Acute chest pain

Fleeschen, C., Goldmann, B. U., Langenbrink, L., Matschuck, G. and Flamm, C. W. Evaluation of a rapid whole blood elisa for quantitation of troponin I in patients with acute chest pain , Clin. Chem., 45,1789-1796 (1999). 

Oral sublingual tablets or spray, 0.4 mg for acute chest pain. Sustained-release patches give 0.4-0.8 mg-h-1. 

Hamm CW, Goldmann BU, Heeschen C, et al, Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I, N Engl J Med 1997 337(23) 1648-1653. 

Montrosi F Briganti I, Salonia A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angio-graphically documented coronary artery disease. Eur Urol 2003 44 360-365. 

At age 12, the patient was admitted with acute chest pain from a left spontaneous pneumothorax (air within the pleural cavity).This required hospitalization and chest tube insertion, but he recovered without sequelae. After the resolution of this problem, pulmonary function testing revealed findings of both severe airway obstruction and destruction of alveolar lung tissue, consistent with emphysema. No further pulmonary problems occurred until the patient was age 16 years, when he developed occasional episodes of bronchospasm (spasmodic contraction of the smooth muscles of the bronchus). Pulmonary function studies at that time, though improved from those immediately following his pneumothorax, still revealed combined obstructive and destructive lung disease. 

A 30-year-old man, a cocaine sniffer, who had used cocaine more than five times a month for 4 years, complained of shortness of breath and acute chest pain. He had episodic cough and bloody sputum. A chest X-ray showed an 80% pneumothorax on the left side. On thoracoscopy the entire lung visceral pleura seemed to be covered by fibrinous exudate. After yttrium aluminium garnet (YAG) laser pleurodesis surgery, which abrades the pleura, he made a full recovery within 4 days. 

Sharkey SW, Glitter MJ, Goldsmith SR. How serious is cocaine-associated acute chest pain syndromes after cocaine use. Cardiol Board Rev 1992 9 58-66. 

White DA, Schwartzberg LS, Kris MG, Bosl GJ. Acute chest pain syndrome during bleomycin infusions. Cancer 1987 59(9) 1582-5. 

In a review of 114 cases, coronary anatomy, defined either by angiography or autopsy, was normal in 38% of chronic cocaine users who had had a myocardial infarction (20). The authors of another review concluded that the vast majority of patients dying with cocaine toxicity, either have no pathological changes in the heart, or only minimal changes (21). There can be a delay between the use of cocaine and the development of chest pain (44). The results of a study of 101 consecutive patients admitted with acute chest pain related to cocaine suggested that it commonly causes chest pain that may not be secondary to myocardial ischemia (45). The use of intranasal cocaine for therapeutic purposes (to treat epistaxis) was associated with myocardial infarction in a 57-year-old man with hypertension and stable angina (46). 

What is the drug of choice for acute chest pain ... 

Heeschen C, Dimmeler S, Fichtlscherer S, Hamm CW, Berger J, Simoons ML, et al. Prognostic value of placental growth factor in patients with acute chest pain. JAMA 2004 291 435-41. 

Patients with acute chest pain role of the ECG and its correlations... 

Despite substantial progress in the diagnosis and treatment of STE-ACS and the evidence that PCI is the preferred method of reperfusion if it can be performed in a timely manner, the implementation of this knowledge in clinical practice has been variable (Henry et ah, 2006). To improve that it is necessary to develop a coordinate system of care that has to start taking ECG to all patients with acute chest pain and improving the diagnostic accuracy of all health care professionals involved in emergency services. 

Lee TH, Cook EF, Weisberg M et al. Acute chest pain in the emergency room identification and examination of low-risk patients. Arch Intern Med 1985 145 65. 

Nitroglycerin must be taken sublingually, not as a paste, during acute chest pain to achieve rapid effect of the medication. 

A 43-year-old woman mistakenly took venlafaxine 300 mg/day instead of 75 mg/day for a few days. She developed acute chest pain and dyspnea due to a takotsubo cardiomyopathy [SEDA-33, 313]. Venlafaxine was withdrawn and she recovered completely. 

Cardktvascnlar The frequency of recent cocaine use in patients with acute chest pain has been studied in Spain, where cocaine consumption has increased significantly over the past few years [10. In a 1-year study of 3363 patients with chest pain, 1240 were under 55 years of age and formed... 

Vascular emergencies play an important role amongst the various differential diagnoses for acute chest pain. Pulmonary embolism, acute aortic syndromes as well as acute coronary artery disease have to be considered.The latest scanner technology available (> 64-slice multi-detector-row spiral CT platforms) allows for a straight-forward work-up in the emergency situation. A dedicated triage based on a sophisticated clinical assessment, however, ist required. 

Acute chest pain is one of the major clinical emergency conditions. Various differential diagnoses have to be considered, some of them are potentially life-threatening. CT assessment for vascular pathologies of the chest can be split up into three major categories. Pulmonary embolism, acute aortic syndromes and coronary artery disease (CAD) require a rapid, reliable and effective diagnostic pathway allowing for an immediate therapeutic decision thereafter. A simple and objective cross-sectional modality should ideally be available on a 24/7 basis. 

In summary, modern MDCT equipment allows for a robust and straight-forward diagnostic work-up for acute chest pain in the emergency situation. The latest scanner technology guarantees a diagnostic examination quality without pre-medication even in acutely fll... 

Acute Chest Pain // DD Coronary Artery Disease... 

Fig. 18.1. a Pathway for patients with acute chest pain, in which CAD is one potential differential diagnosis. In case of a well-known CAD and a high pre-test likelihood, a percutaneous catheter intervention (PCI) should be performed. In case of non-specific symptoms, a MDCT angiography of the coronaries is technically feasible for the exclusion of CAD. b According to the results of the coronary MDCT angiography, the patient can be discharged (exclusion of relevant CAD) or should be... 

Stillman AE, Oudkerk M, Ackerman M, Becker CR, Buszman PE, de Feyter PJ, Hoffmann U, Keadey MT, Marano R, Lip-ton MJ, Raff GL, Reddy GP, Rees MR, Rubin GD, Schoepf UJ, Tamili G, van Beek EJ, Wexler L, White CS (2007) Use of multidetector computed tomography for the assessment of acute chest pain a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol 17 2196-2207... 

Fig. 21.10a,b. CTA of coronary bypass grafts, a Cross-sectional image of a patent saphenous vein graft (arrows) exhibiting severe calcified wall changes. Data of another patient (b) who presented with acute chest pain shows two venous grafts, with thrombus formation (small arrows) and total occlusion of one graft (arrowhead)... 

Schertler T et al. (2007) Dual-source computed tomography in patients with acute chest pain feasibility and image quality. Eur Radiol 17 3179-3188... 

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