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Acute Coronary Syndrome III: Diagnostic Studies01:30

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
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Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
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Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
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Performance analysis considering endpoints for three accelerated diagnostic protocols for chest pain.

Bora Chae1, Shin Ahn1, Seung Mok Ryoo1

  • 1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

The American Journal of Emergency Medicine
|November 27, 2022
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Summary

Three accelerated diagnostic protocols (ADPs) for chest pain assessment showed high sensitivity for major adverse cardiac events (MACE) excluding unstable angina. However, their safety levels decreased when unstable angina was included in MACE.

Keywords:
Acute coronary syndromeChest painEmergency departmentMajor adverse cardiac event

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Accelerated diagnostic protocols (ADPs) like mADAPT, HEART pathway, and EDACS-ADP are crucial for assessing chest pain patients.
  • These protocols typically define Major Adverse Cardiac Events (MACE) as acute myocardial infarction, revascularization, and death, excluding unstable angina.

Purpose of the Study:

  • To compare the performance of three well-known ADPs (mADAPT, HEART pathway, EDACS-ADP) in evaluating patients with chest pain.
  • To assess the diagnostic accuracy of these ADPs for 30-day MACE, both with and without the inclusion of unstable angina.

Main Methods:

  • A single-center prospective observational study was conducted.
  • The study included 1,214 patients presenting with chest pain symptoms.
  • Performance comparison of mADAPT, HEART pathway, and EDACS-ADP was performed for MACE, with and without unstable angina.

Main Results:

  • When unstable angina was excluded, sensitivities for MACE were high (>99%) for all three ADPs.
  • The HEART pathway identified the highest proportion of low-risk patients (39.2%).
  • When unstable angina was included in MACE, sensitivities dropped below 99% for all ADPs (mADAPT: 96.6%, EDACS-ADP: 97.3%, HEART pathway: 97.3%).

Conclusions:

  • All three ADPs demonstrated similar accuracy for MACE risk stratification when unstable angina was excluded.
  • The HEART pathway offered the best balance of sensitivity and early discharge potential.
  • Inclusion of unstable angina in MACE significantly reduced the safety and performance of all evaluated ADPs below acceptable thresholds.