Effects of contemporary troponin assay sensitivity on the utility of the early markers myoglobin and CKMB isoforms in evaluating patients with possible acute myocardial infarction. N Engl J Med. Squizzato A, Keller T, Romualdi E, Middeldorp S. Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease. Vorapaxar for secondary prevention of thrombotic events for patients with previous myocardial infarction: a prespecified subgroup analysis of the TRA 2°P-TIMI 50 trial. [Medline]. Morrow DA, Wiviott SD, White HD, et al. 123(5):474-82.  Universal masking in hospitals in the Covid-19 era. , Sen Randomized trials of universal masking of HCWs during a pandemic are likely not feasible. Nevertheless, this research very clearly shows and confirms to all of us that we already have a highly effective weapon against the virus: “The face mask!” The latter retains the ability to block the survival of the virus by preventing the infection of susceptible individuals. Using electronic medical records, we identified HCWs providing direct and indirect patient care who were tested for SARS-CoV-2 with reverse transcriptase–polymerase chain reaction between March 1 and April 30, 2020. 105(23):2730-6. [Full Text]. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020406s076,021428s023lbl.pdf. Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes. [Full Text]. Circulation. The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely affected health care workers (HCWs).1 As a result, hospital systems began testing HCWs2 and implementing infection control measures to mitigate workforce depletion and prevent disease spread.3 Mass General Brigham (MGB) is the largest health care system in Massachusetts, with 12 hospitals and more than 75 000 employees. J Thromb Thrombolysis. 2011 Mar 26. A simple predictor of demand is rate-pressure product, which can be lowered by beta blockers (eg, metoprolol or atenolol) and pain/stress relievers (eg, morphine), while supply may be improved by oxygen, adequate hematocrit, blood thinners (eg, heparin, IIb/IIIa agents such as abciximab, eptifibatide, tirofiban, or thrombolytics), and/or vasodilators (eg, nitrates, amlodipine).  P, Georgiou 2016 Sep 6. [Medline]. [Medline]. [Full Text]. All dates given are for the year 2020. Conflict of Interest Disclosures: Dr Bhatt discloses the following relationships: advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, PhaseBio, PLx Pharma, Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; chair: American Heart Association Quality Oversight Committee, NCDR-ACTION Registry Steering Committee, VA CART Research and Publications Committee; data monitoring committees: Baim Institute for Clinical Research, Cleveland Clinic, Contego Medical, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; honoraria: American College of Cardiology, Baim Institute for Clinical Research, Belvoir Publications, Duke Clinical Research Institute, HMP Global, Journal of the American College of Cardiology, K2P, Level Ex, Medtelligence/ReachMD, MJH Life Sciences, Population Health Research Institute, Slack Publications, Society of Cardiovascular Patient Care, WebMD; deputy editorship: Clinical Cardiology; research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; royalties: Elsevier; site coinvestigator: Biotronik, Boston Scientific, CSI, St Jude Medical, Svelte; trustee: American College of Cardiology; unfunded research: FlowCo, Merck, Novo Nordisk, Takeda. Accessed: May 27, 2014. Morel O, El Ghannudi S, Jesel L, et al. 267:28-34. doi: 10.1016/S0140-6736(20)30970-3 PubMed Google Scholar Crossref [Medline]. Pharmacologic anticoagulant therapy includes the following: Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin), Factor Xa inhibitors (rivaroxaban, fondaparinux). 2011 Feb. 32(4):430-6. Peak A is the early release of myoglobin or creatine kinase isoenzyme MB (CK-MB) after acute myocardial infarction (AMI). Of 9850 tested HCWs, 1271 (12.9%) had positive results for SARS-CoV-2 (median age, 39 years; 73% female; 7.4% physicians or trainees, 26.5% nurses or physician assistants, 17.8% technologists or nursing support, and 48.3% other). Online Dictionaries: Definition of Options|Tips Options|Tips The severity and duration of coronary arterial obstruction, the volume of myocardium affected, the level of demand on the heart, and the ability of the rest of the heart to compensate are major determinants of a patient's clinical presentation and outcome.  