exudates and Chest-Pain

Gastroesophageal reflux disease is thought to be the commonest cause of 'non-cardiac chest pain'. The use of proton-pump inhibitors resulting in improvement in the chest pain symptom would support this causal association.. To determine the prevalence of gastroesophageal reflux disease in non-cardiac chest pain and the response of chest pain to proton-pump inhibitor therapy.. Patients with recurrent angina-like chest pain and normal coronary angiogram were recruited. The frequency and severity of chest pain were recorded. All patients underwent esophagogastroduodenoscopy and 48-h Bravo ambulatory pH monitoring before receiving rabeprazole 20 mg bd for 2 weeks.. The prevalence of gastroesophageal reflux disease was 66.7% (18/27). The improvement in chest pain score was significantly higher in reflux compared to non-reflux patients (P = 0.006). The proportion of patients with complete or marked/moderate improvement in chest pain symptoms were significantly higher in patients with reflux (15/18, 83.3%) compared to those without (1/9, 11.1%) (P < 0.001).. The prevalence of gastroesophageal reflux disease in patients with 'non-cardiac chest pain' was high. The response to treatment with proton-pump inhibitors in patients with reflux disease, but not in those without, underlined the critical role of acid reflux in a subset of patients with 'non-cardiac chest pain'.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Asian People; Chest Pain; Endoscopy, Digestive System; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Malaysia; Male; Middle Aged; Prevalence; Prospective Studies; Proton Pump Inhibitors; Rabeprazole; Recurrence; Severity of Illness Index; Treatment Outcome

Risk stratification tools that integrate clinical, ECG findings and cardiac biomarkers have been used to facilitate the management of chest pain patients in the emergency department (ED). We studied the feasibility of history, age, electrocardiogram and risk factors (HEAR) score as a risk stratification tool for chest pain patients presented to ED Hospital Universiti Sains Malaysia (HUSM) in comparison to modified HEART score (MHS) based on major adverse cardiac events (MACE) within 6 weeks' time.. We analysed retrospective data of chest pain patients presenting to ED HUSM from 1st June 2020 till 31st January 2021 based on the patient's history, ECG findings, risk factors, age and troponin level. The patients were stratified as low risk (MHS and HEAR score of 0-3), intermediate risk (MHS and HEAR score of 4-6), and high risk (MHS of 7-10 and HEAR score of 7-8). The association of the MHS and HEAR score with MACE at 6 weeks' time was evaluated using simple logistic regression.. This study included 147 patients in the MHS analysis and 71 patients in HEAR score analysis. The incident rate of MACE in low, intermediate and high risk was 0%,16.3%, and 34.7%, in the MHS group, and 0%, 3.22%, and 6.66% in HEAR score group. The mean difference between MACE and non-MACE in MHS and HEAR score groups was -2.29 (CI: -3.13,1.44, p<0.001) and -2.51(CI: -5.23, 0.21, p=0.070), respectively. There was no significant association between the incidence rate of MACE with modified HEART score (MHS) and HEAR score groups (p>0.95).. HEAR score is not feasible to be used as a risk stratification tool for chest pain patients presenting to ED HUSM in comparison to MHS. Further studies are required to validate the results.

Topics: Chest Pain; Electrocardiography; Emergency Service, Hospital; Feasibility Studies; Hospitals; Humans; Infant; Malaysia; Retrospective Studies; Risk Assessment; Risk Factors

A congenital pulmonary airway malformation (CPAM) is a rare cystic anomaly that may occur during development of the fetal airways. The vast majority of CPAMs are detected in neonates; as such, it is unusual for diagnosis to occur in adulthood. We report a 21-year-old male patient who presented to the emergency department of the Hospital Ampang, Kuala Lumpur, Malaysia, in 2015 with chest pain, breathlessness and tachypnoea. Based on an initial chest X-ray, the patient was misdiagnosed with pneumothorax and underwent urgent chest tube insertion; however, his condition deteriorated over the course of the next three days. Further imaging was suggestive of infected

Topics: Blister; Chest Pain; Cystic Adenomatoid Malformation of Lung, Congenital; Delayed Diagnosis; Emergency Service, Hospital; Humans; Malaysia; Male; Radiography; Tachypnea; Tomography, X-Ray Computed; Young Adult

The objective of this study is to look at how well patient history and examination findings can be used in screening for angina.. A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. The data was cleaned; 69 possible variables were extracted, and univariate and multivariate analyses were performed.. From the univariate analysis, it was found that 19 variables are significantly associated with a diagnosis of angina. However, multiple logistic regression reveals that only 11 of these 19 variables are significantly related to a diagnosis of angina. Chest pain aggravated by exertion, history of diabetes mellitus, and history of heart disease (regardless of whether on treatment or not) are significant predictors of angina. Sudden onset chest pain, pain that is persistent, pain relieved by other means, pain aggravated by inspiration, and findings of rhonchi are important predictors of a diagnosis other than angina. The degree of overall accuracy is high at 71.3%. There are eight factors which are significant in the univariate analysis but are not significant in the multivariate analysis. These are marital status, pain relieved by glyceryl trinitrate (GTN), pain relieved by rest, associated nausea, pain aggravated by posture, pain aggravated by cough, history of hypertension, and history of smoking.. These findings suggest that examination findings do not play a significant role in screening for angina.

