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Dr K K Aggarwal

Longer chest pain equals bigger MI risk

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Longer chest pain equals bigger MI risk

Patients with acute myocardial infarction (MI) have longer duration of chest pain than those without MI. Patients with chest pain of short duration, less than 5 minutes, are unlikely to have an acute infarction and have a good prognosis at 30 days.

A single–center study showed that only 8.9% of the patients received a final diagnosis of acute MI, and these patients had a significantly longer duration of chest pain compared with the rest of the cohort (120 versus 40 minutes) according to Carlos Calle–Muller, MD, of Henry Ford Hospital in Detroit, and colleagues. Those who had chest pain lasting less than 5 minutes always had a good outcome, with no acute MIs or deaths within 30 days, as reported in the journal Critical Pathways in Cardiology.

If the clinical assessment and ECG are benign, such patients might be able to be discharged directly from the emergency department without stress testing for outpatient follow-up.

The median chest pain duration was 180 minutes among the 10 patients who died and only 40 minutes for the others.

Among patients with acute MI, longer chest pain duration was not associated with higher 30–day mortality, but it was associated with a higher initial level of cardiac troponin-I.

PERC rule for pulmonary embolism

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , , | | Comments Off on PERC rule for pulmonary embolism

PERC is a tool that rules out pulmonary embolism (PE) and is an alternate to sensitive D-dimer testing in patients with a low-probability assessment for PE. It is best used in patients who present to the emergency department (ED) with dyspnea or chest pain, in whom the gestalt estimate pre-test probability for PE is less than 15%. It is not meant for risk stratification.

The PERC rule has 8 criteria:

  1. Age <50 years
  2. Heart rate <100 beats/minute
  3. Oxyhemoglobin saturation ≥95%
  4. No hemoptysis
  5. No estrogen use
  6. No prior DVT or PE
  7. No unilateral leg swelling
  8. No surgery/trauma requiring hospitalization within the prior 4 weeks

In patients with a low probability of PE who fulfill all the above 8 criteria, the likelihood of PE is low and no further testing is required.

Longer duration of chest pain means bigger MI risk

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Longer duration of chest pain means bigger MI risk

Patients with acute myocardial infarction have longer duration of chest pain than those without a myocardial infarction. Patients with chest pain of short duration, less than 5 minutes, are unlikely to have an acute infarction and have a good prognosis at 30 days. A single–center study showed that only 8.9% of the patients received a final diagnosis of acute MI, and these patients had a significantly longer duration of chest pain compared with the rest of the cohort (120 versus 40 minutes) according to Carlos Calle–Muller, MD, of Henry Ford Hospital in Detroit, and colleagues. Those who had chest pain lasting less than 5 minutes always had a good outcome, with no acute MIs or deaths within 30 days, as reported in the journal Critical Pathways in Cardiology. If the clinical assessment and ECG are benign, such patients might be able to be discharged directly from the emergency department without stress testing for outpatient follow-up. The median chest pain duration was 180 minutes among the 10 patients who died and only 40 minutes for the others. Among patients with acute MI, longer chest pain duration was not associated with higher 30–day mortality, but it was associated with a higher initial level of cardiac troponin-I.

Heart attack symptoms in women and elderly are different

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Heart attack symptoms in women and elderly are different

• Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in Archives of Internal Medicine researchers examined 35 years of research that yielded 69 studies and found that, between 30 and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 to 27 percent of men did not experience chest discomfort.

• Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.

• Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome. They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.

• Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

  1. Rule of 30 seconds: Chest pain, burning, discomfort, heaviness in the center of the chest lasting for over 30 seconds and not localized to a point unless proved otherwise is a heat pain. To this rule, add the rule of pin pointing finger i.e. any chest pain which can be pin pointed by a finger is not a heart pain.
  2. Rule of 5: If you suspect a heart attack, do not wait for more than five minutes and get to a hospital right away.
  3. Rule of 3: Reach hospital within 3 hours in case of heart attack to receive clot-removing angioplasty or clot-dissolving drugs.
  4.  Rule of 300: Chew a tablet of water-soluble 300 mg aspirin and take 300 mg clopidogrel tablets at the onset of cardiac chest pain (heart attack) to reduce mortality.
  5. Rule of 10: Door-to-ECG time is the time within which an ECG should be done in the emergency room and it should be less than 10 minutes.
  6. Rule of 30: Door-to-needle time in acute heart attack is the time before which the clot-dissolving drug should be given after a patient reaches the hospital. In ST elevation heart attack, the door-to-needle time should be less than 30 minutes.
  7. Rule of 40: First-onset acidity or first-onset asthma after the age of 40: Rule out heart attack or heart asthma.
  8. Rule of 90: Door-to-balloon time is the ideal time for primary percutaneous coronary intervention in acute heart attack by an experienced operator and should be less than 90 minutes.