Documents

Acute Coronary Syndrome Differential Diagnoses.pdf

Description
4/6/2014 Acute Coronary Syndrome Differential Diagnoses http://emedicine.medscape.com/article/1910735-differential 1/10 Acute Coronary Syndrome Differential Diagnoses Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD more... Updated: Mar 12, 2014 Diagnostic Considerations As many as half of all cases of ACS are clinically silent in that they do not cause the classic symptoms of this syndrome. Consequently, ACS goes unrecognized by the patient. Maintain a high index of susp
Categories
Published
of 10
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  4/6/2014 Acute Coronary Syndrome Differential Diagnoseshttp://emedicine.medscape.com/article/1910735-differential 1/10 Acute Coronary Syndrome Differential Diagnoses  Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD more...   Updated: Mar 12, 2014   Diagnostic Considerations  As many as half of all cases of ACS are clinically silent in that they do not cause the classic symptoms of thissyndrome. Consequently, ACS goes unrecognized by the patient. Maintain a high index of suspicion for ACS,especially when evaluating women, patients with diabetes, older patients, patients with dementia, and thosewith a history of heart failure. Although ST-segment and T-wave changes are associated with CAD, alternative causes of these findings areleft ventricular aneurysm, pericarditis, Prinzmetal angina, early repolarization, Wolff-Parkinson-Whitesyndrome, and drug therapy (eg, with tricyclic antidepressants, phenothiazines).Increasing public awareness of the typical and atypical presentations of ACS is of the utmost importance for optimal and timely treatment. Many patients do not recognize that their symptoms are cardiac in srcin andtherefore may delay seeking medical help. Guidelines from the European Society of Cardiology(ESC)/American College of Cardiology (ACC)/American Heart Association (AHA) recommend that patients withestablished CAD call emergency medical services if they have chest pain that does not resolve after they takea sublingual nitroglycerin tablet.In patients presenting to the ED with chest pain, a structured diagnostic approach that includes time-focusedED decision points, brief observation, and selective application of early outpatient provocative testing appearedboth safe and diagnostically efficient in a study by Scheuermeyer et al. However, some patients with ACS maybe discharged for outpatient stress testing on the index ED visit. [13] Differential Diagnoses  Anxiety Aortic Stenosis AsthmaCardiomyopathy, DilatedEsophagitisGastroenteritisHypertensive Emergencies in Emergency MedicineMyocardial InfarctionMyocarditisPericarditis and Cardiac Tamponade   Today NewsReferenceEducationLog Out My Account A NovaliaDiscussion   Contributor Information and Disclosures  Author  David L Coven, MD, PhD  Assistant Professor of Clinical Medicine, Columbia University College of Physiciansand Surgeons; Director, Cardiology Outpatient Clinic, St Luke's Site, Attending Physician, Department of Medicine, Division of Cardiology, St Luke's-Roosevelt Hospital Center  4/6/2014 Acute Coronary Syndrome Differential Diagnoseshttp://emedicine.medscape.com/article/1910735-differential 2/10 David L Coven, MD, PhD is a member of the following medical societies:  American College of Physicians, American Medical Association, and Massachusetts Medical SocietyDisclosure: Nothing to disclose.Coauthor(s) Arun Kalyanasundaram, MD, MPH  Interventional Cardiology Fellow, Department of Cardiology, ClevelandClinic  Arun Kalyanasundaram, MD, MPH is a member of the following medical societies:  American College of Cardiology,  American College of Physicians,  American Heart Association, Society for Cardiac Angiography and Interventions, Society of General Internal Medicine, Society of Hospital Medicine, and Southern Medical  AssociationDisclosure: Nothing to disclose. Jamshid Shirani, MD  Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory,Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network Jamshid Shirani, MD is a member of the following medical societies:  American Association for the Advancement of Science,  American College of Cardiology,  American College of Physicians,  American Federation for Medical Research,  American Heart Association,  American Society of Echocardiography, and  Association of Subspecialty Professors Disclosure: Nothing to disclose.Chief Editor  Eric H