病因胸痛中的检测指标。结果:TTE诊断急性高危胸痛的检出率为90.5%,明显高于心电图(ECG)检出率的69.8%,P<0.05;急性心肌梗死(AMI)、主动脉夹层(AD)患者的左室舒张末容积、左室射血分数(LVEF)及AD患者的升主动脉直径与对照组均有明显差异,肺栓塞(PE)患者的右室舒张末期容积和三尖瓣环收缩期运动幅度(TAPSE)与对照组有明显差异,P均<0.05。结论:即时床旁TTE能及时快速有效辅助诊断常见急性高危胸痛,建议临床推广应用。     

胸痛患者108例的诊断与治疗

目的 提高对急诊胸痛的鉴别诊断及治疗.方法 总结108例以胸痛为主要症状患者的临床资料,进行病因、症状、体征、辅助检查以及治疗资料的统计和分析.结果 心源性胸痛占60.2％,非心源性胸痛占39.8％.结论 在临床工作中,急诊医生应高度重视其筛查诊断,使患者尽早得到正确治疗.     

建立一种新的心肌修饰清蛋白检测方法

<正>胸痛是临床常见症状,其病因多种多样,临床意义也各不相同。心源性胸痛,特别是缺血性胸痛,其临床危险性很大,所以快速正确诊断及处理至关重要。既要避免漏诊造成严重后果,又要避免不必要的住院或留观而造成医疗资源的浪费。目     

应激性心肌病的诊断与治疗

急性扩张性心肌病临床上较为少见,但是经常会引起危及生命的心血管事件。其临床表现多样,包括心源性休克、室性心律失常、类似急性心肌梗死的胸痛,早期诊断时应该注意除外一些潜在的、可逆转的病因,包括心脏毒性物质,     

Postural hypotension as the initial presentation of fulminant right ventricular myocarditis

Myocarditis can be totally asymptomatic or can manifest with chest pain syndromes, ranging from mild persistent chest pain of acute myopericarditis to severe symptoms that mimic acute myocardial infarction. About 60% of patients may have antecedent arthralgias, malaise, fevers, sweats, or chills consistent with viral infections 1 to 2 weeks before onset. Here, we report a postpartum young woman who developed postural hypotension as the first manifestation of fulminant myocarditis with initially acute “cold and dry” right-sided heart failure and cardiogenic shock. Common causes of postural hypotension include volume depletion, medications, diabetes, alcohol, infection, and varicose veins as well as dysautonomic syndromes. Fulminant myocarditis can cause cardiogenic shock. Myocardial inflammation more frequently affects localized areas of the left ventricle free wall, rarely right ventricle (RV). However, predominant RV involvement with acute right-sided heart failure and low cardiac output syndrome can be easily overlooked due to lack of typical heart failure signs. On reviewing medical literatures, we had found no report regarding the RV involvement with acute right-sided heart failure as the initial presentation of fulminant myocarditis.     

The use of benzodiazepines in the treatment of chest pain: a review of the literature

Benzodiazepines, although not listed in the American Heart Association's guidelines for the treatment of chest pain, are often used to provide symptomatic relief to patients who experience chest pain. To investigate the utility of benzodiazepines in the treatment of chest pain, the pharmacologic actions and cardiovascular effects of benzodiazepines were reviewed. In addition, a literature search regarding the use of benzodiazepines to treat patients with chest pain was conducted. The results indicated that benzodiazepines reduce anxiety, pain, and cardiovascular activation. Benzodiazepines amplify gamma-aminobutyric acid (GABA) throughout the central nervous system, and act more peripherally to reduce catecholamines. In addition, preliminary evidence indicates that benzodiazepines may cause coronary vasodilatation, prevent dysrhythmias, and block platelet aggregation, though further study is needed. Both non-cardiac chest pain (associated with musculoskeletal, esophageal, neurologic, and psychiatric conditions) and cardiac chest pain (associated with acute and chronic myocardial ischemia) seem to be effectively treated with benzodiazepines. Benzodiazepines are safe and well tolerated when administered alone or in combination with other medications. Moreover, the risk of dependence is minimal when benzodiazepines are prescribed on a short-term basis. Further study of benzodiazepines in the treatment of acute chest pain is needed to confirm these favorable actions and better define their use in the acute medical setting.     

Chest pain in a 12-year-old boy: when is it a harbinger of poor outcome?

Chest pain is usually a benign presentation in children who present to emergency departments (ED) or primary care centers. Unlike adults, where chest pain is commonly due to cardiac causes, in children the cause is more likely secondary to non-cardiac causes. Here we present a case of a child known to have hyper-eosinophilic syndrome (HES) who presented with sudden onset of chest pain and had a rapidly progressive and fatal outcome in the ED. We discuss the ED approach to the child with chest pain and review acute myocardial infarction (AMI) in children.     

