Presentation
[…] mainly on presence of chest pain to define atypical presentation and used medical record reviews to characterise clinical presentation. [bmjopen.bmj.com]
[…] samples at a single timepoint – on presentation to the ED. [h-fabp.com]
Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased. [litfl.com]
Infarction mimics involving Q waves were presented in Vol 18, No. 4 (Oct-Dec 2007); infarction mimics that involve the ST segment or T wave will be presented in a subsequent issue. [nursingcenter.com]
Entire Body System
- Pain
Pain, referred pain and symptoms other than pain were measured dichotomously (yes/no). For the location of pain (direct and referred), patients were asked to point out where pain was occurring. [bmjopen.bmj.com]
Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. NICE, 2010. [bpac.org.nz]
Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain can be unpredictable or get worse even with rest, both hallmark symptoms of unstable angina. [heart.org]
Experiences of a one-hour algorithm in chest pain patients with a nonelevated troponin T at presentation. Critical Pathways in Cardiology, 2018;17(1):6–12. Pubmed Fulltext (DOI) IV. [openarchive.ki.se]
- Chest Discomfort
For example, although several hours of vague chest discomfort in a thin, athletic, healthy-appearing 60-yr-old man who has no known medical problems and who now looks and feels well does not match the typical profile of a myocardial infarction, it would [merckmanuals.com]
She presented to her primary cardiologist the following morning with ongoing chest discomfort. [ahajournals.org]
The description of the chest discomfort as a pressure has little utility in aiding a diagnosis as it is not specific for ACS. [7] Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use. [8] Chest pain with [en.wikipedia.org]
- Congestive Heart Failure
Heart rate 3. Systolic blood pressure 4. Serum creatinine 5. Congestive heart failure: Killip class 6. Cardiac arrest on admission 7. ST-segment deviation 8. [pharmaceutical-journal.com]
Heart sounds are frequently normal. At times, gallop and murmur can be heard. Lung exam is normal, although at times crackles may be heard pointing toward associated congestive heart failure (CHF). Bilateral leg edema may be present indicating CHF. [ncbi.nlm.nih.gov]
heart failure 176 (1.9) 179 (1.9) 0.98 (0.79–1.20) Table 3. [nejm.org]
A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. New Eng J Med 1995;333:1190-1195. rich-mw-beckham-v-wittenberg-c-et-al-1995 Westert GP, Lagoe RJ, Keskimaki I, et al. [heartonline.org.au]
Long-term management includes use of medications shown to be beneficial in the secondary prevention of atherosclerotic disease and congestive heart failure. [thecardiologyadvisor.com]
- Coronary Atherosclerosis
Cerebral atherosclerosis may thus facilitate depressive symptoms and anxiety even before coronary atherosclerosis generates cardiac ischaemia 9. [scielo.isciii.es]
In older adults, there are more extensive calcifications of coronary atherosclerosis with more multi-vessel and left main disease. [20] These adverse changes increase the risk for myocardial injury without new thrombosis. 3. [ncbi.nlm.nih.gov]
Etiology Acute coronary syndrome (ACS) is caused primarily by atherosclerosis. [emedicine.medscape.com]
- Acutely Ill Patient
The acute illness and treatment of ACS should be used to strongly motivate the patient to modify risk factors. [msdmanuals.com]
Respiratoric
- Dyspnea
Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. Class IV Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. [litfl.com]
There may be associated dyspnea, diaphoresis, and nausea. If significant myocardial pump dysfunction is present, the patient may report orthopnea or paroxysmal nocturnal dyspnea. [thecardiologyadvisor.com]
They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea [mayoclinic.org]
PURPOSE: reduction of the clinical problem, the pathophysiological mechanism (decline of tissue, atherosclerosis), reduction of the symptoms (pain, dyspnea), complications (sudden death, thromboembolism, arrhythmia, heart failure progression) or new cardiovascular [rauche.net]
Or similarly, not pursuing a standard evaluation on an unsympathetic patient (eg, minimizing the significance of dyspnea in a verbally abusive patient or someone with COPD who continues to smoke). [merckmanuals.com]
- Exertional Dyspnea
dyspnea that resolves with pain or rest Diaphoresis from sympathetic discharge Nausea from vagal stimulation Decreased exercise tolerance Physical findings can range from normal to any of the following: Hypotension: Indicates ventricular dysfunction [emedicine.medscape.com]
Gastrointestinal
- Nausea
[…] of these common signs of an acute coronary syndrome: Chest pain or discomfort, which may involve pressure, tightness or fullness Pain or discomfort in one or both arms, the jaw, neck, back or stomach Shortness of breath Feeling dizzy or lightheaded Nausea [heart.org]
