Clinical and electrocardiographic profile of patients presenting with acute coronary syndrome in emergency department in a Tertiary Care Hospital (original) (raw)
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Journal of Ayub Medical College Abbottabad
Background: The HEART score is reported to be a useful tool for the assessment of suspected acute coronary syndrome (ACS) patients, however, data regarding its validity in our population is scarce. Therefore, aim of this study was to evaluate the prognostic utility of the HEART score to predict major adverse cardiac events (MACE) within 6 weeks in patients presenting to emergency department with chest pain. Methods: This prospective observational study included suspected ACS patients presented with chest pain to the emergency department of a tertiary care cardiac center. Inclusion criteria for the study were consecutive adult patients with suspected ACS, patients with definite diagnosis of ACS based on history, electrocardiography (ECG), and cardiac enzymes were excluded from the study. HEART score was calculated and patients with ≥7 score were also excluded. MACE over the 6-weeks after discharge were observed. Results: Total of 281 patients were included in this analysis, 191 (68%)...
A Comparative Study on Short-term Clinical Outcome in Acute Coronary Syndrome
Journal of Armed Forces Medical College, Bangladesh
Introduction: Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome. Objective: To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre. Materials and Methods: The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk fact...
Scripta Medica, 2020
Introduction: Acute coronary syndrome (ACS) is one of the m ost common and most dramatic manifestations of ischaemic h eart disease and distinguishing of ACS from non-cardiac chest pain represents a diagnostic challenge. Objective: Determine the frequency of ACS types: NSTEMI, STEMI and unstable angina pectoris (UAP) and examine the frequency and significance of risk factors and cardiospecific enzymes in patients with ACS. Methods: The analysis included patients who were referred from the prehospital level of the Banja Luka Primary Healthcare Centre (Emergency Department and Family Medicine Department) and treated under the ACS diagnosis in the coronary unit of the Cardiovascular Diseases Clinic of the Banja Luka University Clinical Centre of the Republic of Srpska (UCCRS) in the first 6 months of 2011. The study included patients older than 18, with recorded information on their gender, age, smoking status, hypertension, diabetes, obesity and family burden. Values of cholesterol, t...
Acute Coronary Syndrome and Its Sub-Types Among Patients Admitted in Chest Pain Unit
2017
Background: Acute coronary syndrome (ACS) is an acute emergency. It covers a wide spectrum of symptoms ranging from anginal pain to life threatening emergencies of myocardial infarctions. ACS can end up in various complications. Objective: To determine the patterns of acute coronary syndrome, in cases presenting to chest pain unit of Sheikh Zayed Hospital, Rahim Yar Khan. Methodology: This cross sectional study was carried out at chest pain unit at (CPU), Emergency Department, Sheikh th th Zayed Hospital, Rahim Yar Khan from 15 January to 16 July 2015. The cases with age range of 30 to 80 years with typical chest pain and ECG changes were included. The case with end stage renal failure, electrolyte imbalance, trauma, and documented cases of IHD were excluded from the study. The cases with ST segment elevation were labeled as STEMI while with ST-T changes with raised cardiac enzymes as NSTEMI and normal enzymes as unstable angina. They were also assessed for in hospital complications...
Epidemiological profile and predictors of mortality in acute coronary syndrome: a prospective study
2018
Background: India has shown a rising trend in the prevalence of coronary artery disease (CAD) in urban as well as in rural population. Acute coronary syndrome (ACS) is the main reason for the mortality in India. Study of risk factors and biomarkers is important to catch the diagnosis early in order to decrease the mortality. Objective was to study risk factors and brain natriuretic peptide (BNP), troponine I, and CKMB and their effect on outcome in ACS patients in tertiary hospital. Methods: One hundred and fifty ACS patients were studied in Emergency Department of Medicine, Nehru Hospital, BRD Medical College, Gorakhpur from January 2017 to December 2017. Data on age sex socioeconomic status, medical history, baseline clinical characteristics, time to reach hospital and treatment in hospital, along with biomarkers including BNP, Troponin Iand CKMB was estimated. Baseline ECG was obtained at admission and repeated at 12 -24 hours and every 24 hours thereafter. A 2D Echocardiogram wa...
