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

Steele, R.; McNaughton, Timothy; McConahy, M.L.; Lam, J.K.

doi:10.1017/s1481803500013671

Cited by 20 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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...

show abstract

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

show abstract

“…Another common belief is that if a patient's ANTCP is relieved by GTN then it is likely of cardiac origin. Contradicting this belief, several studies have shown there is no correlation between relief of NTCP with GTN and ACS or CAD (35)(36)(37)(38)(39) and has an unhelpful LR of 1.1 (22).…”

Section: Use Of Glyceryl Trinitratementioning

confidence: 99%

Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute, Non-Traumatic Chest Pain: The RSVP₃ Heart Exam

Colbeck

2016

Australasian Journal of Paramedicine

View full text Add to dashboard Cite

This article describes why most of the current methods taught to paramedics to identify ACS patients contradicts evidence that has been reported in the literature over the past 20 years. Areas where current teaching contradicts the evidence are highlighted, traditionally taught assessments which are non-diagnostic are identified, and those that are most diagnostic are listed and explained using a novel, evidence-based method to assess the patient’s history; the acronym RSVP3 (Radiation, Similarity, Variation, Pleuritic, Positional, Palpation) This acronym is meant to replace other commonly used, but non-diagnostically sensitive, acronyms such as OPQRST, DOLOR, SOCRATES and CHEST PAIN. Evidence to support this recommendations is given.

show abstract

“…A cautionary note also applies to the use of a response to sublingual nitroglycerine therapy as a diagnostic manoeuvre 3–6 . (Class B;LOE IV).…”

Section: Symptoms and Signsmentioning

confidence: 99%

Acute Coronary Syndromes: Presentation with ACS. ARC and NZRC Guideline 2011

2011

Emerg Medicine Australasia

View full text Add to dashboard Cite

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

Cited by 20 publications

References 19 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute, Non-Traumatic Chest Pain: The RSVP₃ Heart Exam

Acute Coronary Syndromes: Presentation with ACS. ARC and NZRC Guideline 2011

Contact Info

Product

Resources

About

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

Cited by 20 publications

References 19 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute, Non-Traumatic Chest Pain: The RSVP3 Heart Exam

Acute Coronary Syndromes: Presentation with ACS. ARC and NZRC Guideline 2011

Contact Info

Product

Resources

About

Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute, Non-Traumatic Chest Pain: The RSVP₃ Heart Exam