Changes in the Numeric Descriptive Scale for Pain After Sublingual Nitroglycerin Do Not Predict Cardiac Etiology of Chest Pain

Diercks, Deborah B.; Boghos, E.; Guzman, H; Amsterdam, Ezra A.; Kirk, J. Douglas

doi:10.1016/j.annemergmed.2004.12.009

Cited by 40 publications

(14 citation statements)

References 10 publications

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“…This study corroborates recent work done by Shry and colleagues, 15 Henrikson and coworkers, 16 and Diercks and associates 17 ( Table 2). Several important differences exist between those studies and ours.…”

Section: Discussionsupporting

confidence: 83%

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Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

Steele

McNaughton

McConahy

et al. 2006

CJEM

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Introduction:It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin. Objective: To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain. Design: Prospective observational cohort study with a 4-week follow-up of patients enrolled. Setting: Academic tertiary care hospital, with 60 000 visits/year. Inclusion criteria: Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain. Exclusion criteria: Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization. Results: 270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%-80%), and the specificity was 37% (34%-41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96-1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate. Conclusions: Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain. RÉSUMÉ Introduction :On croit souvent que la douleur thoracique soulagée par la nitroglycérine indique que cette douleur est attribuable à une insuffisance coronarienne. Objectif : Déterminer si le soulagement de la douleur thoracique à l'aide de la nitroglycérine peut servir de test diagnostique permettant de différencier la douleur thoracique d'origine cardiaque de la douleur d'origine non cardiaque. Méthodologie : Étude prospective par observation de cohortes avec un suivi après 4 semaines des patients inclus dans l'étude. Cadre : Hôpital universitaire de soins tertiaires recevant 60 000 visites/année. Critères d'inclusion : Les patients adultes s'étant présentés à l'urgence pour une douleur tho- ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

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Section: Discussionsupporting

confidence: 83%

“…14 Recent studies have failed to show the diagnostic utility of NTG. [15][16][17] By more clearly defining NTG pain relief, avoiding the use of confounding pain medications (e.g., morphine) and by ensuring a more rigorous patient followup, this study aims to confirm the danger of relying on pain relief with NTG as a diagnostic strategy.…”

Section: Introductionmentioning

confidence: 99%

Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

Steele

McNaughton

McConahy

et al. 2006

CJEM

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“…Amerikan Kalp Cemiyeti (AHA) ve Amerikan Kardiyoloji Derneği (ACC), AS'lerde AKS ön tanısı için kullandığı kılavuzlar-da, göğüs ağrısının şiddetinden çok koroner arter hastalığı olma ihtimalini başvuru anındaki ağrı karakterine, fizik muayene bulgularına, EKG analizi ve kardiyak enzimler gibi bazı parametrelere dayandırmışlardır. [8] Bu sınıflamalarda semptom sırasında hastaların EKG'lerinde 0.5 milimetre ST segment değişikliğinin olması, troponin yüksekliğinin bulunması ve göğüs ağrısının tipik karakterde olması hastanın AKS Çalışmamız tamamlandığı süre içinde hastaların EKG bulguları ve ağrı karakteri ile AKS olma olasılığı arasındaki ilişkiyi değerlendiren birçok literatür bulunmasına rağmen, AS'ye göğüs ağrısı ile başvuran hastalarda, ağrı şiddeti ile eşza-manlı olarak çekilen EKG'lerin ST segmentindeki değişiklik-lerin ve AKS ilişkisini araştıran çalışma bulunmamaktadır. Bu nedenle bulgularımızı evrensel verilerle karşılaştırma imkanı bulamamak çalışmamızın en büyük dezavantajı olarak karşı-mıza çıkmıştır.…”

Section: Discussionunclassified

The Relation Between The Intensity Of Chest Pain Of The People Who Applied To Emergency Room With Their Chest Pain Complaints With St Segment Changes And Acute Coronary Syndrome

Dedeoglu

Topaçoğlu²

2011

Tr J Emerg Med

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SUMMARY Objectives In this study, we aimed to reveal the relationship between the intensity of chest pain and likelihood of ACS and ST segment deviation in electrocardiography (ECG) of the patients who presented with chest-pain. Methods Total ÖZET AmaçÇalışmamızda, acil servise göğüs ağrısı ile başvuran hastaların, gö-ğüs ağrısı şiddeti ile eşzamanlı EKG'de bulunan ST segmenti deği-şikliklerinin ilişkisini ve akut koroner sendrom (AKS) olasılığını ortaya koymak amaçlandı. Gereç ve YöntemÇalışmaya acil servise (AS) ardışık olarak göğüs ağrısı şikayeti ile başvuran 18 yaşından büyük 232 hasta alındı. Hastaların AS'ye gelişlerinde, göğüs ağrısının şiddetini gösteren geliş Nümerik Derecelendirme Ölçeği (NRS) skorları ile EKG'deki ST segment değişik-liği, AKS olasılığı ve troponin I düzeyleri arasındaki ilişkiler analiz edildi. BulgularÇalışmaya 232 hasta alındı, 129'u (%55.6) erkekti. Hastaların geliş NRS ortalamaları 5.5±2.8 olarak saptandı. Acil servise geliş EKG'lerinde ST segment değişikliği saptanan 96 hastanın (%41.4) geliş NRS ortalamaları 5.7±2.8 tespit edilirken, geliş EKG'si normal olan 136 (%58.6) hastanın 5.3±2.8 olarak bulundu (p=0.281). Akut koroner sendrom tanısı alan 126 hastanın geliş NRS ortalamaları 5.4±2.8 iken, AKS tanısı almayan 106 hastanın 5.5±2.9 olarak saptandı (p=0.853). SonuçÇalışmamızda göğüs ağrısı şiddetinin hastaların AKS olup olmaması ve EKG'deki ST segment değişikliğini göstermesi üzerine etkisinin olmadığı görülmüştür.Anahtar sözcükler: Akut koroner sendrom; elektrokardiyografi; göğüs ağrı-sı; ST değişikliği.

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“…Five studies (LOE D3 68,78,105 ; LOE D4 106,107 ) using reduction in pain after nitroglyercin administration as an end point, found that reduction of pain does not reliably identify presence of ACS.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Changes in the Numeric Descriptive Scale for Pain After Sublingual Nitroglycerin Do Not Predict Cardiac Etiology of Chest Pain

Cited by 40 publications

References 10 publications

Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

The Relation Between The Intensity Of Chest Pain Of The People Who Applied To Emergency Room With Their Chest Pain Complaints With St Segment Changes And Acute Coronary Syndrome

Part 9: Acute Coronary Syndromes

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