Topics: Adult; Age Distribution; Aged; Angina Pectoris; Chest Pain; Diagnosis, Differential; Diagnostic Tests, Routine; Electrocardiography; Female; Humans; Incidence; Logistic Models; Malaysia; Male; Mass Screening; Medical History Taking; Middle Aged; Odds Ratio; Physical Examination; Registries; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Sex Distribution; Statistics, Nonparametric

The aim of the study was to use data from an electronic medical record system (EMR) to look for factors that would help us diagnose acute myocardial infarction (AMI) with the ultimate aim of using these factors in a decision support system for chest pain. We extracted 887 records from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. We cleaned the data, extracted 69 possible variables and performed univariate and multivariate analysis. From the univariate analysis we find that 22 variables are significantly associated with a diagnosis of AMI. However, multiple logistic regression reveals that only 9 of these 22 variables are significantly related to a diagnosis of AMI. Race (Indian), male sex, sudden onset of persistent crushing pain, associated sweating and a history of diabetes mellitus are significant predictors of AMI. Pain that is relieved by other means and history of heart disease on treatment are important predictors of a diagnosis other than AMI. The degree of accuracy is high at 80.5%. There are 13 factors that are significant in the univariate analysis but are not among the nine significant factors in the multivariate analysis. These are location of pain, associated palpitations, nausea and vomiting; pain relieved by rest, pain aggravated by posture, cough, inspiration and exertion; age more than 40, being a smoker and abnormal chest wall and face examination. We believe that these findings can have important applications in the design of an intelligent decision support system for use in medical care as the predictive capability can be further refined with the use of intelligent computational techniques.

Topics: Adult; Age Factors; Chest Pain; Diagnosis, Differential; Exercise Test; Female; Hospital Records; Humans; Incidence; Malaysia; Male; Middle Aged; Myocardial Infarction; Population Surveillance; Predictive Value of Tests; Regression Analysis; Retrospective Studies; Risk Factors; Severity of Illness Index

Acute pulmonary thromboembolism (PE) has been considered rare among Asians. We aim to describe the frequency and clinical features of this condition in a hospital in Singapore. Among patients admitted by the Emergency Department (ED), comparisons were made between those primarily diagnosed in the ED and those who were not.. Retrospective review of all cases of radiologically proven acute PE over a 20-month period.. Sixty-two patients were identified. The mean age was 61.5 +/- 18.0 years with a female to male ratio of 1.8:1. There were more Malays compared to other races. There were also more Caucasians, given the proximity of the hospital to the airport and the inclusion of tourists. The commonest symptoms were dyspnoea and chest pain, while the commonest signs were tachycardia and tachypnoea. Prolonged immobilisation was the commonest risk factor. Electrocardiographic S1Q3T3 pattern was seen in more patients compared to Western studies. Cardiomegaly was the commonest chest X-ray finding. Thirty-two patients were identified to have a source of embolisation. Overall mortality rate was 21%. The ED diagnosed 36% of the cases. Alternative admitting diagnoses were predominantly ischaemic heart disease and pneumonia. The group diagnosed in the ED were notably female (P = 0.044), Caucasian (P = 0.002) and had prolonged immobilisation (P = 0.025) prior to the onset of PE.. Acute PE is not as rare here as previously thought. Clinical features reveal more similarities than differences compared to other studies in the literature. We advocate a high index of suspicion for earlier diagnosis in the ED.

Topics: Acute Disease; Adult; Age Distribution; Aged; Aged, 80 and over; Cardiomegaly; Chest Pain; Diagnostic Errors; Dyspnea; Electrocardiography; Female; Hospitals, General; Humans; Immobilization; Malaysia; Male; Middle Aged; Pulmonary Embolism; Retrospective Studies; Risk Factors; Sex Distribution; Singapore; Tachycardia; Tomography, X-Ray Computed; Travel; White People

Twenty-nine patients (16 males, 13 females) with spontaneous pneumothorax admitted into Hospital Universiti Sains Malaysia, Kubang Kerian, from September 1984 to September 1990 were reviewed. Their ages ranged from newborn to 75 years. The commonest chief presenting symptom was dyspnoea (69%), followed by chest pain (35%). Four patients had chronic obstructive airway disease, 7 had pneumonia, 2 had pulmonary tuberculosis, one patient had emphysema while 4 patients had multiple underlying lung disorders. The left and right lungs were involved with equal frequency. Bilateral pneumothorax occurred in one patient. Most patients had a single episode of pneumothorax but recurrent pneumothoraces occurred in 3 patients (10%). Six patients were observed conservatively, 20 patients required chest tube insertion alone and 3 patients also required pleurodesis. Death occurred in 8 patients (28%) mainly due to coexisting infection and respiratory failure.

Topics: Adolescent; Adult; Aged; Cause of Death; Chest Pain; Child; Child, Preschool; Dyspnea; Female; Hospitals, Teaching; Humans; Incidence; Infant; Infant, Newborn; Lung Diseases; Malaysia; Male; Middle Aged; Pneumothorax; Recurrence