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Main Data
Author: Christopher P. Cannon, William Franklin Peacock
Editor: W. Frank Peacock, Christopher P. Cannon
Title: Short Stay Management of Chest Pain
Publisher: Humana Press
ISBN/ISSN: 9781603279482
Edition: 1
Price: CHF 166.60
Publication date: 01/01/2009
Content
Category: Medizin & Pharmazie
Language: English
Technical Data
Pages: 272
Kopierschutz: DRM
Geräte: PC/MAC/eReader/Tablet
Formate: PDF
Table of contents

Acute coronary syndrome (ACS) continues to challenge our health care system in the complexity of presentation and the ever increasing number of patients exhibiting signs and symptoms of an acute coronary syndrome. Written by leading experts, Short Stay Management of Chest Pain provides scientific and clinical insights on the management of patients who arrive at the hospital with a presentation consistent with a potential acute coronary syndrome. Focusing on the cardiology aspects of chest pain, Short Stay Management of Chest Pain is a valuable tool for acute care physicians, nurses, and hospital administrators devoted to caring for this population. Short Stay Management of Chest Pain details the remarkable improvements in diagnostic accuracy and improved patient outcomes for patients presenting with suspected acute coronary syndromes.

Table of contents
Preface5
References7
Contents9
Contributors11
Epidemiology and Demography of Coronary Artery Disease13
History of the Study of Epidemiology and Coronary Artery Disease14
Cardiovascular Disease Statistics15
Coronary Artery Disease Statistics17
Risk Factors of CAD20
Hypertension20
Physical Inactivity20
Tobacco Use22
Hyperlipidemia22
Overweight and Obesity23
Diabetes23
References25
Financial Impact of Acute Coronary Syndromes: The Need for New Care Delivery Models26
Introduction26
The High Costs of Cardiovascular Disease27
The Chest Pain Dilemma28
Historical Perspective of CPU29
Forces Affecting Cardiac Care Reimbursement30
Reimbursement for Chest Pain and ACS32
Clinical and Fiscal Rational for a CPU33
Re-engineering the Chest Pain Delivery Model-New Solutions35
Measuring Changes Is Critical43
Conclusion44
References45
Why Have a Chest Pain Unit?47
Background on Why Chest Pain Units Are Needed48
So Why Not Admit All Suspect Chest Pain Patients?49
What Is a Chest Pain Center? What Is a Chest Pain Unit?50
Why Have a Chest Pain Unit?51
Reduction in Mortality and Morbidity Risk for ACS Patients52
Reduction in Unnecessary Inpatient Admissions, Costs, and Length of Stay for Chest Pain Patients54
Improved Patient and Physician Satisfaction57
Improved Hospital Resource Utilization - Increased Capacity, Decreased Ambulance Diversion, Fewer Patients that Leave ED Without Being Seen58
Economic Benefits - More Cost-Effective, Decreased Compliance Risk, More Equitable Admissions, New Service Line, Marketing Advantage, Decreased Liability Risk59
Summary62
References62
Pathophysiology and Definition of the Acute Coronary Syndromes65
Spectrum of the Acute Coronary Syndromes66
Vulnerable Plaque and Plaque Rupture68
Inflammation and Morphology68
Coronary Thrombosis70
Degree of Coronary Stenosis71
Clinicopathologic Correlations72
Nonatherosclerotic Causes of MI74
Conclusions74
References74
Emergency Department Presentation76
Arrival to ED76
Classical Presentations of Acute Coronary Syndrome77
Confounders79
Differential Diagnosis81
Guideline Recommendations83
Cardiac Biomarkers84
References85
Risk Stratification: History, Physical, and EKG88
Introduction88
History and Risk Factors89
Physical Examination90
Electrocardiogram91
Risk Prediction Tools94
References96
Cardiac Markers: A Chest Pain Center Focus100
Introduction101
Cardiac Necrosis Markers102
Cardiac Troponin T and Cardiac Troponin I102
Diagnosis of Myocardial Infarction102
Early Risk Stratification104
Clinical Decision Making105
CK-MB Measurement106
Myoglobin107
Ischemia and Risk Stratification Markers107
Ischemia-Modified Albumin108
Myeloperoxidase108
High-Sensitivity C-Reactive Protein109
B-Type Natriuretic Peptide and N-Terminal proBNP110
Future Development111
Point-of-Care Testing for Cardiac Biomarkers111
Clinical Confounders for Biomarker Testing112
Renal Insufficiency and End-Stage Renal Disease113
Blunt Chest Trauma114
Pulmonary Embolism114
Chemotherapy114
Recent Cardiac Procedures115
Reinfarction116
Panels117
Future Developments117
References118
Risk Stratification Using Scoring Systems123
Goldman Risk Score123
ACI-TIPI125
Artificial Neural Networks126
TIMI Risk Score127
PURSUIT Risk Score129
GRACE Risk Score129
Clinical Impression130
References131
Emergency Department Disposition of Patients Presenting with Chest Pain133
Introduction133
Risk Stratification134
Who Warrants Immediate PCI or Thrombolysis?135
Which Patients Require Hospitalization?137
Patients Who May Warrant Early Intervention?138
Which Patients Require Hospitalization or an Observation Unit?139
Patients Appropriate for an Observation Unit141
Patients Appropriate for Discharge142
Special Considerations143
Women143
Diabetes Mellitus143
Elderly144
Cocaine and Methamphetamine-Induced Chest Pain144
Conclusions145
References145
Short-Stay Unit Requirements150
References152
Medical Therapy in Patients Managed in a Chest Pain Observation Unit153
Aspirin Therapy153
Anticoagulation154
Nitrates155
Beta Blockers155
Conclusion156
References156
Provocative Testing160
Introduction160
Patient Selection162
Test Selection163
Inability to Exercise163
Baseline ECG Changes164
Added Value of Cardiac Imaging165
Recommendations for Choice of Diagnostic Test165
Exercise Treadmill Testing166
Test Performance and Interpretation166
Prognostic Scores169
Supervision and