RESUMO
OBJECTIVE: To evaluate the appropriate clinical use of an acute rest myocardial perfusion imaging (R-MPI) in the initial emergency department (ED) evaluation of a patient presenting with chest pain (CP). METHODS: This is a retrospective study of patients evaluated with CP at the ED with an acute R-MPI. The data collected included medical history, clinical presentation, electrocardiogram, laboratory data, MPI results, confirmatory studies, disposition diagnosis and cost analysis. RESULTS: Three-hundred-sixty-six (366) patients were evaluated. The population studied had a mean Thrombolysis in Myocardial Infarction (TIMI) score of 2 and predominance of patients in the Virginia Commonwealth University (VCU) CP Category-Scale between level 3 and 4 (34% and 49% respectively). The risk of acute coronary syndrome (ACS) was significantly higher in patients with abnormal compared to normal studies (50% versus 0.4%; P < .0005; RR, 129.5; 95% CI, 18 to 924). There were a total of 14 and 19 major adverse cardiovascular events (MACE) events during the follow-up of 30-days and 1-year respectively. There were no cardiovascular fatalities. The risk of MACE at 30-days was significantly higher in patients with abnormal compared to normal studies (12% versus 0.4%; P < .001; RR, 32; 95% CI, 4.2 to 240), as well as with 1-year of follow-up (14% versus 1.6%; P < .001; RR, 9.1; 95% CI, 3.1 to 27). CONCLUSION: Using acute R-MPI in the evaluation of non-high risk patients presenting with CP is a safe, reliable and cost-effective strategy to be used in the ED to predict ACS and future MACE.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/etiologia , Imagem de Perfusão do Miocárdio/métodos , Síndrome Coronariana Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos , United States Department of Veterans Affairs , Adulto JovemRESUMO
Hypertension not only is the most frequently listed cause of death worldwide; but also a well-recognized major risk factor for cardiovascular disease and stroke. Based on the latest published statistics published by the American Heart Association, hypertension is very prevalent and found in one of every 3 US adults. Furthermore, data from NHANES 2007 to 2010 claims that almost 6% of US adults have undiagnosed hypertension. Despite this staggering statistic, previous US guidelines for the prevention, detection, and treatment of hypertension (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 [JNC 7]), released in 2003, stated that; "unfortunately, sufficient numbers of Mexican Americans and other Hispanic Americans... have not been included in most of the major clinical trials to allow reaching strong conclusions about their responses to individual antihypertensive therapies." However, the recently published JNC 8 offers no comment regarding recommendations or guideline treatment suggestions on Hispanics. The purpose of this article not only is to raise awareness of the lack of epidemiological data and treatment options regarding high blood pressure in the US Hispanic population; but also to make a case of the racial, cultural and social makeup of this ethnic group that places them at risk of cardiovascular complications related to hypertension.
Assuntos
Ensaios Clínicos como Assunto/métodos , Hispânico ou Latino , Hipertensão/etnologia , Seleção de Pacientes , Adulto , Doenças Cardiovasculares/etnologia , Cultura , Demografia , Hispânico ou Latino/genética , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Hipertensão/genética , Fatores de Risco , Comportamento Social , Estados Unidos/epidemiologiaRESUMO
Lower extremity peripheral artery disease is a manifestation of systemic atherosclerotic disease, which affects over 8 million Americans and conveys a significant health burden globally. Although PAD can be asymptomatic and subclinical, it is associated with a reduction in functional capacity and quality of life when symptomatic, and, in its most severe form, is a major cause of limb amputation. Peripheral arterial disease (PAD) commonly results from progressive narrowing of arteries in the lower extremities. Previous studies have shown that PAD is associated with a significantly elevated risk of cardiovascular disease morbidity and mortality. This is the reason screening is crucial for diagnosis and prevention of future adverse cardiovascular events. The most common etiology is atherosclerosis, although other disease process like inflammatory, immune, and hypercoagulable disorders can cause signs and symptoms of arterial insufficiency. When recognized early and appropriately managed, complications that lead to limb loss can be minimized. All patients should have a comprehensive history taken and be examined for PAD, but patients with risk factors should be specifically examined which is currently suboptimal in our daily practice.