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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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Acute Coronary Syndrome I: Introduction01:30

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
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FOCUS may detect wall motion abnormalities in patients with ACS.

Alexander Bracey1, Lyndsay Massey2, Andrew C Pellet1

  • 1Albany Medical Center Hospital, Department of Emergency Medicine, Albany, NY, USA.

The American Journal of Emergency Medicine
|April 10, 2023
PubMed
Summary

Focused cardiac ultrasound (FOCUS) can accurately detect regional wall motion abnormalities (RWMA) in patients with suspected acute coronary syndrome (ACS). This emergency physician-performed ultrasound shows promise in identifying OMI when ECG results are equivocal.

Keywords:
Acute coronary syndromeFOCUSOMIPOCUSRWMA

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Chest pain is a frequent emergency department (ED) complaint, with electrocardiograms (ECG) as the primary tool for diagnosing acute coronary syndrome (ACS).
  • Ischemia from occluded coronary vessels causes wall motion abnormalities (RWMA) detectable by echocardiogram.
  • Focused cardiac ultrasound (FOCUS) by emergency physicians lacks a defined role in diagnosing occluded myocardial infarction (OMI).

Purpose of the Study:

  • To assess FOCUS's accuracy in identifying RWMA in suspected ACS patients.
  • To determine if RWMA detected by FOCUS correlates with OMI.
  • To evaluate FOCUS performance across different emergency physician training levels.

Main Methods:

  • Retrospective review of adult patients with suspected ACS undergoing FOCUS in the ED.
  • Comparison of FOCUS findings to formal echocardiography for RWMA detection.
  • Analysis of FOCUS sensitivity, specificity, and accuracy for RWMA and association with OMI.

Main Results:

  • FOCUS demonstrated 94% sensitivity, 35% specificity, and 78% accuracy for RWMA detection.
  • FOCUS identified RWMA in 87% of patients with confirmed OMI.
  • Both residents and fellows/attendings showed high sensitivity in detecting RWMA.

Conclusions:

  • FOCUS performed by emergency physicians can detect RWMA in high-concern ACS patients.
  • FOCUS may be particularly useful for equivocal ECGs in suspected OMI cases.
  • Further research is needed to confirm FOCUS's role in guiding emergent interventions.