Tietze’s Syndrome in the emergency department: A rare etiology of atraumatic chest pain

Tietze’s Syndrome is an uncommon disorder that presents with painful, tender, non-suppurative swelling of the anterior chest wall. We report a case of a female patient who presented to the emergency department with a chief complaint of atraumatic chest pain and swelling of the anterior chest wall. After a thorough history and physical examination, as well as basic laboratory tests and chest radiography, she was diagnosed with Tietze’s Syndrome. The expedient accurate diagnosis of Tietze’s Syndrome is important for the physical and emotional well-being of a patient, and avoids overlooking more dangerous pathologies. Tietze’s Syndrome needs to be considered in the differential diagnosis of a patient presenting with spontaneous swelling of the anterior chest.

Growing pains: What do we know about etiology? A systematic review

BACKGROUND Growing pains is the most common cause of musculoskeletal pain in early childhood and was first described in 1823 by French physician Marcel Duchamp.Although it has been researched extensively, the etiology is still unknown.Several theories have been proposed throughout the years.AIM Analyze the available scientific literature to provide an update on the latest evidence on the etiology.METHODS According to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the scientific literature on the etiology of growing pains was systematically reviewed using the following inclusion criteria: studies of any level of evidence reporting clinical or preclinical results and dealing with the etiology of growing pains. The medical electronic databases PubMed and Web of Science were searched by two independent authors on October 20, 2018.The search string used was "(growing pains OR benign nocturnal limb pains OR musculoskeletal pains) AND(etiology OR pathogenesis) AND(pediatrics)".RESULTS A total of 32 articles were included. The etiology of growing pains still remains poorly understood. Many theories have been proposed, but none of them are decisive. A lower pain threshold has been found among patients suffering from growing pains in comparison to healthy controls. Furthermore, evidence suggests an association between growing pains and reduced bone strength in young patients, although this finding still remains controversial. Changes in the vascular perfusion pattern have also been studied. However, the etiology of growing pains does not seem related to a vascular component. The anatomical/mechanical theory has not been supported, but the role of vitamin D deficiency has been investigated many times. Strong recent evidence indicates a genetic susceptibility in the pathogenesis of growing pains. Furthermore,psychological factors also seem to play a strong role in the onset.CONCLUSION The scientific literature about the etiology of growing pains presents heterogeneity and lack of consensus; more studies are needed to understand the genesis of benign musculoskeletal pain syndrome of childhood.

Application Value of NLR,PLR,LMR,HEART score,and POCT in Early Warning and Accurate Graded Diagnosis of High-Risk Chest Pain in Emergency Medicine

Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and point-of- care testing (POCT) in the early warning and precise diagnosis of high-risk chest pain in emergency medicine. Methods: A total of 157 patients with acute chest pain who were admitted to the emergency department and chest pain treatment unit of our hospital between August 2022 and September 2023 were selected. Rapid testing of bedside myocardial markers (ultrasensitive troponin (hs-cTnI), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), D-dimer (D-Dimer), and N-terminal B-type natriuretic peptide precursor (NT-proBNP)) was performed on the patients using a POCT device (ThermoKing BioMQ60proB). A HEART score was used to classify the patients into low (n = 53), intermediate (n = 59), and high-risk (n = 45) groups, and the NLR, PLR, and LMR were calculated. The NLR, PLR, and LMR values were compared among the three groups of patients, and the optimal cutoff values as well as sensitivity and specificity were determined based on receiver operating characteristic (ROC) analysis. Results: The HEART scores of patients in the low-risk, intermediate-risk, and high-risk groups were (2.72 ± 0.24), (4.75 ± 0.56), and (5.32 ± 0.73) respectively, and the differences were statistically significant (P < 0.05). Compared with the low-risk group, the intermediate-risk group and high-risk group had a significantly higher NLR and PLR, and a significantly lower LMR;the high-risk group had higher NLR and PLR and lower values of LMR as compared to the other two groups, and the difference was statistically significant (P < 0.05). The ROC curves suggested that the area under the curve, sensitivity, and specificity of the combined diagnosis of NLR, PLR, LMR, HEART score, and POCT were greater than those of LR, PLR, and LMR with HEART score and POCT alone. Conclusion: The combined application of NLR, PLR, LMR, HEART score, and POCT has significant application value in the early warning and precise diagnosis of emergency high-risk chest pain. It provides a more simple, easy-to-access, and efficient assessment index for the clinical prediction and treatment of emergency high- risk chest pain.

