Chest Pain

Sep 1, 2020 Issue
Esophageal Motility Disorders [Article]

Esophageal motility disorders are diagnosed based on esophageal manometry findings. Achalasia has objective diagnostic criteria, and effective treatments are available. Hypercontractile motility disorders are generally self-limited and may be overdiagnosed, leading to unnecessary and irreversible interventions.

Feb 15, 2018 Issue
No Effect on Mortality with Oxygen Therapy in Nonhypoxemic Patients with Suspected MI [POEMs]

In patients with suspected MI and normal oxygen levels, giving immediate supplemental oxygen therapy does not improve mortality at one year. Although this study was underpowered because of fewer than expected deaths in the control group, the results were consistent across all subgroups, as well as with findings from other literature.

Sep 1, 2017 Issue
Pleuritic Chest Pain: Sorting Through the Differential Diagnosis [Article]

Once diagnoses requiring emergent attention are excluded, a virus is a likely causative agent to consider. Some patients must be reexamined with radiography after they receive treatment to ensure complete resolution of illness.

Sep 1, 2017 Issue
Predictors of Acute Myocardial Infarction [FPIN's Help Desk Answers]

The most useful element for ruling in acute MI is chest pain with radiation to both arms, followed by radiation to the right arm. The most useful elements for ruling out acute MI are pleuritic chest pain, sharp pain, and pain reproduced by palpation.

Sep 1, 2017 Issue
Exercise Stress Testing: Indications and Common Questions [Article]

Find out how to use exercise stress testing for risk stratification before surgery, which patients can be evaluated with testing alone, and which patients benefit from adjunctive imaging.

Jun 15, 2016 Issue
Rapid Protocols to Rule out Myocardial Infarction [Point-of-Care Guides]

Cardiac troponin T and I are released into the bloodstream when cardiac muscle is damaged. Cardiac troponin tests have been available for decades and are the preferred biomarkers for the diagnosis of acute myocardial infarction (AMI). However, until recently, they lacked sensitivity in the first few hours following an acute myocardial injury.

Dec 1, 2015 Issue
CCTA and Radionuclide Stress Testing Similar for Evaluation of Chest Pain [POEMs]

For the evaluation of chest pain in intermediate-risk patients, CCTA is comparable with myocardial perfusion imaging in its ability to select patients for invasive management. Both modalities are also similar when it comes to downstream resource use and adverse cardiovascular events. CCTA is associated with less radiation exposure.

Feb 1, 2013 Issue
Outpatient Diagnosis of Acute Chest Pain in Adults [Article]

Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rul...

Mar 1, 2011 Issue
Evaluation of Chest Pain in Primary Care Patients [Point-of-Care Guides]

Chest pain can be caused by conditions that range from benign and self-limited (e.g., chest wall pain) to serious (e.g., anxiety disorder) or life-threatening (e.g., unstable angina, aortic dissection, pulmonary embolism). Accurate identification of life-threatening and serious causes of chest pain ...

Nov 15, 2010 Issue
Can ECG Rule Out ACS if Performed While the Patient Is Having Chest Pain? [AFP Journal Club]

Is negative ECG performed while the patient is having chest pain good at ruling out acute coronary syndrome? Although this study says yes, other higher-quality studies say it does not rule out cardiac disease. Observational studies are not ideal for testing some hypotheses.

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