They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea [mayoclinic.org]
Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability. [patient.info]
Common symptoms include: Chest pain or discomfort Pain or discomfort in one or both arms, the back, jaw, neck, or stomach Shortness of breath Dizziness or feeling lightheaded Indigestion Nausea or vomiting Sweating These symptoms are very serious and [medicalnewstoday.com]
Our dyspnoea and sweating cluster has two common symptoms similar to the Riegel et al 26 stress symptoms cluster, which includes shortness of breath, sweating, nausea, indigestion, dread and anxiety. [bmjopen.bmj.com]
- Vomiting
They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea [mayoclinic.org]
Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability. [patient.info]
Common symptoms include: Chest pain or discomfort Pain or discomfort in one or both arms, the back, jaw, neck, or stomach Shortness of breath Dizziness or feeling lightheaded Indigestion Nausea or vomiting Sweating These symptoms are very serious and [medicalnewstoday.com]
Generally, discomfort associated with an acute MI lasts at least 20 minutes and it may be associated with breathlessness, syncope, diaphoresis, nausea and/or vomiting. [heartonline.org.au]
Symptoms suggestive of an acute coronary syndrome include: 1 Chest pain and/or pain in areas such as the upper arms, back or jaw, that lasts longer than 15 minutes Chest pain in combination with nausea and vomiting, sweating, breathlessness, and particularly [bpac.org.nz]
Cardiovascular
- Chest Pain
Experiences of a one-hour algorithm in chest pain patients with a nonelevated troponin T at presentation. Critical Pathways in Cardiology, 2018;17(1):6–12. Pubmed Fulltext (DOI) IV. [openarchive.ki.se]
Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. NICE, 2010. [bpac.org.nz]
Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain can be unpredictable or get worse even with rest, both hallmark symptoms of unstable angina. [heart.org]
They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea [mayoclinic.org]
[…] evaluated 664 chest pain patients presenting to two coronary units in the UK. [h-fabp.com]
- Heart Failure
Many heart failure medications modify neurohormonal responses to break the vicious cycle of heart failure. See Combating the neurohormonal cycle in heart failure. [heartonline.org.au]
Reason for readmission in heart failure : perspective of patients, care givers, cardiologists, anda heart failure nurses. Heart and lung. 38(5):427-43 Au,A.G., McAlister, F.A., Bakal, J.A., Ezekowitz, J., Kaul, P., Walraven, C.V. 2012. [journal.unusa.ac.id]
The Heart Outcomes Prevention Evaluation (HOPE) study enrolled 9,297 high-risk patients with evidence of vascular disease or diabetes plus one other cardiovascular risk factor who were not known to have heart failure or low ejection fraction. [uspharmacist.com]
[…] to 09 June 2018 Dublin - Ireland Heart Failure 2018 & World Congress on Acute Heart Failure 26 May to 29 May 2018 Vienna - Austria Frontiers in CardioVascular Biology 2018 20 April to 22 April 2018 Vienna - Austria EuroPrevent 2018 19 April to 21 April [spo.escardio.org]
If heart failure or abnormal heart rhythms develop, the aneurysm may be removed surgically. Historically, about 20% of people who have had a heart attack form clots inside the heart, over the area of dead heart muscle. [merckmanuals.com]
- Hypertension
Role of angiotension and its inhibition in hypertension, iscemic heart disease and heart failure. Hypertension. 37:342. Guyton, A and Hall, J. 2004. Textbook of medical phisiology. Elsevier (Singapore) Pte Ltd. [journal.unusa.ac.id]
Hypertensive mouse model shows Ccl19 overexpression, which responsible for exhibiting similar MBPS as seen in human essential hypertension. [insights.ovid.com]
In general, PAP improves arterial hypertension only mildly. However, several studies have included non-hypertensive or pharmaceutically well-treated patients. [err.ersjournals.com]
"It's a warning sign but still an indication considering the risk factors of the patient (with hypertension, diabetes, stress, and anxiety)," he said. [news.abs-cbn.com]
Presence of hypertension is very common and can exacerbate the progress of HF. About 5-10% of HF is from non-ischaemic dilated cardiomyopathies. [heartonline.org.au]
- Hypotension
Patients present with hypotension and distended neck veins, but without signs of pulmonary odema. [rcemlearning.co.uk]
S3/S4, APO, edema, distended tender liver) Look for any evidence of cardiogenic shock (altered mental state, poor skin perfusion +/- hypotension) Clinical Risk Stratification for ACS in Patients Presenting with Chest Pain (i.e. possible not confirmed [litfl.com]