Impact of Optimizing Emergency Nursing Processes on Resuscitation Success in Patients with Acute Chest Pain

Objective:To analyze the effect of optimizing the emergency nursing process in the resuscitation of patients with acute chest pain and the impact on the resuscitation success rate.Methods:66 patients with acute chest pain received by the emergency department of our hospital from January 2022 to December 2023 were selected as the study subjects and divided into two groups according to the differences in the emergency nursing process,i.e.,33 patients receiving routine emergency care were included in the control group,and 33 patients receiving the optimization of emergency nursing process intervention were included in the observation group.Patients’resuscitation effect and satisfaction with nursing care in the two groups were compared.Results:The observation group’s consultation assessment time,reception time,admission to the start of resuscitation time,and resuscitation time were shorter than that of the control group,the resuscitation success rate was higher than that of the control group,and the incidence of adverse events was lower than that of the control group,with statistically significant differences(P<0.05);and the observation group’s satisfaction with nursing care was higher than that of the control group,with statistically significant differences(P<0.05).Conclusion:Optimization of emergency nursing process intervention in the resuscitation of acute chest pain patients can greatly shorten the rescue time and improve the success rate of resuscitation,with higher patient satisfaction.

The main etiologies for patients presented to ER with chest pain or chest pain equivalent in Beijing,China

Objectives To identify the mian etilogoies for patients presented to the ER with chest pain or chest pain equivalent and further analyze the common presenting symptom of coronary heart disease patients in the ER.Methods We conducted a prospective,cross-sectinal survey of all patinets presented to the ER with chest pain and chest pain equivalent syndrome in 17 medical centre in Beijing,China from Ju ly to August 2009.Data was collected by structured interviews and medical record reviews.The mean follow up period was 30 days.Results A total of 5666 patients entered the study [age(58.09±18.39)years,2663 males and 3303 females]. Their final diagnoses are;Chest pain(4.65%) Coronary heart disease 1506(27.4%),Acute Heart failure 149(2.6%), Pericarditis 4(0.1%),Pulmonary embolism 11(0.2%),Aortic dissection8(0.1%),Acute cerebrovascular disease 431 (7.6%),Non-cardic chest pain 2538(44.9%).We further analyzed the cornary heart disease patients.Eight-eight percent patients with cornary heart disease have symptoms at their presentation.The other 12%? patients without symptom.71% with chest prseur sensation.38.8%with shorness of breath, 23.3%with dyspnea,irritable,1.6%syncope,1.0%Loss of Consciousness 33.2%Palpitation,22.0%dizziness,14.7% nausea and vomiting,19.1%sluggish.Conclusions A quarter of patients(27.4%) presented to the ER with chest pain or chest pain equivalent have defined etiology of coronary heart deisease.Howerer,nearly half(48.8%) of the coronary heart disease patients present with no chest pain and 18.7% CHD patients presents with chest pain equivalent syndrome. This study suggest chest pain is not a prerequisite for the diagnosis of CHD.Therefore,special vigilance and thorough coronary artery evaluation is needed for all patients with chest discomfort or respiratory distress in the ER,even for patients without chest pain complaints.

Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress

AIM To investigate the effects of depression and anxiety on health-related quality of life(QoL)in gastroesophageal reflux disease(GERD)patients and those suffering from cardiac(CCP)and noncardiac(NCCP)chest pain in Wuhan,China.METHODS In this cross-sectional study,a total of 358 consecutive patients with GERD were enrolled in Wuhan,China,of which 176 subjects had complaints of chest pain.Those with chest pain underwent coronary angiography and were divided into a CCP group(52 cases)and NCCP group(124 cases).Validated GERD questionnaires were completed,and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of Qo L and psychological symptoms,respectively.RESULTS There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP.However,the QoL was obviously lower in GERD with CCP than NCCP(48.34±17.68 vs 60.21±20.27,P<0.01).In the GERD-NCCP group,rather than the GERD-CCP group,the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression.Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP(all P<0.01),but only a weak relationship with mental components of QoL in GERD-CCP.CONCLUSION High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP.This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients.

A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS） in the emergency department （ED）.Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events （MACE） defined as a composite of acute myocardial infarction （AMI）, percu-taneous intervention （PCI）, coronary artery bypass graft （CABG）, or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients （46.6%） had a MACE within three months： 205 patients （15.8%） were diag-nosed with AMI, 465 patients （35.8%） underwent PCI, and 119 patients （9.2%） underwent CABG. There were 10 （0.8%） deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased （P ＆lt; 0.001 byχ2 for trend）. The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups： low risk （score 0-2）, intermediate risk （score 3-4）, and high risk （score 5-10）. Event rates were 1.1%, 18.5%, and 67.0%, respectively （P ＆lt; 0.001）.ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

Prognostic performance of interleukin-10 in patients with chest pain and mild to moderate coronary artery lesions an 8-year follow-up study

