Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds

Jonsbu, J; Rollag, Arnfinn; Aase, O.; Lippestad, C; Arnesen, K; Erikssen, Jan; Koss, Adam

doi:10.1111/j.1365-2796.1991.tb00322.x

Cited by 16 publications

(7 citation statements)

References 13 publications

(1 reference statement)

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“…However, formal investigations have yielded conflicting findings and have demonstrated that these descriptors predict AMI weakly or not at all. 2,3,[24][25][26][27][28] Extensive meta-analyses by Chun and Magee 29 and Panju et al 24 determined that typical predictors of pain such as pressurelike were associated with positive likelihood ratios of 1 to 2, which are values that are not robust enough to be independently useful in establishing a myocardial infarction (MI) diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…However, some authors have made efforts to combine elements. 2,28,[55][56][57][58][59][60][61][62][63][64] Several simply combined atypical features into a decision rule or a scale, 2,[55][56][57] whereas others used computer-aided algorithms. [58][59][60][61][62][63][64] Although several of these studies have demonstrated an ability to improve triage decisions within an experimental framework, these protocols have either not been validated or have demonstrated mixed results when implemented in clinical settings.…”

Section: Combinations Of Characteristics Of the Chest Pain History Tomentioning

confidence: 99%

“…Pain not related to exertion or that occurs in a small inframammary area of the chest wall 14,31,42 Probable High Risk Pain described as pressure, is similar to that of prior myocardial infarction or worse than prior anginal pain, or is accompanied by nausea, vomiting, or diaphoresis 3,14,24,25,[27][28][29]…”

Section: Probable Low Riskmentioning

confidence: 99%

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Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes

Swap

Nagurney²

2005

JAMA

359

194

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Context The chest pain history, physical examination, determination of coronary artery disease (CAD) risk factors, and the initial electrocardiogram compose the information immediately available to clinicians to help determine the probability of acute myocardial infarction (AMI) or acute coronary syndrome (ACS) in patients with chest pain. However, conflicting data exist about the usefulness of the chest pain history and which components are most useful. Objective To identify the elements of the chest pain history that may be most helpful to the clinician in identifying ACS in patients presenting with chest pain. Evidence Acquisition MEDLINE and Ovid were searched from 1970 to September 2005 by using specific key words and Medical Subject Heading terms. Reference lists of these articles and current cardiology textbooks were also consulted. Evidence Synthesis Certain chest pain characteristics decrease the likelihood of ACS or AMI, namely, pain that is stabbing, pleuritic, positional, or reproducible by palpation (likelihood ratios [LRs] 0.2-0.3). Conversely, chest pain that radiates to one shoulder or both shoulders or arms or is precipitated by exertion is associated with LRs (2.3-4.7) that increase the likelihood of ACS. The chest pain history itself has not proven to be a powerful enough predictive tool to obviate the need for at least some diagnostic testing. Combinations of elements of the chest pain history with other initially available information, such as a history of CAD, have identified certain groups that may be safe for discharge without further evaluation, but further study is needed before such a recommendation can be considered reasonable. Conclusion Although certain elements of the chest pain history are associated with increased or decreased likelihoods of a diagnosis of ACS or AMI, none of them alone or in combination identify a group of patients that can be safely discharged without further diagnostic testing.

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Section: Methodsmentioning

confidence: 99%

Section: Combinations Of Characteristics Of the Chest Pain History Tomentioning

confidence: 99%

See 1 more Smart Citation

Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes

Swap

Nagurney²

2005

JAMA

359

194

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“…Numerous studies do not support the use of any clinical signs and symptoms independent of electrocardiograph (ECG) tracings, cardiac biomarkers, or other diagnostic tests to rule in or rule out ACS in prehospital or emergency department (ED) settings. [215][216][217][218][219][220][221][222][223][224][225][226][227][228] To improve ACS outcome, all dispatchers and EMS providers must be trained to recognize ACS symptoms, even if atypical. It is reasonable for dispatchers to advise patients with potential cardiac symptoms to chew an aspirin (160 to 325 mg), providing the patient has no history of aspirin allergy and no signs of active or recent gastrointestinal bleeding (Class IIa, LOE C).…”

Section: Special Resuscitation Situations Acute Coronary Syndromesmentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

701

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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“…In response to this situation of ever increasing demand for CCU beds in the face of limited resources, interest has grown in the development of safe and efficient means of identifying those patients for whom CCU care is not necessary ( Lee et al . 1990 , Jonsbu et al . 1991 , Madias 1995, Goldman et al .…”

Section: Introductionmentioning

confidence: 99%

Determining chest pain patients’ suitability for transfer to a general ward following admission to a cardiac care unit

Quinn

Thompson

Boyle

2000

Journal of Advanced Nursing

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The objective of this study was to assess the performance of a consensus-derived decision algorithm in determining chest pain patients' suitability for early transfer to a lower dependency ward by predicting complications. The sample comprised 516 patients with chest pain presumed to be cardiac in origin, admitted to a cardiac care unit (CCU) in northern England from the community or from the accident and emergency department. A decision algorithm was designed following a review of the literature and amended to take into account a clinical consensus of consultant physicians. Patients were assessed on admission by CCU nurses using the algorithm, and 'triage' decisions recorded (keep on CCU or suitable for early transfer to a general ward). Admission ECGs (electrocardiographs) and baseline clinical data were recorded independently by a researcher 'blinded' to actual clinical course, and applied to the algorithm using statistical software. On discharge or death, patients' case notes were retrieved and the hospital course examined for death or severe complications. Performance of the algorithm and CCU nurses were compared for sensitivity, specificity, positive predictive value and negative predictive value. The main outcome measures were death or severe complications occurring during hospitalization, and during the first 2 days following CCU admission. While sensitivity of both the algorithm (0.98) and CCU nurses (0.95) was high, specificity was low in both groups (0.11 and 0.21, respectively), making it unlikely that the algorithm would prove useful in clinical practice. Further studies are required to develop the optimal triage tool for the assessment of patients with acute chest pain.

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Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds

Cited by 16 publications

References 13 publications

Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes

Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes

Part 5: Adult Basic Life Support

Determining chest pain patients’ suitability for transfer to a general ward following admission to a cardiac care unit

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