{"id":637,"date":"2019-02-07T18:55:09","date_gmt":"2019-02-07T18:55:09","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=637"},"modified":"2019-02-07T18:55:10","modified_gmt":"2019-02-07T18:55:10","slug":"symptoms-and-signs-in-acs","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=637","title":{"rendered":"Symptoms and Signs in ACS"},"content":{"rendered":"\n

Body, R., Carley, S., Wibberley, C., McDowell, G.<\/strong>, Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.\u2019 Resuscitation<\/em>81 pp. 281-286. <\/p>\n\n\n\n

Objective:<\/strong>Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the value of individual historical and examination findings for diagnosing acute myocardial infarction (AMI) and predicting adverse cardiac events in undifferentiated Emergency Department (ED) patients with chest pain. <\/p>\n\n\n\n

Methods:<\/strong>We prospectively recruited patients presenting to the ED with suspected cardiac chest pain. Clinical features were recorded using a custom-designed report form. All patients were followed up for the diagnosis of AMI and the occurrence of adverse events (death, AMI or urgent revascularization) within 6 months.<\/p>\n\n\n\n

Results:<\/strong>AMI was diagnosed in 148 (18.6%) of the 796 patients recruited. Following adjustment for age, sex and ECG changes, the following characteristics made AMI more likely (adjusted odds ratio, 95% confidence intervals): pain radiating to the right arm (2.23, 1.24\u20134.00), both arms (2.69, 1.36\u20135.36), vomiting (3.50, 1.81\u20136.77), central chest pain (3.29, 1.94\u20135.61) and sweating observed (5.18, 3.02\u20138.86). Pain in the left anterior chest made AMI significantly less likely (0.25, 0.14\u20130.46). The presence of rest pain (0.67, 0.41\u20131.10) or pain radiating to the left arm (1.36, 0.89\u20132.09) did not significantly alter the probability of AMI. <\/p>\n\n\n\n

Conclusions:<\/strong>Our results challenge many widely held assertions about the value of individual symptoms and signs in ED patients with suspected acute coronary syndromes. Several \u2018atypical\u2019 symptoms actually render AMI more likely, whereas many \u2018typical\u2019 symptoms that are often considered to identify high-risk populations have no diagnostic value.<\/p>\n\n\nLink to Journal<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., Carley, S., Wibberley, C., McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.\u2019 Resuscitation81 pp. 281-286.  Objective:Patient history and physical examination are widely accepted as cornerstones<\/p>\n","protected":false},"author":1,"featured_media":597,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-ah","jetpack-related-posts":[{"id":624,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=624","url_meta":{"origin":637,"position":0},"title":"P-Selectin in AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R., Pemberton, P., Ali, F.,\u00a0McDowell, G., Carley, S., Smith, A. & Mackway-Jones, K. (2011) \u2018Low soluble P-selectin may facilitate early exclusion of acute myocardial infarction.\u2019\u00a0Clin Chem Acta412 pp. 614-618. Background:Suspected cardiac chest pain accounts for over 25% of medical admissions but, as only a minority have acute coronary syndromes,\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/P-Selectin-1-e1549807984127.png?fit=400%2C333&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":629,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=629","url_meta":{"origin":637,"position":1},"title":"Risk Factors and AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G.,Carley, S. & Mackway-Jones, K. (2008) \u2018Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the emergency department.\u2019\u00a0Resuscitation79 pp. 41-45.\u00a0 Background:Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Risk-factors-for-ED-diagnosis-e1549807935709.png?fit=400%2C313&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":637,"position":2},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":568,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=568","url_meta":{"origin":637,"position":3},"title":"T-MACS and POCT Troponin","date":"January 17, 2019","format":false,"excerpt":"The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid for rapid rule-in and rule-out of acute coronary syndromes using a contemporary point of care troponin assay Richard Body; Malak Almashali; Niall Morris; Phil Moss; Heather Jarman; Andrew Appelboam; Richard Parris; Louisa Chan; Alison Walker; Mark Harrison; Andrea Wootten; Garry McDowellc\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":646,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=646","url_meta":{"origin":637,"position":4},"title":"Undetectable hs-cTnT","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019\u00a0J Am Coll Cardiol58 pp. 1332-1339. Objectives:This paper sought to evaluate whether high sensitivity troponin (hs-cTnT)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png?fit=400%2C268&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":637,"position":5},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction.\u2019\u00a0Resuscitation82 pp. 1041-1046.\u00a0 Objective:Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png?fit=400%2C341&resize=350%2C200","width":350,"height":200},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/637"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=637"}],"version-history":[{"count":2,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/637\/revisions"}],"predecessor-version":[{"id":640,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/637\/revisions\/640"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/597"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}