JRM, Bailey Positivity rates included the first positive test result for all HCWs in the numerator and HCWs who never tested positive plus those who tested positive that day in the denominator. 2011 May. ... Niraj Bhatt. [Full Text]. [Medline]. Kastrati A, Mehilli J, Neumann FJ, et al. Alexander JH, Lopes RD, James S, et al. Cytokine. 306(24):2684-93. 125(4):568-76. Datasets are an integral part of the field of machine learning. [Full Text]. Clin Cardiol. Assessing the requirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies. If you log out, you will be required to enter your username and password the next time you visit. [Full Text]. Arun Kalyanasundaram, MD, MPH Interventional Cardiology Fellow, Department of Cardiology, Cleveland Clinic A 62-year-old woman with a history of chronic stable angina and a "valve problem" presents with new chest pain. Ribichini F, Tomai F, De Luca G, et al. Apixaban with antiplatelet therapy after acute coronary syndrome. The institutional review board of MGB approved the study and waived informed consent. Lancet. In the setting of ongoing symptoms and electrocardiogram (ECG) changes, nitrates titrated to 10% reduction in blood pressure and symptoms, beta blockers, and heparin are all indicated. [Guideline] Chou R, for the High Value Care Task Force of the American College of Physicians. 2005 Nov. 51(11):2198-200. [Full Text]. The current contract with Charter Spectrum will expire in 2026. Circulation. A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after eating a large meal. 2020 Aug 29. ehaa575. Drip and ship: a new strategy for the treatment of acute coronary syndromes. Sorensen JT, Terkelsen CJ, Steengaard C, et al. ), Attention to the underlying mechanisms of ischemia is important when managing ACS. 2013 Feb 12. 107(10):1436-40. [Medline]. Am Heart J. 43(6):966-71. Recommendations for Selection of Preferred Management Strategy. [Medline]. Available at https://www.medscape.com/viewarticle/917551. News, 2003 Am J Cardiol. 363(18):1704-14. Lopes RD, Alexander KP, Manoukian SV, et al. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. Stiles S. More evidence that blood transfusions raise thrombosis risk in ACS patients. Hubbard BL, Newton CR, Carter PM, et al. Int J Cardiol. [Medline]. Am Heart J. 2009 Jul 28. Diet plays an important role in the development of CAD. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. Bivalirudin for patients with acute coronary syndromes. Am J Cardiol.  Lancet . Despite these local and statewide measures, the case number continued to increase in Massachusetts throughout the study period,6 suggesting that the decrease in the SARS-CoV-2 positivity rate in MGB HCWs took place before the decrease in the general public. 2015 Mar 17. 2012 Apr. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2002 Jun 11. 2010 Sep 22. Terms of Use| The inability of B-type natriuretic protein to predict short-term risk of death or myocardial infarction in non-heart-failure patients with marginally increased troponin levels. infected sooner or later the SARS-CoV-2 will be overwhelmed by the immune system and die. Int J Cardiol. The higher moral (and scientifically accurate) argument promoting the public good should still be made, since some individuals may respond to it. We identified 3 phases during the study period: a preintervention period before implementation of universal masking of HCWs (March 1-24, 2020); a transition period until implementation of universal masking of patients (March 25–April 5, 2020) plus an additional lag period to allow for manifestations of symptoms (April 6-10, 2020), as previously defined5; and an intervention period (April 11-30, 2020). Medscape [serial online]. [Medline]. Antman EM, Tanasijevic MJ, Thompson B, et al. J Am Coll Cardiol. Victoria joined CCLC in 2017 as a paralegal in the education law team and commenced a training contract in 2018, qualifying as a solicitor in 2020. James S, Akerblom A, Cannon CP, et al. A cardiac rehabilitation program after discharge may reinforce education and enhance compliance. 