Background Interleukin （IL）-10, IL-6 and their ratio （IL-6/IL-10） play an important role in the risk of developing coronary artery disease, and may correlate with its outcomes. Few clinical trials have investigated the prognostic impact of these factors on long-term car- diovascular events in patients presented with chest pain. Methods A prospective study was performed on 566 patients admitted with chest pain and identified mild to moderate coronary artery lesions. 1L-10, IL-6 and IL-6/IL-10 were measured. Results A total of 511 patients com- pleted the follow-up. The median follow-up time was 74 months. Kaplan-Meier analysis demonstrated a clear increase of the incidence of major adverse cardiac events during the follow-up period in patients with below-median levels of IL-10 （P = 0.006） and above-median levels of IL-6/IL-10 （P = 0.012）. Multivariate Cox proportional hazards analysis indicated the IL-10 levels to be strong independent predictors after adjustment for underlying confounders. Conclusions Elevated IL-10 levels are associated with a more favorable long-term prognosis in patients with chest pain and mild to moderate coronary artery lesions. IL-10 could be used for early risk assessment of long-term prognosis.

Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature

The aim of this paper is to report an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses(MHE) coming to our observation for chest pain as the only symptom of an intra-thoracic localization. A 16 years old patient with familiar history of MHE came to our observation complaining a left-sided chest pain. This pain had increased in the last months with no correlation to a traumatic event. The computed tomography(CT) scan revealed the presence of three exostoses located on the left third, fourth and sixth ribs, all protruding into the thoracic cavity, directly in contact with visceral pleura. Moreover, the apex of the one located on the sixth rib revealed to be only 12 mm away from pericardium. Patient underwent video-assisted thoracoscopy with an additional 4-cm mini toracotomy approach. At the last 1-year followup, patient was very satisfied and no signs of recurrence or major complication had occured. In conclusion, chest pain could be the only symptom of an intra-thoracic exostoses localization, possibly leading to serious complications. Thoracic localization in MHE must be suspected when patients complain chest pain. A chest CT scan is indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopic surgery can be considered a valuable option for exostoses removal, alone or in addiction to a mini-thoracotomy approach, in order to reduce thoracotomy morbidity.

Chest pain without a clue-ultrasound to rescue occult multiple myeloma: A case report

BACKGROUND Chest pain is one of the most common symptoms with which a patient presents to a doctor.Differentials include,but are not limited to,cardiac pulmonary,gastrointestinal,psychosomatic and musculoskeletal causes.In our case,ultrasound of the chest wall paved the way for the diagnosis of multiple myeloma,which occultly presented with chronic chest pain.CASE SUMMARY Here we report a case of 50-year-old man with chronic chest pain without anemia or renal failure who was diagnosed with multiple myeloma,despite negative bence jones protein and M band electrophoresis.An ultrasound of the chest wall showed cortical irregularities along with a hypoechoic mass in the sternum and left 5th rib,which helped us in clinching the diagnosis.CONCLUSION Ultrasound of bone can often aid in reaching a diagnosis indirectly if not directly.

Diagnosis of chest pain with foregut symptoms in Chinese patients

AIM:To evaluate the diagnosis of chest pain with foregut symptoms in Chinese patients. METHODS:Esophageal manometric studies, 24-h introesophageal pH monitoring and 24-h electrocardiograms(Holter electrocardiography)were performed in 61 patients with chest pain. RESULTS:Thirty-nine patients were diagnosed with non-specific esophageal motility disorders(29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia).Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux(two patients had concomitant myocardial ischemia),and one patient was diagnosed with nutcracker esophagus. CONCLUSION:The esophageal manometric studies, 24-h intra-esophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain,particularly in patients with foregut symptoms.In cases of esophageal motility disorders,pathological gastroesophageal reflux may be a major cause of chest pain with non-specific esophageal motility disorders.Spasm of the esophageal smooth muscle might affect the heart-coronary smooth muscle,leading to myocardial ischemia.

