Online ISSN: 2515-8260

Keywords : chest pain


Evaluation of the HEART Score for Chest Pain Patients at the Emergency Department: An Institutional Based Study

Vivek Tripathi, Mohit Sikka, Ravindra Keshavrao Nitturker

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 5935-5938

Background: Chest pain representing acute coronary syndrome (ACS) is the most common reason patients presenting to the emergency department (ED) are admitted to the hospital. This study was a prospective validation of the HEART score for chest pain patients at the emergency department.
Materials & Methods: Patients admitted to the cardiac emergency department due to chest pain irrespective of age were included in the study. Complete patient history was taken. Only the troponin value of the first blood sample was used for the HEART score calculation. The primary endpoint in this study was the occurrence of a major adverse cardiac event (MACE), within six weeks of initial presentation. Statistical analysis was performed with R (Version 2.9; The R foundation for Statistical Computing, Vienna, Austria).
Results: In the present study total patients included were 400 in which total males were 72.5%. 15% patients had a history of AMI, 10.5% had history of CABG, 21.25% patients had history of PCI, 4.25% patients had history of stroke and 4% patients had history of peripheral arterial disease. 90 patients had MACE<6 weeks and 310 patients had no MACE<6 weeks. In the present study 90 patients had MACE<6 weeks and 310 patients had no MACE<6 weeks. The five elements of the HEART score differed significantly between the groups with and without MACE.
Conclusion: The present study concluded that HEART score differed significantly between the groups with and without MACE.

Clinical, angiographic profile and follow-up of patients with myocardial bridges at a tertiary hospital

Neha Mukesh Goel, Pranav Shamraj, Amit Bhalerao, Sagar Subhash Nanaware

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 6832-6837

Background: Myocardial bridging can occasionally generate clinically important complications, despite usually being a benign condition. Myocardial bridging can be associated with stable and unstable angina, myocardial infarction, myocardial stunning, atrioventricular nodal block, ventricular tachycardia and sudden death. Present study was aimed to study clinical, angiographic profile and follow-up of patients with myocardial bridges at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in patients, >18 years, of both sexes, who underwent diagnostic conventional coronary angiography. Myocardial bridge (MB) was identified based on narrowing of coronary artery in systolic phase resulting in at least 50% reduction of luminal diameter in comparison with the diastolic phase.
Results: During study period, out of 1962 diagnostic conventional coronary angiography procedures satisfying study criteria, myocardial bridge (MB) was noticed in 81 cases, incidence was 4.13 %. Common indications for diagnostic conventional coronary angiography among patients of myocardial bridge (MB) were unstable angina (USA) (19.75 %), STEIWMI (18.52 %), chronic stable angina (CSA) (16.05 %), STEAWMI (13.58 %), atypical chest pain (9.88 %), Others (8.64 %), pre-surgery (8.64 %) & NSTEMI (4.94 %). In patients of myocardial bridge (MB) on follow up symptoms noted were atypical chest pain (38.27 %), dyspnoea on exertion (27.16 %) & chest pain (23.46 %). On follow up, myocardial bridge (MB) was associated with 2 cases of acute myocardial infarction, no major adverse cardiac events, myocardial ischemia or cardiovascular death noted.
Conclusion: Clinical suspicion of Myocardial bridges should be considered in young patients with acute coronary syndrome with typical or atypical chest pain, though casual association needs further studies with larger sample size & longer follow up.

A STUDY ON PERSISTENT SYMPTOMS IN PATIENTS WHO WERE DISCHARGED FROM A DEDICATED COVID HOSPITAL INTENSIVE CARE UNIT (ICU)

Dr. Hema.HA,Dr. Shruthi Jayaram, Dr. Ravi. S, Dr. Lakshmeesha.T

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2034-2039

Introduction: A significant proportion of patients who had COVID-19 have experienced symptoms persisting even weeks after recovery from the acute phase of infection. For some patients the symptoms were mild but few have experienced moderate to severe symptoms hampering their daily routine. Studies to know the long term effects of COVID-19 are needed to effectively plan healthcare delivery.
Aim: To know the persistent symptoms in patients who were discharged from a dedicated COVIDhospital’s intensive care unit (ICU).
Materials and Methods: In this cohort studyfour hundred and forty six patients with laboratory confirmed COVID 19, who were treated and discharged from intensive care unit(ICU) between April 2019 to Nov 2019 were included. The telephonic survey was done four times in three months after being discharged. First follow up was on the15th day of discharge, second on the first month of discharge, third follow up on the second month of discharge and the fourth at the end of third month. Patients were asked to retrospectively recollect the symptoms which were present during the acute phase of the disease and if those symptoms or any new symptoms are present now.
Results: Tiredness(fatigue), dyspnea, cough and chest pain were the common symptoms observed. Among 446 patients followed up, 37.4% had no symptoms at the first follow up and 87% were symptom free by the end of third month. 26.09% complained of tiredness at the 15th day of discharge, but only 4.4% of them complained of this symptom at the end of third month. Dyspnea was seen in 21.5% of patients in the first follow up and by the end of third month none of them had dyspnea. There was a gradual decline in number of patients having cough from 19.5% in the first follow up to 0.24% in the last follow up. Chest pain was seen in 7% of the patients on the 15th day of discharge and was seen only in 0.24% of them at the end of third month. Out of 446 patients followed up for a period of three months we observed a mortality of 6.27%.
Conclusion: Patients experience persistent symptoms even after recovering from COVID 19infection and getting discharged from intensive care unit. There is a need for follow up and assessment of discharged patients to know to what extent these symptoms have affected them physically and mentally.
 

Assessment Of 120 Cases Of Pleural Effusion Underwent Medical Thoracoscopy

Jagpoornima Katoch; R. S. Negi; S. K. Sharma; Sunil Sharma; Malay Sarkar; Sanjeev Prabhakar; Ranjit Kaur

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 1069-1074

Background: The present study was conducted to determine 120 cases of pleural effusion underwent medical thoracoscopy.
Materials & Methods: 120 patients who underwent medical thoracoscopy in 79 Males and 41 females were recruited. Diagnostic pleural aspiration was done and the pleural fluid was analyzed for sugar, protein, Lactate dehydrogenase (LDH), Adenosine deaminase (ADA), gram-stain, Acid-fast bacilli (AFB) smear, culture, CBNAAT, and cytological analysis. Patients with unhelpful results of pleural fluid analysis (Light’s criteria) underwent medical thoracoscopy and pleural biopsy.
Results: 98 (81.7%) had pleural effusion on (CE-CT) thorax as 6 (5%) had mass lesion on left side where 6 (5%) had lesion on right side, 10 (8.3%) had other findings like passive collapse, consolidation, atelectasis, mediastinal lymphadenopathy. 13 (10.8%) patients had edematous mucosa on FOB, 19 (15.85%) patients had external compression on FOB, whereas 77 (64.2%) had the normal study on bronchoscopy, whereas 11 (9.2%) had other findings like anthracotic patches. 38 (31.7%) had inflammation, sago grain like nodules, adhesions on thoracoscopy, 25 (20.8%) had inflammation and adhesions, 51 (42.5%) had inflammation with nodules/masses/plaques, 2 (1.7%) had necrotic/ulcerative/other lesions on thoracoscopy. Conclusion: Medical diagnostic thoracoscopy should be considered in all patients having undiagnosed pleural effusion and fit for medical thoracoscopy