The American journal of emergency medicine
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To examine whether posturally induced changes in cardiac output differentiate patients presenting with dyspnea to the emergency department (ED) with acute heart failure (AHF) from other causes. ⋯ Patients with AHF have greater TFC but lower CI responses to postural changes compared to patients with asthma and COPD. Knowledge of these changes may help rapidly differentiate AHF from asthma and COPD in the ED.
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Case Reports
Initial dose effect of 5-fluorouracil: rapidly improving severe, acute toxic myopericarditis.
5-Fluorouracil (5-FU) has a significant antineoplastic activity and has been used for the management of various malignant neoplasms. Cardiotoxicity of 5-FU is rare but may be life-threatening. A 55-year-old female patient was admitted to our hospital with atypical chest pain. ⋯ Transthoracic echocardiography revealed global myocardial hypokinesia with impaired left ventricular systolic function (ejection fraction, 20%). Coronary angiography revealed normal coronary arteries with no vasospasm, and therefore, she was hospitalized with the diagnosis of acute toxic myopericarditis and was treated medically. In literature, this case is the first case of acute toxic myocarditis occurring because of the first dose of 5-FU.
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Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all emergency department (ED) visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF. ⋯ The Framingham risk factors for AF are commonly encountered among ED patients with newly diagnosed AF. The ED might provide an opportunity to identify patients at high risk for AF and refer them for primary prevention interventions.
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We aimed to evaluate the Global Registry of Acute Cardiac Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in patients with suspected but not proven acute coronary syndrome (ACS). ⋯ The GRACE and TIMI scores are little better than age alone as predictors of major adverse events in patients with suspected but not proven ACS, and thus add little to prognostic assessment of such patients.
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Comparative Study
Comparison of acute nonthrombolytic and thrombolytic treatments in ischemic stroke patients 80 years or older.
The aim of this study was to compare the clinical outcomes of acute ischemic stroke patients 80 years or older treated with intravenous recombinant tissue plasminogen activator (i.v. rt-PA), or endovascular intervention with or without i.v. rt-PA, or nonthrombolytic medical treatment. ⋯ A prominently higher rate of neurologic improvement and favorable clinical outcome was observed among acute ischemic stroke patients 80 years or older treated with i.v. rt-PA or endovascular intervention when compared with nonthrombolytic medical treatment, supporting the use of acute thrombolytic therapies in this patient population when contraindications are not present.