Yang, MD  Associate Professor of Medicine, Director of Cardiac Catheterization Laboratory andInterventional Cardiology, Mayo Clinic Arizona Eric H Yang, MD is a member of the following medical societies:  Alpha Omega AlphaDisclosure: Nothing to disclose. Additional Contributors Craig T Basson, MD, PhD  Gladys and Roland Harriman Professor of Medicine, Director of the Center for Molecular Cardiology, Director of Cardiovascular Research, Division of Cardiology, Department of Medicine,Weill Cornell Medical College; Attending Physician, New York Presbyterian HospitalCraig T Basson, MD, PhD is a member of the following medical societies:  American College of Cardiology and American Heart AssociationDisclosure: Nothing to disclose. Edward Bessman, MD, MBA  Chairman and Clinical Director, Department of Emergency Medicine, JohnHopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns HopkinsUniversity School of MedicineEdward Bessman, MD, MBA is a member of the following medical societies:  American Academy of EmergencyMedicine,  American College of Emergency Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; ViceChair, Department of Emergency Medicine, Massachusetts General HospitalDavid FM Brown, MD is a member of the following medical societies:  American College of EmergencyPhysicians and Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Steven J Compton, MD, FACC, FACP  Director of Cardiac Electrophysiology, Alaska Heart Institute,Providence and Alaska Regional Hospitals  4/6/2014 Acute Coronary Syndrome Differential Diagnoseshttp://emedicine.medscape.com/article/1910735-differential 3/10 Steven J Compton, MD, FACC, FACP is a member of the following medical societies:  Alaska State Medical Association,  American College of Cardiology,  American College of Physicians,  American Heart Association,  American Medical Association, and Heart Rhythm SocietyDisclosure: Nothing to disclose. Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor,Division of Emergency Medicine, Harvard Medical SchoolGary Setnik, MD is a member of the following medical societies:  American College of Emergency Physicians,National Association of EMS Physicians, and Society for Academic Emergency MedicineDisclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Managementposition; ProceduresConsult.com Royalty Other  Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Medscape Salary Employment References 1. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronarysyndromes in patients presenting without persistent ST-segment elevation: The Task Force for themanagement of acute coronary syndromes (ACS) in patients presenting without persistent ST-segmentelevation of the European Society of Cardiology (ESC). Eur Heart J  . Sep 21 2011;[Medline].2. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus documentof The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinitionof myocardial infarction. J Am Coll Cardiol  . Sep 2000;36(3):959-69. [Medline].3. O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, et al. Part 9: acute coronarysyndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and EmergencyCardiovascular Care Science With Treatment Recommendations. Circulation . Oct 19 2010;122(16 Suppl2):S422-65. [Medline].4. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med  . Oct 31 1996;335(18):1342-9. [Medline].5. Heidenreich PA, Alloggiamento T, Melsop K, McDonald KM, Go AS, Hlatky MA. The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol  . Aug 2001;38(2):478-85. [Medline].6. Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP. What is the optimal blood pressure in patientsafter acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in thePRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction(PROVE IT-TIMI) 22 trial. Circulation . Nov 23 2010;122(21):2142-51. [Medline].7. [Best Evidence] LeLeiko RM, Vaccari CS, Sola S, Merchant N, Nagamia SH, Thoenes M, et al.Usefulness of elevations in serum choline and free F2)-isoprostane to predict 30-day cardiovascular outcomes in patients with acute coronary syndrome.  Am J Cardiol  . Sep 1 2009;104(5):638-43. [Medline].8. Ma RC, Tong PC. Testosterone levels and cardiovascular disease. Heart  . Nov 2010;96(22):1787-8.[Medline].9. Sanchis J, Nunez J, Bodí V, et al. Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome. Mayo Clin Proc  . Apr 2011;86(4):291-6. [Medline]. [Full Text]. 