This can be due to acute thrombosis and plaque rupture, or to increased supply and demand from comorbid disease presentations (e.g., tachycardia, hypotension or anemia). [ncbi.nlm.nih.gov]
The physical examination related to ACS is often nonspecific, but the complications associated with infarction and cardiac pump dysfunction may be manifest as tachycardia, bradycardia, hypotension, elevated jugular venous pressure, wheezes, crackles, [thecardiologyadvisor.com]
Heart failure, low blood pressure (hypotension), and/or shock develop. If more than half of the heart tissue is damaged or dies, the heart generally cannot function, and severe disability or death is likely. [merckmanuals.com]
- Vascular Disease
According to Cardiologist of UMM Hospital dr Andi Wahjono Adi SpJp, the desease of SKA was the one of vascular disease due to blockage and reduction of oxygen supply suddenly. According to Andi its solution by inserting catheter into blood vessels. [umm.ac.id]
F or patients with contraindications or severe side effects to beta blockers, such as shortness of breath on initiation and those with severe peripheral vascular disease, a non-dihydropyridine calcium channel blocker (diltiazem or verapamil) can be given [pharmaceutical-journal.com]
Previous hospitalisations: previous ACS and ischaemic heart disease admissions; Charlson comorbidities (MI, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, connective tissue disease, ulcers, dementia, cerebrovascular [nzma.org.nz]
[…] the prevention of MI, ischemic stroke, or vascular death. [uspharmacist.com]
Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373:1849–1860. 9. [romanianjournalcardiology.ro]
Skin
- Sweating
For example, a patient with prior stents comes in sweating and clutching his chest in agony, I have a pretty high suspicion that he's having an MI – let's say, 60%. That is my pretest probability. [thennt.com]
Our dyspnoea and sweating cluster has two common symptoms similar to the Riegel et al 26 stress symptoms cluster, which includes shortness of breath, sweating, nausea, indigestion, dread and anxiety. [bmjopen.bmj.com]
[…] these common signs of an acute coronary syndrome: Chest pain or discomfort, which may involve pressure, tightness or fullness Pain or discomfort in one or both arms, the jaw, neck, back or stomach Shortness of breath Feeling dizzy or lightheaded Nausea Sweating [heart.org]
[…] pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea) Sudden, heavy sweating [mayoclinic.org]
Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability. [patient.info]
Neurologic
- Confusion
(P8) Junior nurses are less confident and more confused Generally, the junior activities include administering an intravenous infusion, providing something, just like that. [opennursingjournal.com]
At times, pneumonia, pneumothorax, cholecystitis, peptic ulcer disease, and herpes zoster may be confused with ACS. D. Physical Examination Findings. [thecardiologyadvisor.com]
Psychiatric patients who develop a physical disorder are particularly likely to be subject to attribution errors because not only may they be subject to negative stereotyping but they often describe their symptoms in unclear, inconsistent, or confusing [merckmanuals.com]
The statements of Participant-4, Participant-9, Participant-11, and Participant-15 indicated that junior nurses were less confident and more confused when handling ACS patients (Table 2). 3.2. [benthamopen.com]
For example, it may be counter-productive and confusing to change a high-potency statin or an angiotensin receptor blocker from one brand to another if patients confirm their home medications are well tolerated and affordable. [journals.lww.com]
- Burning Sensation
Complaints reported by patients with ACS include the following: Palpitations Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either [emedicine.medscape.com]
- Hyperactivity
These included the time when the skin or mucosa of mice turned to cherry red and the times when the mice exhibited hyperactivity, opisthotonus or fatigue. [spandidos-publications.com]
Workup
New emerging lipid workups comprising atherogenic index (AI) and TG/HDL ratio were also calculated to predict the severity of coronary artery disease. Significant stenosis was defined as a reduction of at least 50% in the coronary artery. [longdom.org]
Computerized tomography angiography might also be utilized for further workup depending on availability and cardiologist preference. [ncbi.nlm.nih.gov]
(See Workup.) Attention to the underlying mechanisms of ischemia is important when managing ACS. [emedicine.medscape.com]
Further evaluation to delineate these possibilities included a broad laboratory workup. [ahajournals.org]
Other ECG Findings
- Abnormal ECG
In the early stages people with Takotsubos and heart attacks have a similar presentation, with chest pain, dyspnoea, abnormal ECG and blood tests. [heartonline.org.au]
