Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, April 5, 2016

Chest pain evaluation

Resultado de imagen de St Emlyn´s
St. Emlyn´s - April 5, 2016 by Rick Body
"I was honoured to open the day’s proceedings with my talk: ‘A war on two fronts – how to get your chest pain evaluation right’. The aims of my talk were to bring everyone up to speed with the best evidence about how factors from your evaluation of a patient with chest pain influence the probability that the patient actually has an acute coronary syndrome, but then also to understand what constitutes an acceptable risk of a missed diagnosis and why it’s important that we’re not too over-cautious...
In the first half of my talk, I described how the patient’s history and physical exam might influence the probability that the patient is having an acute MI. A lot of this was based on the research I did in my PhD from 2005 to 2009, in which we recruited just over 800 patients with chest pain, recorded their symptoms and evaluated their outcome...
In fact, the evidence clearly shows that the patient’s history and physical exam aren’t that helpful. There are some features that change the probability:
  • If the patient vomited with their pain, there’s a 41% chance that they’re having an acute MI
  • If the patient looks sweaty, there’s a 59% chance that it’s an acute MI – that’s more predictive than a single hs-troponin test at the regular cut-off!
But the bottom line is that, if your patient has symptoms that could be compatible with ACS and you haven’t got another clear cut cause, then you ought to be thinking about investigating for ACS. Anything else puts your patients at risk – there’s good evidence for that."