Chest pain in the emergency department: the broad spectrum of causes

Knockaert, Daniël; Buntinx, Frank; N, Stoens; Bruyninckx, Rudi; Delooz, Herman

doi:10.1097/00063110-200203000-00007

Cited by 76 publications

(67 citation statements)

References 27 publications

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“…1 Nobody suggests that gut feeling is a special paranormal gift of GPs, 10 although the finding could not be confirmed in patients with chest pain examined in a university teaching hospital's emergency department. 11 Most likely, GPs combine a number of verbal and non-verbal clues, however it is not possble to disentangle this information or the way in which it is used. However, while GPs continue to allow gut feeling to remain a poorly described mystic state gained only by experience, we cannot teach the use of this information to students or young GPs.…”

Section: Gut Feelingmentioning

confidence: 99%

Dealing with low-incidence serious diseases in general practice

Buntinx¹,

Mant²,

Bruel³

et al. 2011

Br J Gen Pract

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Cost-effective health care depends on high-quality triage. The most challenging aspect of triage, which GPs confront on a regular basis, is diagnosing rare but serious disease. Failure to shoulder any risk in this situation overloads the health system and subjects patients to unnecessary investigation. Adopting too high a risk threshold leads to missed cases, late diagnosis, and sometimes avoidable death. It also undermines the credibility of primary care practitioners. Quantification of diagnostic risk suggests there is a potential risk gap between the maximum certainty with which GPs can assess the risk of serious disease at presentation and the minimum certainty required by many health systems for further investigation or hospital referral. Physician gutfeeling and diagnostic safety netting are often employed to fill the gap. Neither strategy is well defined or well supported by evidence. It should be possible to reduce the diagnostic risk gap cost-effectively by adopting more explicit diagnostic algorithms and providing better GP access to new diagnostic technologies. It is also essential, given the decreasing experience of triage clinicians employed in a number of countries, that a teachable evidence base is constructed for gut feeling and diagnostic safety netting. However, this construction of an evidence base requires very large-scale studies, and the global primary care research community remains small. The challenge therefore needs to be met by urgent and effective international collaboration.

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Section: Gut Feelingmentioning

confidence: 99%

Dealing with low-incidence serious diseases in general practice

Buntinx¹,

Mant²,

Bruel³

et al. 2011

Br J Gen Pract

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“…Musculoskeletal causes for chest pain are found in about 25% of patients with acute chest pain [66,67]. The pain is mostly triggered by degenerative changes of the spine or a discus prolapse, originates in the chest or neck, and radiates into both arms [68].…”

Section: Non-life-threatening Causes Of Acute Chest Painmentioning

confidence: 99%

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

et al. 2008

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Triage decisions in patients suffering from acute chest pain remain a challenge. The patient's history, initial cardiac enzyme levels, or initial electrocardiograms (ECG) often do not allow selecting the patients in whom further tests are needed. Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account. Nowadays, contrast-enhanced multi-detector-row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of PE or acute aortic syndrome is raised. At the same time, CT is capable of detecting a multitude of non-vascular causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries. In patients with acute chest pain, the optimization of triage decisions and cost-effectiveness using cardiac CT in the emergency department have been repetitively demonstrated. Triple rule-out CT denominates an ECG-gated protocol that allows for the depiction of the pulmonary arteries, thoracic aorta, and coronary arteries within a single examination. This can be accomplished through the use of a dedicated contrast media administration regimen resulting in a simultaneous attenuation of the three vessel territories. This review is intended to demonstrate CT parameters and contrast media administration protocols for performing a triple rule-out CT and discusses radiation dose issues pertinent to the protocol. Typical life-threatening and non-life-threatening diseases causing acute chest pain are illustrated. Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings Abstract Triage decisions in patients suffering from acute chest pain remain a challenge. The patient's history, initial cardiac enzyme levels, or initial electrocardiograms (ECG) often do not allow selecting the patients in whom further tests are needed. Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account. Nowadays, contrast-enhanced multidetector-row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of PE or acute aortic syndrome is raised. At the same time, CT is capable of detecting a multitude of non-vascular causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries. In patients with acute chest pain, the optimization of triage decisions and cost-effectiveness using cardiac CT in the emergency department have been repetitively demonstrated....

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“…Another 50% of acute chest pain admissions are for non-cardiac-related reasons 7 ; and in acute chest pain clinics, musculoskeletal chest pain accounts for between 5% and 20% of total visits. [8][9][10] Chest pain of a serious cardiovascular concern, for example, myocardial infarction and acute coronary syndrome, is seen less often in the primary care setting than in the emergency care setting. 11 Chest pain presentations in chiropractic clinics may be of a musculoskeletal origin.…”

Section: Introductionmentioning

confidence: 99%

Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases

Larson¹

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic. Clinical Features: A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation. Intervention and Outcome: In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting. Conclusion: Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.

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Chest pain in the emergency department: the broad spectrum of causes

Cited by 76 publications

References 27 publications

Dealing with low-incidence serious diseases in general practice

Dealing with low-incidence serious diseases in general practice

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases

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