CLINICAL OR INTERVENTIONAL TREATMENT IN ACUTE CORONARY SYNDROME (Atena Editora)
CLINICAL OR INTERVENTIONAL TREATMENT IN ACUTE CORONARY SYNDROME (Atena Editora), 2023
Introduction: ACS has a wide clinical presentation, ranging from asymptomatic conditions to cardiac arrest, with chest discomfort being the main clinical symptom. Chest pain is a challenge for doctors in the emergency room and accounts for 5 to 10% of visits. Differentiating non-cardiac chest pain from that of cardiac origin requires attention and mastery of diagnostic methods through the patient's clinic and tests such as troponin and electrocardiogram. Given the wide prognostic range, patients must receive a risk classification and, based on these data, receive appropriate therapeutic management. Goals: The main objective of this work is to understand the diagnostic methods and procedures applicable to everyday clinical practice, remaining within the recommendations of current scientific literature. Methods: This is a narrative bibliographic review. Scientific articles selected from the VHL, PubMed and Scielo databases were consulted. The eligibility of previously selected publications was based on the most recent studies available on the topic of ACS and AMI, preferably from 2019. Conclusions: The doctor must have ready access to the main recommendations and conduct of the most relevant guidelines on the subject of ACS/AMI and be able to adapt them to the local reality. This way, this work takes into consideration practical issues, based on current references and with a direct and objective reading on which flow to establish for each patient according to the technical structure of the unit where the patient with acute coronary syndrome was admitted and thus allow decision making between clinical or interventional treatment.
Acute Coronary Syndrome: Diagnostic Evaluation
American family physician, 2017
Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. Coronary artery disease is the leading cause of mortality in the United States. Chest pain is a common presentation in patients with MI; however, there are multiple noncardiac causes of chest pain, and the diagnosis cannot always be made based on initial presentation. The assessment of a possible MI includes evaluation of risk factors and presenting signs and symptoms, rapid electrocardiography, and serum cardiac troponin measurements. A validated risk score, such as the Thrombolysis in Myocardial Infarction score, may also be useful. Electrocardiography should be performed within 10 minutes of presentation. ST elevation MI is diagnosed with ST segment elevation in two contiguous leads on electrocardiography. In the absence of ST segment elevation, non-ST elevation ACS can be diagnosed. An elevated cardiac...
European heart journal. Acute cardiovascular care, 2018
Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group (p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group (p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk (p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.
Research Paper Epidemiology and Risk Factors of Patients with Acute Coronary Syndrome
Qom University of Medical Sciences Journal, 2021
Background and Aim: Cardiovascular disease (CVD) is the most important cause of death worldwide. The incidence and outcome of risk factors differ by type of acute coronary syndrome (ACS). The aim of the present study was to determine the epidemiology and risk factors of patients with ACS in Iran. Materials and Methods: This is a cross-sectional descriptive study, which was conducted at the Heart Center Hospital, Iran on patients presenting with ACS for a period of one year. An interviewer collected data using an administered data collection form, and epidemiological patterns and risk factors were analyzed by SPSS. One-way analysis of variance (ANOVA) and Chi-square test were used to analyze the hypothesized patterns. Results: The sample included 710 patients diagnosed with ACS, with Mean±SD age of 60.4±10.27 years, of whom 509 cases (71%) were men and 201 cases (29%) were women. Regarding the type of ACS, 51% of patients were diagnosed with unstable angina (UA), 22% with non-ST elevation myocardial infarction (NSTEMI), and 27% with ST-elevation myocardial infarction (STEMI). Nearly, 37% of cases with STEMI diagnosis, 22.6% with NSTEMI diagnosis, and 16.3% with UA diagnosis were smokers, which indicates a significant association between smoking and STEMI diagnosis (P=0.003). According to the body mass index, a large percentage of the patients were overweight (49%) and only 20.7% had normal body weight. Almost 60% of cases with UA diagnosis, 57% with NSTEMI diagnosis, and 50.5% with STEMI diagnosis had hypertension (HT) (P=0.455), indicating no significant association between hypertension and UA, NSTEMI, and STEMI. About 59% of patients with NSTEMI, 53.2% of patients with UA, and 52% of patients with STEMI had dyslipidemia (P=0.569), indicating no significant association between dyslipidemia and UA, NSTEMI, and STEMI. About 40% of cases with NSTEMI, 37% with STEMI, and 33% with UA diagnosis had diabetes mellitus (P=0.508), indicating no significant association between diabetes mellitus and UA, NSTEMI, and STEMI. Conclusion: Regarding the occurrence and effect of risk factors, there are three types of ACS. It is necessary to plan to enhance the health level of these patients. Therefore, patients with ACS need special attention in order to be identified and treated as soon as possible.