Headache angina

The initial recognition of acute myocardial infarction at the time of the emergency department (ED) visit may be difficult in the absence of typical presentations such as chest pain, diaphoresis, and radiation tenderness. Headache angina, although reported in several instances in the past with variable patient outcomes, is still an uncommon phenomenon in patients with acute myocardial infarction. We report a patient with inferior myocardial infarction who presented to the ED with a complaint of severe headache and subsequent cardiogenic shock secondary to ventricular fibrillation.     

Chest pain

The purpose of this article has been to review the multiple causes of chest pain. Because acute chest pain can be the only presenting symptom of a potentially life-threatening illness, it is important that the physician identify these patients rapidly and arrange appropriate hospital care. Likewise, it is also important that the physician recognize the less severe causes of chest pain so that the patient can be appropriately reassured in the office or sent for evaluation of the cause of this pain. Although nearly every patient with acute chest pain views this pain as an emergency, the majority of patients with this type of pain presenting to a physician's office can be evaluated and reassured using only basic office skills.     

Identifying chest pain emergencies in the primary care setting

The majority of patients presenting to a primary care physician with acute chest pain will have non-life-threatening etiologies. Nevertheless, catastrophic cause of chest pain such as ACS, AD, PE, esophageal perforation, and pericarditis must be considered in the differential diagnosis. Often, these deadly conditions have atypical clinical presentations that must be recognized. Furthermore, the physical examination can be deceptively benign in patients harboring a catastrophic etiology of chest pain. By identifying these atypical presentations, recognizing the utility of the physical examination, and understanding of the limitations of traditional diagnostic imaging, primary care physicians can effectively diagnose patients who have life-threatening cause of acute chest pain.     

Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report

BACKGROUNDSpontaneous coronary artery dissection (SCAD) is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors. Chest pain is the most frequently described presenting symptom, but syncope is extremely rare. Herein, we report on a 16-year-old girl who presented with an episode of syncope occurring during a race. Despite significantly elevated troponin level, the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed. CASE SUMMARYA 16-year-old girl presented with an episode of syncope. Myocardial injury markers were positive. Echocardiography showed a mildly reduced left ventricular ejection fraction (50%). Although initially stable, she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock, necessitating emergent revascularization. Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery (LMT). Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT. Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT. A 3.5 mm × 24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT. A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation. The diagnosis of SCAD was confirmed. Transthoracic echocardiography showed an improved left ventricular ejection fraction (57%). The patient was asymptomatic during the 24-mo. follow-up period.CONCLUSIONSCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients, regardless of age.     

Eosinophilic granulomatosis with polyangiitis presenting with repetitive acute coronary syndrome,refractory coronary vasospasm,and spontaneous coronary dissection: a case report

Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of eosinophilic vasculitis that is mainly limited to small- and medium-sized arteries. Cardiac involvement is the leading cause of death in patients with EGPA. Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in middle-aged women with no or few traditional cardiovascular risk factors. EGPA manifesting as repetitive acute coronary syndrome and SCAD has not been reported. A 45-year-old woman presented with recurrent chest pain and cardiogenic shock associated with coronary vasospasm refractory to common vasodilators. Coronary angiography showed SCAD at the proximal right coronary artery. Blood tests showed significant eosinophilia. In addition to sinusitis as shown by nasal computed tomography and abnormal nerve conduction velocity, the diagnosis of EGPA was made and immunosuppression commenced. During a 20-month follow-up, the patient remained free from symptoms and adverse cardiovascular events. EGPA can involve coronary arteries and may rarely manifest as SCAD or vasospasm. We herein review the mechanism underlying coronary involvement of EGPA and emphasize special clues for its detection. Early recognition and initiation of immunosuppression therapy are important.     

Acute chest pain--it's not always the heart! What additional laboratory and diagnostic imaging is needed

Few diagnostic decisions in medicine have been more heavily researched and debated than the approach to patients with acute chest pain. In addition, the question is which patients with acute chest pain have a presentation benign enough to make discharge from the emergency department safe and appropriate despite the advances in diagnostic tests. There is always the possibility of missed diagnosis which may cause substantial morbidity and mortality. The use of algorithms or protocols is not always sufficient to avoid missed diagnosis and the individual physicians's diagnostic performance and clinical experience is as important as the best algorithm for atypical chest pain! Patients with atypical symptoms are most likely to be mistakenly discharged. This article does mainly focus on diagnostic tests including ECG and biomarkers such as troponin and D-dimer as well as the investigation by helical CT scan in patients with suspected pulmonary embolism. The article also discuss the importance of repeated assessments of biomarkers and the determination of the exact time interval between the first clinical symptoms and the presentation to the emergency department. This time interval can be very crucial for the diagnostic work-up of patients with acute chest pain.