2005 Apr. Peak B is the cardiac troponin level after infarction. [Full Text]. Safety and efficiency of a chest pain diagnostic algorithm with selective outpatient stress testing for emergency department patients with potential ischemic chest pain. [Full Text]. [Guideline] Welsford M, Nikolaou NI, Beygui F, et al, for the Acute Coronary Syndrome Chapter Collaborators. [Guideline] Collet JP, Thiele H, Barbato E, et al, for the ESC Scientific Document Group . 2017 AHA/ACC clinical performance and quality measures for adults with ST-Elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Lack of recognition of symptoms may cause tremendous delays in seeking medical attention. Universal masking at MGB was associated with a significantly lower rate of SARS-CoV-2 positivity among HCWs. Fox KA, Antman EM, Cohen M, Bigonzi F. Comparison of enoxaparin versus unfractionated heparin in patients with unstable angina pectoris/non-ST-segment elevation acute myocardial infarction having subsequent percutaneous coronary intervention. The image below depicts a 62-year-old woman with a history of chronic stable angina and a "valve problem. 1998 Nov 3. [Medline]. (See Medication.). In March 2020, MGB implemented a multipronged infection reduction strategy involving systematic testing of symptomatic HCWs and universal masking of all HCWs and patients with surgical masks.4 This study assessed the association of hospital masking policies with the SARS-CoV-2 infection rate among HCWs. [Guideline] Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, et al. Test Your Skills, a Critical Images slideshow, to help identify a variety of electrocardiographic abnormalities. [Full Text]. Jamshid Shirani, MD Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network Use of cardiac markers in the ED. ): Development of pathologic Q waves on electrocardiogram (ECG), Significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB), Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, Introcoronary thrombus identified by angiography or autopsy, The terms transmural and nontransmural (subendocardial) myocardial infarction are no longer used because ECG findings in patients with this condition are not closely correlated with pathologic changes in the myocardium. 357(20):2001-15. Mega JL, Braunwald E, Wiviott SD, et al. ca. 2013 Sep 3. [Full Text]. Stone GW, Maehara A, Lansky AJ, et al. 2006 Apr 5. J Am Coll Cardiol. This event is followed by platelet activation and aggregation, activation of the coagulation pathway, and vasoconstriction. The GUSTO-IIa Investigators. 2010 Oct 5. [Medline]. [3, 4]. ACS without elevation in demand requires a new impairment in supply, typically due to thrombosis and/or plaque hemorrhage. Scheuermeyer FX, Innes G, Grafstein E, et al. In some instances, however, stable coronary artery disease (CAD) may result in ACS in the absence of plaque rupture and thrombosis, when physiologic stress (eg, trauma, blood loss, anemia, infection, tachyarrhythmia) increases demands on the heart. The study period is divided into 3 phases: a preintervention period before implementation of universal masking of HCWs (pink), which includes March 26, the day after implementation of universal masking for HCWs, to account for HCWs who became symptomatic after business hours on March 25 and were tested on March 26; a transition period until implementation of universal masking of patients (purple) plus an additional lag period (yellow); and the intervention period (green). Accessibility Statement, Our website uses cookies to enhance your experience. 2011 Dec. 32(23):2970-88. [Medline]. Lancet. Clin Chem. JAMA. As a prominent firm at the forefront of public law and human rights issues, Bindmans LLP is a trusted adviser to prolific campaign groups, individuals and commercial organisations. Hughes S. New European lipid guidelines take aggressive approach. Eggers KM, Oldgren J, Nordenskjold A, Lindahl B. Usefulness of initial glucose level to improve acute coronary syndrome diagnosis in the emergency department. Acute coronary syndrome: Relationship between genetic variants and TIMI risk. Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS. Test Your Skills, Cholesterol Charts (What the Numbers Mean), http://www.medscape.com/viewarticle/825391, http://www.medscape.com/viewarticle/810373, http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022287s011lbl.