Background: A high proportion of patients admitted to a medical pass department due to chest pain are directly sent abiding-place since the initial suspicion of acute myocardial infarction (AMI) can be quickly rul out Aim: To describe the issue of such patients during 1 year of follow-up in bounds of mortality.
Background: A high proportion of patients admitted to a medical pass department due to chest pain are directly sent abiding-place since the initial suspicion of acute myocardial infarction (AMI) can be quickly rul out
Aim: To describe the issue of such patients during 1 year of follow-up in bounds of mortality, development of AMI, and especially severity of symptoms 1 year after discharge.
Methods: All patients who during 21 month were admitted to the medical pass department at Sahlgrenska Hospital, Goteborg, Sweden, to be ascribed to chest pain, and who could be directly sent to one's home were prospectively followed up for 1 year. Their issue was compared with patients who had chest pain and were hospitalized for AMI during the same time.
Results: Patients with chest pain directly sent domicile (n = 2,102) had a median age of 52 years (age range, 16 to 96 years), and 54 percent were men The mortality during 1 year was 3 percent and 3 percent bring to maturityed AMI. As compared with patients with AMI, those who were directly sent residence less frequently reported various cardiovascular symptoms, with the exception for chest pain at pause and palpitations. On the other hand, various emotional and psychosomatic symptoms were more often reported by patients who were directly sent domicile than by patients with AMI.
Conclusion: Patients who came to a medical juncture department due to chest pain, and who were sent hearth had a low risk of death and growth of infarction during the following year. Survivors after 1 year do, however, more often report emotional and psychosomatic symptoms than survivors of AMI.
About 20 percent of all patients admitted to a medical exigency department have chest pain or other symptoms suggestive of acute myocardial infarction (AMI).[1] About 40 percent of so patients are directly sent fireside because an initial suspicion of AMI can be quickly rul out[2] As previously reported, this patient population is heterogeneous.[1] The issue of these patients in a longer perspective is poorly described in the literature.
This article therefore aims at giving a description of the issue for such patients during 1 year in names of mortality, development of AMI, and with emphasis forward severity of various symptoms after 1 year. The issue will be compared with that of patients who during the same period of time were hospitalized and perform the operations indicated ined a confirmed AMI during the first 3 days in hospital.
METHODS
Between February 15 1986 and November 9 1987 all patients admitted to the medical crisis department of Sahlgrenska Hospital, Goteborg, Sweden, appropriate to chest pain or other symptoms suggestive of AMI were prospectively registered and followed up for 1 year. Sahlgrenska Hospital shrouds an urban area of 230000 inhabitants. Based forward this register, the present meditation involves all patients who reported chest pain and were directly sent to one's home from the emergency department. These patients are compared with those who reported chest pain, were hospitalized, and fulfilled the criteria for a confirmed AMI during the first 3 days in hospital.
Based in succession history, electrocardiogram at the time of hospital admission, and clinical examination, the patients were prospectively classified at the physician on duty in the pinch department into one of four categories according to the measure of suspicion of AMI. These categories were as follows: (1) obvious AMI; typical symptoms, and ST-elevation with or without Q-waves onward the initial 12-lead electrocardiogram; (2) efficient suspicion of AMI, which included subcategories; (a) typical symptoms, if it were not that an electrocardiogram without ST elevation or Q-waves; (b) atypical symptoms, yet ST-T changes or Q-waves upon the electrocardiogram; (c) sudden storming of severe congestive heart failure without ST elevation forward the electrocardiogram; (d) unstable angina pectoris regardless of electrocardiogram; (3) vague suspicion of AMI: difficulties in the interpretation of the symptoms and no signs of acute ischemia upon the electrocardiogram; and (4) no suspicion of AMI; (a) no suspicion of ischemic heart disease; (b) stable angina pectoris.
Patients who were directly sent residence did, with very few exceptions, belong to category 4 already in the turn of events department. In many of these cases, particularly in patients in whom there was a suspicion of ischemic heart disease, cardiac enzyme plains were measured and found to be normal before they were sent residence In all patients, a 12-lead standard electrocardiogram was recorded immediately after admission to hospital. In none of the patients was myocardial scintigraphy performed in the unforeseen occasion department.
All registered patients were asked in the exigency department about smoking habits and about a history of cardiovascular diseases, including hypertension, diabetes mellitus, angina pectoris, congestive heart failure, and previous AMI. According to the determination of the physician on custom every patient in category 4 was classified into single in kind of the following diagnostic groups: stable angina pectoris, musculoskeletal pain, gastrointestinal pain, pleuropulmonary pain, pulmonary embolism, psychogenic pain, other defined origin of pain, and mystic origin of the pain.
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