The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery

Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

Exertional esophageal pH-metry and manometry in recurrent chest pain

AIM: To investigate the diagnostic efficacy of 24-h and exertional esophageal pH-metry and manometry in patients with recurrent chest pain. METHODS: The study included 111 patients (54% male) with recurrent angina-like chest pain, non-respon- sive to therapy with proton pump inhibitors. Sixty-five (59%) had non-obstructive lesions in coronary artery angiography, and in 46 (41%) significant coronary artery narrowing was found. In all patients, 24-h esophageal pH-metry and manometry, and treadmill stress tests with simultaneous esophageal pH-metry and manometry monitoring were performed. During a 24-h examination the percentage of spontaneous chest pain (sCP) episodes associated with acid reflux or dysmotility (symptom index, SI) was calculated. Patients with SI > 50% for acid gastroesophageal reflux (GER) were classified as having GER-related sCP. The remaining symptomatic individuals were determined as having non-GER-related sCP. During the stress test, the occurrence of chest pain, episodes of esophageal acidification (pH < 4 for 10 s) and esophageal spasm with more than 55% of simultaneous contractions (exercise-provoked esophageal spasm or EPES) were noted. RESULTS: Sixty-eight (61%) individuals reported sCP during 24-h esophageal function monitoring. Eleven of these (16%) were classified as having GER-related sCP and 53/68 (84%) as having non-GER-related sCP. The exercise-provoked chest pain during a stress test occurred in 13/111 (12%) subjects. In order to compare the clinical usefulness of 24-h esophageal function monitoring and its examination limited only to the treadmill stress test, the standard parameters of diagnostic test evaluation were determined. The occurrence of GER- related or non-GER-related sCP was assumed as a "gold standard". Afterwards, accuracy, sensitivity and specificity were calculated. These parameters expressed a prediction of GER-related or non-GER-related sCP occurrence by the presence of chest pain, esophageal acidification and EPES. Accuracy, sensitivity and specificity of chest pain during the stress test predicting any sCP occurrence were 28%, 35% and 80%, respectively, predicting GER- related sCP were 42%, 0% and 83%, respectively, and predicting non-GER-related sCP were 57%, 36% and 83%, respectively. Similar values were obtained for exercise-related acidification with pH < 4 longer than 10 s in the prediction of GER-related sCP (44%, 36% and 92%, respectively) and EPES in relation to non-GER-related sCP (48%, 23% and 84%, respectively). CONCLUSION: The presence of chest pain, esophageal acidification and EPES had greater than 80% specificity to exclude the GER-related and non-GER-related causes of recurrent chest pain.

Congenital partial absence of the pericardium in a young man with atypical chest pain

Pericardial defects are infrequent congenital anomalies due to agenesis caused by premature atrophy of the common cardinal vein or Cuvier duct during the 5th or 6th week of embryonic life. These congenital defects are rare, typically observed as an incidental finding and usually remain asymptomatic. Nevertheless, the more widespread use of modern imaging techniques has contributed to an increase of its incidence in recent years. There is currently no consensus regarding therapeutic options, all of which are based on small retrospective studies that evaluate the risk of developing a life-threatening complication such as herniation and incarceration of the myocardium. We report on a 22-year-old male who presented with sudden onset of sharp chest pain and dyspnea. Computed tomography and cardiac magnetic resonance scan revealed a pericardial defect adjacent to the lateral free wall of the left atrium with associated herniation of the left atrial appendage. The patient was managed conservatively and had an uneventful clinical progress.

Exercise-provoked esophageal motility disorder in patients with recurrent chest pain

AIM:To investigate the relationship between exerciseprovoked esophageal motility disorders and the prognosis for patients with chest pain.METHODS:The study involved 63 subjects with recurrent angina-like chest pain non-responsive to empirical therapy with proton pump inhibitor(PPI).In all,a coronary artery angiography,panendoscopy,24-h esophageal pH-metry and manometry,as well as a treadmill stress test with simultaneous esophageal pH-metry and manometry monitoring,were performed.Thirtyfive subjects had no significant coronary artery lesions,and 28 had more than 50% coronary artery narrowing.In patients with hypertensive esophageal motility disorders,a calcium antagonist was recommended.The average follow-up period was 977 ± 249 d.RESULTS:The prevalence of esophageal disorders,such as gastroesophageal reflux or diffuse esophageal spasm,was similar in patients both with and without significant coronary artery narrowing.Exercise prompted esophageal motility disorders,such as a decrease in the percentage of peristaltic and effective contractions and their amplitude,as well as an increase in the percentage of simultaneous and non-effective contractions.In 14(22%) patients the percentage of simultaneous contractions during the treadmill stress test exceeded the value of 55%.Using Kaplan-Meier analysis and the proportional hazard Cox regression model,it was shown that the administration of a calcium channel antagonist in patients with such an esophageal motility disorder significantly decreased the risk of hospitalization as a result of a suspicion of acute coronary syndrome after the 2.7-year follow-up period.CONCLUSION:In patients with chest pain non-responsive to PPIs,a diagnosis of exercise-provoked esophageal spasm may have the effect of lowering the risk of the next hospitalization.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.

Takotsubo cardiomyopathy misdiagnosed as acute myocardial infarction under the Chest Pain Center model:A case report

BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.

An unusual emergency department case： ruptured ectopic pregnancy presenting as chest pain

INTRODUCTIONEctopic pregnancy occurs at a rate of 1%-2% of all pregnancies, and tends to occur at a higher rate （up to 4%） in patients receiving fertility treatments. Women with ectopic pregnancies are often asymptomatic or may complain of amenorrhea, vaginal spotting, and lower abdominal cramping pain.