The baseline electrocardiogram (ECG) abnormalities recorded were ≥1-mm ST-segment elevation or depression or ≥1-mm T-wave inversion in at least two contiguous leads. [cjasn.asnjournals.org]
Treatment
[…] while referencing recent treatment guidelines. [hospitalmedicine.org]
Geometric LS means were adjusted for treatment + baseline value + clopidogrel status at randomization. [clinicaltrials.gov]
treatment information from x t to x 1. [bmcmedinformdecismak.biomedcentral.com]
Information on the reasons why evidence-based treatments are not utilised will be collected. To evaluate in-hospital patient outcome. [escardio.org]
Oxygen treatment should not be routinely administered. [bpac.org.nz]
Prognosis
The prognosis for smaller people is worse than that for larger people. This finding may help explain why the prognosis for women who have had a heart attack is, on average, worse than that for men. [msdmanuals.com]
A 35-year perspective (1975 to 2009) into the long-term prognosis and hospital management of patients discharged from the hospital after a first acute myocardial infarction. Am J Cardiol., 116 (2015), pp. 24-29 [4] K.A. Fox, K.F. Carruthers, D.R. [revespcardiol.org]
It is helpful to distinguish the syndromes because prognosis and treatment vary. [merckmanuals.com]
Factors associated with a poorer prognosis include: [ 6 ] Advancing age. Presence and severity of ECG changes of ischaemia. Magnitude of rise in biomarkers of myocardial injury (eg, serum troponin). Left ventricular dysfunction, cardiogenic shock. [patient.info]
Etiology
This systematic review also shows that isolated signs and symptoms are not helpful in identifying the underlying ischemic etiology for chest pain. [thennt.com]
Some forms of CHD can be asymptomatic, but ACS is always symptomatic. [1] [2] [3] Etiology ACS is a manifestation of CHD (coronary heart disease) and usually a result of plaque disruption in coronary arteries (atherosclerosis). [ncbi.nlm.nih.gov]
[…] disorders can elevate cTn levels (see table Causes of Elevated Troponin Levels); not all elevated levels detected with hs-cTn represent myocardial infarction, and not all myocardial necrosis results from an acute coronary syndrome event even when the etiology [msdmanuals.com]
Epidemiology
Journal of Emergency Nursing, 40(3), pp.270–275. ↑ Research and Markets; EpiCast Report: Acute Coronary Syndrome ACS - Epidemiology Forecast to 2022", 2014, Cardiovascular Week,, pp. 17. ↑ Davies, M.J. et al., 1993. [physio-pedia.com]
Several studies have assessed the influence of sex, race or age on the epidemiology of MI. [ncbi.nlm.nih.gov]
Epidemiology See also separate Epidemiology of Coronary Heart Disease article. [patient.info]
Percutaneous transluminal coronary angioplasty in the elderly: epidemiology, clinical risk factors and in-hospital outcomes. The Northern England Cardiovascular Disease Study Group. [smj.org.sg]
Epidemiological studies suggest age and sex differences in the association between OSA and cardiovascular outcome. [err.ersjournals.com]
Pathophysiology
Pathophysiological mechanisms of CO poisoning: Pathophysiology of CO poisoning and subsequent DNS is very complex and remains poorly understood. A well-known underlying pathophysiological mechanism in CO poisoning is hypoxic stress. [nrronline.org]
Pathophysiology Acute Coronary Syndrome (ACS) refers to any condition attributed to obstruction of the coronary arteries which reduces blood flow to the heart, and includes unstable angina and myocardial infarction (MI). [heartonline.org.au]
Classification by pathophysiology By our definitions, both patients have had a ‘myocardial infarction’. However, there is clearly different pathophysiology at work. The ESC has again come to the rescue with a helpful classification system. [geekymedics.com]
Pathophysiology of the metabolic disorder. Dalam C. Mensing (editor), the art and science of diabetes self management : a desk reference for healthcare professionals. Chicago:American Association of Diabetes Educators. 143-161. [journal.unusa.ac.id]
Pathophysiology The underlying pathophysiology in ACS is decreased blood flow to part of heart musculature which is usually secondary to plaque rupture and formation of thrombus. [ncbi.nlm.nih.gov]
Prevention
These advances undoubtedly offer new opportunities to improve long-term secondary prevention. [revespcardiol.org]
Secondary prevention of coronary artery disease with omega-3 fatty acids. Am J Cardiol. 2006;98:61i-70i. 36. [uspharmacist.com]
Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005;353:2373–2383. 11. [romanianjournalcardiology.ro]
NICE lipid modificati on guidance (clinical guidance 181) [11] suggests high intensity statins should be used for secondary prevention. [pharmaceutical-journal.com]
Patients should also be counseled on the importance of dual antiplatelet therapy to prevent recurrent MI and to prevent stent thrombosis if a stent was implanted during PCI. [thecardiologyadvisor.com]