| Abstrakt: |
Introduction: An acute coronary syndrome (ACS) needs to be distinguished from a variety of other cardiac and non cardiac diseases that may cause chest pain. The challenge in the ED is not only to identify patients at the highest risk, but also to identify patients with non-urgent diseases. These patients may be discharged immediately with minimal testing or intervention. In addition, this causes the occupation of hospital beds through admission of such patients and associated increase in medical costs. Aims and Objectives: The aim is to identify the elements of the chest pain history and to assess the likelihood ratio of each symptom in predicting ACS. Materials and Methods: This cross sectional study was a conducted in the emergency department of VS hospital after getting approval from Institutional ethical committee. Total 500 patients presenting to the emergency department of VS Hospital with chest pain were included. Information was obtained regarding basic characteristics of chest pain, associated symptoms, past medical history, previous medications. Characteristics of ischemic chest pain and non ischemic chest pain were compared using chi square test. P value less than 0.05 was considered as significance. Results: Of the 500 patients presenting with chest pain to emergency department, 216 patients (43.2%) had ischemic chest pain while the rest 284 patients (56.8%) had non ischemic chest pain. It was found that chest pain is more likely to be due to myocardial ischemia if it is heavy in nature [LR-5.05], retrosternal in location [LR-1.82], radiating to both shoulders [LR-17.09], back [LR-2.007], epigastrium [LR-3.94] or left shoulder +/- left hand [LR-3.39]. Features of chest pain like throbbing in nature [LR- 0.31], burning in nature [LR- 0.39], constricting in nature [LR- 0.41], gnawing in nature [LR- 0.09], pin-pricking in nature [LR- 0.55], stretching in nature [LR- 0.4], right sided chest pain [LR-0.22], epigastric pain [LR-0.4], non radiating chest pain [LR- 0.43], and that associated with local tenderness [LR-0.12], decreases the likelihood of chest pain being ischemic in nature. Conclusion: Thus despite the recent advances & technology (bedside 2D ECHO, bedside troponin I measurements etc.), proper history taking is still the most vital component in evaluating and managing chest pain in emergency department. There is a need for spreading awareness in community about early & appropriate consultation for chest pain. [ABSTRACT FROM AUTHOR] |
