Browsing by Subject "Chest pain"

Now showing 1 - 6 of 6
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    Blunt aortic injury-traumatic aortic isthmus pseudoaneurysm with right iliac artery dissection aneurysm: A case report
    (Baishideng Publishing Group, 2022) Fang, Xiao-Xin; Wu, Xin-Hui; Chen, Xiao-Feng; Radiation Oncology, School of Medicine
    Background: Blunt aortic injury is a special type of aortic disease. Due to its low incidence, high prehospital mortality and high probability of leakage diagnosis, the timely identification of patients with blunt aortic injury who survive the initial injury has always been a clinical challenge. Case summary: We report a case of traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm that was diagnosed 3 mo after a traffic accident. The patient is a 76-year-old male who was knocked down by a fast-moving four-wheel motor vehicle while crossing the road (the damage mechanism was side impact). He received chest, cranial computed tomography (CT) and whole abdomen enhanced CT in the local hospital. The images suggested subarachnoid hemorrhage, right frontoparietal scalp hematoma, fracture of the right clavicle and second rib, lump-shaped mediastinal shadow outside the anterior descending thoracic aorta (mediastinal hematoma), mesenteric vascular injury with hematoma formation, pelvic fracture, and subluxation of the left sacroiliac joint. After the pelvic fracture was fixed with an external stent, he was sent to our hospital for further treatment. In our hospital, he successfully underwent partial resection of the small intestine and CT-guided screw internal fixation of the left sacroiliac joint and returned to the local hospital for rehabilitation treatment. However, since the accident, the patient has been suffering from mild chest pain, which has not aroused the attention of clinicians. During rehabilitation, his chest pain gradually worsened, and the thoracic aorta computed tomography angiography performed in the local hospital showed a pseudoaneurysm in the initial descending segment of the aortic arch. After transfer to our hospital, a dissecting aneurysm of the right external iliac artery was incidentally found in the preoperative evaluation. Finally, endovascular stent graft repair was performed, and he was discharged on the 10th day after the operation. No obvious endo-leak was found after 4 years of follow-up. Conclusion: We highlight that emergency trauma centers should consider the possibility of aortic injury in patients with severe motor vehicle crashes and repeat the examination when necessary to avoid missed diagnoses.
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    Characterizing pain leading to emergency medical services activation in heart failure
    (Wolters Kluwer, 2022) Smith, Asa B.; Jung, Miyeon; Lee, Christopher; Pressler, Susan J.; School of Nursing
    Background: Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS. Methods: Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ 2 , analysis of variance, and logistic and multiple linear regression analyses were used. Results: The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age ( b = -0.05, SE = 0.013), being a woman ( b = 1.17, SE = 0.357), and White race ( b = -1.11, SE = 0.349). Conclusions: Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.
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    Chest pain while gardening: a Stanford type A dissection involving the aortic root extending into the iliac arteries-an uncommon and potentially catastrophic disease process
    (BioMed Central, 2019-08-30) Taylor, Gregory M.; Barney, Michael W.; McDowell, Eric L.; Emergency Medicine, School of Medicine
    BACKGROUND: An aortic dissection is an uncommon and potentially catastrophic disease process that carries with it a high morbidity and mortality. The inciting event is a tear in the intimal lining of the aorta. This allows passage of blood through the tear and into the aortic media, resulting in the creation of a false lumen. CASE PRESENTATION: We describe the case of a 71-year-old male with a history of hypertension that suffered a Stanford type A dissection with an intimal flap beginning at the level of the aortic root and extending into the bilateral iliac arteries. His clinical presentation was further complicated by shock, cardiac tamponade, severe coagulopathy, an ischemic right lower extremity, infarction of his thoracic spinal cord, and subacute infarcts secondary to malperfusion and embolic disease. Despite maximal intervention, the patient continued to clinically decline and ultimately died on day 5. CONCLUSION: The clinical presentation of an acute aortic dissection is often atypical and mimics other common disease processes. The signs and symptoms largely depend on the extent of the aortic dissection and the presence or absence of malperfusion. With a mortality increasing by 1-2% for every hour until definitive treatment, early recognition and prompt operative intervention are crucial for patient survival.
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    Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial
    (Elsevier, 2023-01) Connors, Jill Nault; Kroenke, Kurt; Monahan, Patrick; Chernyak, Yelena; Pettit, Kate; Hayden, Julie; Montgomery, Chet; Brenner, George; Millard, Michael; Holmes, Emily; Musey, Paul; Psychiatry, School of Medicine
    ackground Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. Objectives The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. Methods The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. Discussion PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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    Emergency Department Physician Attitudes, Practices, and Needs Assessment for the Management of Patients with Chest Pain Secondary to Anxiety and Panic
    (Office of the Vice Chancellor for Research, 2016-04-08) Lee, J. Austin; Musey Jr., Paul I.
    Background Chest pain is a common medical complaint, accounting for 7 million annual visits to US Emergency Departments (EDs) [1]. Most research and clinical resources are focused on the management of the life-threatening acute coronary syndrome (ACS); however, about 80% of all patients presenting to EDs with chest pain do not have a cardiopulmonary emergency [2-4]. Non-ACS chest pain can be caused by anxiety or a panic disorder, and such etiologies remain undiagnosed in almost 90% of cases, and frequently have worse outcomes [5-9]. Objective and Methods The study objective was to assess ED physician’s attitudes, practices, and needs in managing chest pain related to anxiety and panic. A REDCap survey of 15 Likert-style questions was constructed using expert consensus to ensure content validity then administered to all faculty and resident physicians in the IU Department of Emergency Medicine (113 individuals, 65.5% response-rate). Results ED providers believe a significant proportion (31.5%) of patients with chest pain at low risk for ACS are due to panic/anxiety. Providers give such patients instructions on how to manage their panic/anxiety only 34.8% of the time, while even fewer (19.0%) make a diagnosis of anxiety or panic disorder in their documentation. Most providers (77.0%) would welcome a narrative to aid in discussing anxiety/panic as a cause of chest pain and nearly all (85.1%) would find it helpful to have specific clinic information available to aid in follow-up. Conclusions A significant number of ED patients with chest pain are likely due to anxiety, and a majority of physicians report not having the resources necessary to manage these patients. Further work to develop relevant resources would aim to improve provider confidence in treating these patients, and would hope to improve management of anxiety or panic as a cause of chest pain in the ED.
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    Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department
    (Wiley, 2021) Musey, Paul I., Jr.; Bellolio, Fernanda; Upadhye, Suneel; Chang, Anna Marie; Diercks, Deborah B.; Gottlieb, Michael; Hess, Erik P.; Kontos, Michael C.; Mumma, Bryn E.; Probst, Marc A.; Stahl, John H.; Stopyra, Jason P.; Kline, Jeffrey A.; Carpenter, Christopher R.; Emergency Medicine, School of Medicine
    This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high-sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits.