The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis ...The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis is obstruction of the heart collaterals,and treatment mainly adopts dredging collaterals and relieving pain.Based on the treatment principles of dredging collaterals with pungent,aiming at the etiology,pathogenesis and disease characteristics of angina pectoris in coronary heart disease,this article systematically analyzes the Method of Dredging Collaterals with Pungent including the methods of dredging collaterals with pungent moisture,dredging collaterals with pungent warm,dredging collaterals with pungent aroma,and dredging collaterals with insect type drugs,to provide ideas for the treatment of angina pectoris in coronary heart disease.展开更多
AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest pain.METHODS We studied individuals who were consecutively admitted to our Chest Pain...AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest pain.METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit.At admission,investigators performed a standardized interview and recorded14 chest pain features.Based on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and categorically.As the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to rule-out.In order to assess reproducibility,a second cardiologist did the same procedure.RESULTS In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of accuracy.Accordingly,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.展开更多
The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to...The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.展开更多
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 a...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.展开更多
Coronary artery disease (CAD) is the leading cause of death in both sexes worldwide, and becomes number one killer in women due to many factors including increase in traditional risk factors, delays in apparition of s...Coronary artery disease (CAD) is the leading cause of death in both sexes worldwide, and becomes number one killer in women due to many factors including increase in traditional risk factors, delays in apparition of symptoms, under estimation of diagnosis test and treatment. Our study aims to identify risk factors for coronary artery disease among women with chest pain underwent coronary angiography during years (2010-2013) in cardiology center. The study design is an observational among 688 women-aged 32 - 96 years;the mean age of our study population is 61 years. Risk factors are abstracted from patients’ files. Women with documented coronaries disease tend to be older, have higher, systolic blood pressure, serum level of triglyceride, and impaired clearance creatinine. 59.4% of them are menopause with higher prevalence of hypertension and diabetes (58.6% and 63.6%). Significant positive association is found in women with myocardial infarction, unstable angina, stable angina and presence of obstructive coronary artery disease respectively (89.6%, 82.3%, 59.1%) in opposite women presented with atypical chest pain have high prevalence of normal coronaries (95.7%). About 57.6% have more than three risk factors, and 55.3% are obese or overweight. In addition, 42.1% of them have impaired systolic function. We conclude that cardiovascular risk factors are highly prevalent among Palestinians women in Gaza and the combination of risk factors is common. Interventions to minimize CAD in our population are needed.展开更多
BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community...BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community physicians to be assessed by specialists within the hospital system in rapid access chest pain clinics(RACPC).The role of a highly sensitive troponin I(uscTnI)assay in the diagnosis of suspected CAD in a RACPC in a“real-life”setting in a non-academic hospital has not been explored.AIM To examine the diagnostic value of uscTnI(detection limit 0.12 ng/L,upper reference range 8.15 ng/L,and detected uscTnI in 96.8%of the reference population),in the evaluation of stable CAD in a non-selected patient group,with several co-morbidities,who presented to the RACPC.METHODS One hundred and seventy two RACPC patients were assigned to either functional or anatomical testing according to the hospital protocol.RESULTS The investigations offered to patients were exercise tolerance test 7.6%,24 h ECG 1.2%,Echocardiogram 14.5%,stress echocardiogram 8.1%,coronary computed tomography angiography(CCTA)12.8%,coronary angiogram 13.4%,17.4%were diagnosed with non-cardiac chest pain,3.5%treated as stable angina,8.2%reviewed by cardiologists,electronic medical records were not available in 10.4%.Receiver operating characteristic curves for CAD used uscTnI values measured in patients who underwent functional testing,angiogram or CCTA.Values>0.52 ng/L showed 100%sensitivity and at>11.6 ng/L showed 100%specificity.In the range>0.52-11.6 ng/L,uscTnI may not have the same diagnostic potential.In patients assigned to coronary angiogram higher concentrations of uscTnI was associated with severe CAD.Low levels of uscTnI and low pre-test probability of CAD(QRISK3)may decrease patient numbers assigned to CCTA.CONCLUSION The uscTnI diagnostic cut-off values in a RACPC will depend on patient population and their presenting co-morbidity.In the presence of clinical comorbidities and previous CAD the uscTnI needs to be used in conjunction with clinical assessment.展开更多
BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patient...BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.展开更多
Cardiovascular disease is a leading cause of morbidity and death among women.Our knowledge of ischemic heart disease has grown tremendously over the past few decades as sex differences in prevalence,presentation,and p...Cardiovascular disease is a leading cause of morbidity and death among women.Our knowledge of ischemic heart disease has grown tremendously over the past few decades as sex differences in prevalence,presentation,and pathophysiology are increasingly being recognized.Women with ischemic heart disease have less coronary atherosclerosis than men.Coronary endothelial dysfunction and microvascular disease have been proposed as important mechanisms that contribute to the cause and prognosis of ischemic heart disease in women.This review outlines sex-specifi c issues in ischemic heart disease,including prevalence,prognosis,pathophysiology,traditional and nontraditional risk factors,screening,and diagnostic testing,as well as management strategies.展开更多
基金Supported by the Youth Science Fund Project of the National Natural Science Foundation of China(30304117474)Scientific Research Project of Shanghai Municipal Health Commission(202040308)。
文摘The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis is obstruction of the heart collaterals,and treatment mainly adopts dredging collaterals and relieving pain.Based on the treatment principles of dredging collaterals with pungent,aiming at the etiology,pathogenesis and disease characteristics of angina pectoris in coronary heart disease,this article systematically analyzes the Method of Dredging Collaterals with Pungent including the methods of dredging collaterals with pungent moisture,dredging collaterals with pungent warm,dredging collaterals with pungent aroma,and dredging collaterals with insect type drugs,to provide ideas for the treatment of angina pectoris in coronary heart disease.
文摘AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest pain.METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit.At admission,investigators performed a standardized interview and recorded14 chest pain features.Based on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and categorically.As the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to rule-out.In order to assess reproducibility,a second cardiologist did the same procedure.RESULTS In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of accuracy.Accordingly,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.
文摘The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.
文摘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.
文摘Coronary artery disease (CAD) is the leading cause of death in both sexes worldwide, and becomes number one killer in women due to many factors including increase in traditional risk factors, delays in apparition of symptoms, under estimation of diagnosis test and treatment. Our study aims to identify risk factors for coronary artery disease among women with chest pain underwent coronary angiography during years (2010-2013) in cardiology center. The study design is an observational among 688 women-aged 32 - 96 years;the mean age of our study population is 61 years. Risk factors are abstracted from patients’ files. Women with documented coronaries disease tend to be older, have higher, systolic blood pressure, serum level of triglyceride, and impaired clearance creatinine. 59.4% of them are menopause with higher prevalence of hypertension and diabetes (58.6% and 63.6%). Significant positive association is found in women with myocardial infarction, unstable angina, stable angina and presence of obstructive coronary artery disease respectively (89.6%, 82.3%, 59.1%) in opposite women presented with atypical chest pain have high prevalence of normal coronaries (95.7%). About 57.6% have more than three risk factors, and 55.3% are obese or overweight. In addition, 42.1% of them have impaired systolic function. We conclude that cardiovascular risk factors are highly prevalent among Palestinians women in Gaza and the combination of risk factors is common. Interventions to minimize CAD in our population are needed.
文摘BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community physicians to be assessed by specialists within the hospital system in rapid access chest pain clinics(RACPC).The role of a highly sensitive troponin I(uscTnI)assay in the diagnosis of suspected CAD in a RACPC in a“real-life”setting in a non-academic hospital has not been explored.AIM To examine the diagnostic value of uscTnI(detection limit 0.12 ng/L,upper reference range 8.15 ng/L,and detected uscTnI in 96.8%of the reference population),in the evaluation of stable CAD in a non-selected patient group,with several co-morbidities,who presented to the RACPC.METHODS One hundred and seventy two RACPC patients were assigned to either functional or anatomical testing according to the hospital protocol.RESULTS The investigations offered to patients were exercise tolerance test 7.6%,24 h ECG 1.2%,Echocardiogram 14.5%,stress echocardiogram 8.1%,coronary computed tomography angiography(CCTA)12.8%,coronary angiogram 13.4%,17.4%were diagnosed with non-cardiac chest pain,3.5%treated as stable angina,8.2%reviewed by cardiologists,electronic medical records were not available in 10.4%.Receiver operating characteristic curves for CAD used uscTnI values measured in patients who underwent functional testing,angiogram or CCTA.Values>0.52 ng/L showed 100%sensitivity and at>11.6 ng/L showed 100%specificity.In the range>0.52-11.6 ng/L,uscTnI may not have the same diagnostic potential.In patients assigned to coronary angiogram higher concentrations of uscTnI was associated with severe CAD.Low levels of uscTnI and low pre-test probability of CAD(QRISK3)may decrease patient numbers assigned to CCTA.CONCLUSION The uscTnI diagnostic cut-off values in a RACPC will depend on patient population and their presenting co-morbidity.In the presence of clinical comorbidities and previous CAD the uscTnI needs to be used in conjunction with clinical assessment.
文摘BACKGROUND:Patients with suspected acute coronary syndrome (ACS) in whom myocardial infarction has been ruled out are still at risk of having obstructive coronary artery disease (CAD).This rate is higher among patients with intermediate high-sensitivity troponin I (hsTnI) concentrations (5 ng/L to 99th percentile) than low concentrations (<5 ng/L).Therefore,an intermediate concentration has been suggested as a candidate for downstream investigation with computed tomography coronary angiography(CTCA).We tried to compare the HEART score-guided vs.hsTnI-guided approach for identifying obstructive CAD.METHODS:From a prospective cohort study of patients presenting to the emergency department with suspected ACS,433 patients without elevated hsTnI who also underwent CTCA were selected and analyzed.The performances of hsTnI concentration and HEART score were compared using sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV).RESULTS:Overall,120 (27.7%) patients had obstructive CAD.Patients with intermediate hsTnI concentrations were more likely to have obstructive CAD than those with low hsTnI concentrations(40.0%vs.18.1%);patients with non-low-risk HEART scores (≥4 points) were also more likely to have obstructive CAD than those with low-risk scores (0 to 3 points)(41.0%vs.7.6%).The HEART score had higher sensitivity and NPV for detecting obstructive CAD in each classification than hsTnI concentration (sensitivity:89.2%vs.63.3%;NPV:92.4%vs.81.9%,respectively).CONCLUSION:After excluding myocardial infarction in patients with suspected ACS,adding the HEART score for selecting candidates for CTCA could improve patient risk stratification more accurately than relying on hsTnI concentration.
文摘Cardiovascular disease is a leading cause of morbidity and death among women.Our knowledge of ischemic heart disease has grown tremendously over the past few decades as sex differences in prevalence,presentation,and pathophysiology are increasingly being recognized.Women with ischemic heart disease have less coronary atherosclerosis than men.Coronary endothelial dysfunction and microvascular disease have been proposed as important mechanisms that contribute to the cause and prognosis of ischemic heart disease in women.This review outlines sex-specifi c issues in ischemic heart disease,including prevalence,prognosis,pathophysiology,traditional and nontraditional risk factors,screening,and diagnostic testing,as well as management strategies.