10. Gurm HS, Gore JM, Anderson FA Jr, et al. Comparison of Acute Coronary Syndrome in PatientsReceiving Versus Not Receiving Chronic Dialysis (from the Global Registry of Acute Coronary Events[GRACE] Registry).  Am J Cardiol  . Jan 1 2012;109(1):19-25. [Medline].11. Chughtai H, Ratner D, Pozo M, et al. Prehospital delay and its impact on time to treatment in ST-  4/6/2014 Acute Coronary Syndrome Differential Diagnoseshttp://emedicine.medscape.com/article/1910735-differential 4/10 elevation myocardial infarction.  Am J Emerg Med  . May 2011;29(4):396-400. [Medline].12. Than M, Cullen L, Reid CM, Lim SH, Aldous S, Ardagh MW, et al. A 2-h diagnostic protocol to assesspatients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observationalvalidation study. Lancet  . Mar 26 2011;377(9771):1077-84. [Medline].13. Scheuermeyer FX, Innes G, Grafstein E, et al. Safety and Efficiency of a Chest Pain Diagnostic AlgorithmWith Selective Outpatient Stress Testing for Emergency Department Patients With Potential IschemicChest Pain.  Ann Emerg Med  . Jan 4 2012;[Medline].14. Keller T, Zeller T, Ojeda F, et al. Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction. JAMA . Dec 28 2011;306(24):2684-93. [Medline].15. O'Neil BJ, Hoekstra J, Pride YB, Lefebvre C, Diercks D, Frank Peacock W, et al. Incremental benefit of 80-lead electrocardiogram body surface mapping over the 12-lead electrocardiogram in the detection of acute coronary syndromes in patients without ST-elevation myocardial infarction: Results from theOptimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction(OCCULT MI) trial.  Acad Emerg Med  . Sep 2010;17(9):932-9. [Medline].16. Damman P, Holmvang L, Tijssen JG, et al. Usefulness of the Admission Electrocardiogram to PredictLong-Term Outcomes After Non-ST-Elevation Acute Coronary Syndrome (from the FRISC II, ICTUS, andRITA-3 [FIR] Trials).  Am J Cardiol  . Jan 1 2012;109(1):6-12. [Medline].17. Damman P, Wallentin L, Fox KA, et al. Long-Term Cardiovascular Mortality After Procedure-Related or Spontaneous Myocardial Infarction in Patients With Non-ST-Segment Elevation Acute CoronarySyndrome: A Collaborative Analysis of Individual Patient Data From the FRISC II, ICTUS, and RITA-3Trials (FIR). Circulation . Jan 31 2012;125(4):568-76. [Medline].18. Iliou MC, Fumeron C, Benoit MO, Tuppin P, Calonge VM, Moatti N, et al. Prognostic value of cardiacmarkers in ESRD: Chronic Hemodialysis and New Cardiac Markers Evaluation (CHANCE) study.  Am J Kidney Dis . Sep 2003;42(3):513-23. [Medline].19. Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, et al. Cardiac troponinT levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med  . Oct31 1996;335(18):1333-41. [Medline].20. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammationin relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin duringInstability in Coronary Artery Disease. N Engl J Med  . Oct 19 2000;343(16):1139-47. [Medline].21. Newby LK, Christenson RH, Ohman EM, Armstrong PW, Thompson TD, Lee KL, et al. Value of serialtroponin T measures for early and late risk stratification in patients with acute coronary syndromes. TheGUSTO-IIa Investigators. Circulation . Nov 3 1998;98(18):1853-9. [Medline].22. Lindahl B, Venge P, Wallentin L. Relation between troponin T and the risk of subsequent cardiac eventsin unstable coronary artery disease. The FRISC study group. Circulation . May 1 1996;93(9):1651-7.[Medline].23. Stubbs P, Collinson P, Moseley D, Greenwood T, Noble M. Prognostic significance of admission troponinT concentrations in patients with myocardial infarction. Circulation . Sep 15 1996;94(6):1291-7. [Medline].24. Apple FS, Parvin CA, Buechler KF, Christenson RH, Wu AH, Jaffe AS. Validation of the 99th percentilecutoff independent of assay imprecision (CV) for cardiac troponin monitoring for ruling out myocardialinfarction. Clin Chem . Nov 2005;51(11):2198-200. [Medline].25. Eggers KM, Oldgren J, Nordenskjöld A, Lindahl B. Diagnostic value of serial measurement of cardiacmarkers in patients with chest pain: limited value of adding myoglobin to troponin I for exclusion of myocardial infarction.  Am Heart J  . Oct 2004;148(4):574-81. [Medline].26. Macrae AR, Kavsak PA, Lustig V, Bhargava R, Vandersluis R, Palomaki GE, et al. Assessing therequirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies. Clin Chem . May 2006;52(5):812-8.[Medline].27. Kavsak PA, MacRae AR, Newman AM, Lustig V, Palomaki GE, Ko DT, et al. Effects of contemporary
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks