PV card: Diagnosis of DVT (ACCP guidelines)

A patient presents with an asymmetric leg with trace pitting edema in the affected leg. What is your diagnostic approach to such a patient? What is the role of D-dimer and ultrasound (U/S)? Does this match the 2012 American College of Chest Physicians (ACCP) guidelines?

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By Michelle Lin, MD|2017-08-01T23:34:35-07:00Jan 24, 2013|ALiEM Cards, Cardiovascular|

Patwari Academy videos: Low risk chest pain

One of the most common complaints in the Emergency Department is chest pain. Is it something serious? How do I risk-stratify patients with potential acute coronary syndrome? What should I be thinking of and not missing?

Rahul goes over the low-risk chest pain patient in 2 great, short teaching videos, based partly on the 2010 AHA/ACC Guideline for ACS risk stratification.

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By Michelle Lin, MD|2019-01-28T22:08:02-08:00Jan 20, 2013|Cardiovascular, Patwari Videos|

MIA 2012: Smith SW et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. Ann Emerg Med. 2012 Dec;60(6):766-76

Bottom Line

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Cardiovascular, ECG|

MIA 2012: Levy P et al. Subclinical hypertensive heart disease in black patients with elevated blood pressure in an inner-city emergency department. Ann Emerg Med. 2012 Oct;60(4):467-74.e1.

Bottom Line¹

In asymptomatic black patients who presented to the ED with elevated blood pressure, subclinical hypertensive heart disease was detected in 9 of every 10 patients.

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Cardiovascular|

MIA 2012: Canto JG et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012 Feb 22;307(8):813-22.

Bottom Line ¹

Chest pain free MI is a very real phenomenon and it is associated with higher mortality – especially in younger women (NRMI study).

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Cardiovascular|

MIA 2012: Hoffmann U et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012 Jul 26;367(4):299-308.

Bottom Line ¹

ROMICAT-II study: Coronary CT angiography (CCTA) is a safe and faster diagnostic strategy than the standard evaluation of low-to-intermediate risk chest pain patients. CCTA, however, results in higher radiation exposure and more downstream testing.

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By Michelle Lin, MD|2016-11-11T18:38:52-08:00Jan 1, 2013|Cardiovascular|

MIA 2012: Than M et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012 Jun 5;59(23):2091-8.

Bottom Line ¹

For ED patients presenting with undifferentiated chest pain, a TIMI score of 0, together with a non-ischemic EKG, and a negative cTnI at 0 hours and 2 hours, can identify patients at very low-risk for having a major adverse cardiac event (MACE) in 30 days.

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By Michelle Lin, MD|2016-11-11T18:42:29-08:00Jan 1, 2013|Cardiovascular|