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020406s076,021428s023lbl.pdf, http://www.medscape.com/viewarticle/777535, http://www.astrazeneca.com/Media/Press-releases/Article/20150903, https://www.medscape.com/viewarticle/936676, https://www.medscape.com/viewarticle/917552, https://www.medscape.com/viewarticle/885509, https://www.medscape.com/viewarticle/885683, https://www.medscape.com/viewarticle/917551, http://www.medscape.com/viewarticle/818076, Society for Cardiovascular Angiography and Interventions, American Association for the Advancement of Science, Signs or symptoms of heart failure, or new or worsening mitral regurgitation, Hemodynamic instability or cardiogenic shock, Recurrent angina/ischemia at rest, or with low-level activities despite intensive medical therapy, Sustained ventricular tachycardia or ventricular fibrillation, Low-risk score (eg, TIMI 0 or 1, GRACE < 109), Patient or physician preference in the absence of high-risk features, New or presumably new ST-segment depression, Renal insufficiency (GFR < 60 mL/min/1.73m, Reduced LV systolic function (LVEF < 40%). It appears to have happened at the same time, though perhaps masks had an additional effect. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Administrative, technical, or material support: Wang, Ferro, Hashimoto. N Engl J Med. [Medline]. November 11, 2014. Acquisition, analysis, or interpretation of data: All authors.  et al. Rao SV, Sherwood MW. 2000 Sep 5. via Harvard University, Schlesinger Library on the History of Women in America, Radcliffe Institute, Part of the Izetta Jewel Pap ers, 1852-1978 David L Coven, MD, PhD is a member of the following medical societies: American College of Physicians, American Medical Association, Massachusetts Medical SocietyDisclosure: Nothing to disclose. Medscape. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. 2009 Mar 24. The decrease in HCW infections could be confounded by other interventions inside and outside of the health care system (Figure), such as restrictions on elective procedures, social distancing measures, and increased masking in public spaces, which are limitations of this study. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. [12] This is because on-scene time was the biggest fraction of "pre-hospital time." [Medline]. [11]. Ciliberti G, Coiro S, Tritto I, et al. These patients were enrolled in the Global Registry of Acute Coronary Events (GRACE) at 123 hospitals in 14 countries from 1999-2007. She is symptomatic on arrival, complaining of shortness of breath and precordial chest tightness. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors or thienopyridines: results from the OASIS 5 (Fifth Organization to Assess Strategies in Ischemic Syndromes) trial. Recorded July 14, 2020. Over 50 years ago, the late Lawrence Kohlberg formulated six stages of moral reasoning that are still used in studies of moral reasoning today (2-4). 304(12):1339-49. 2018 Jan 14. Drs Wang and Ferro contributed equally to this article. Emerg Med J. Effect of the novel thienopyridine prasugrel compared with clopidogrel on spontaneous and procedural myocardial infarction in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38: an application of the classification system from the universal definition of myocardial infarction. [Full Text]. Using weighted nonlinear regression, we fit the best curve for the preintervention and intervention periods (based on R2 value). 2006 May. 2017 AHA/ACC clinical performance and quality measures for adults with ST-Elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. All Rights Reserved. Incremental benefit of 80-lead electrocardiogram body surface mapping over the 12-lead electrocardiogram in the detection of acute coronary syndromes in patients without ST-elevation myocardial infarction: Results from the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) trial. Patients should be informed about the benefits of a low-cholesterol, low-salt diet. Third universal definition of myocardial infarction. [Medline]. [Medline]. Jaffe AS, Babuin L, Apple FS. Time for Universal Masking and Prevention of Transmission of SARS-CoV-2, John T. Brooks, MD; Jay C. Butler, MD; Robert R. Redfield, MD, Universal Masking in the United States: the Role of Mandates, Health Education, and the CDC. She is given nitroglycerin sublingually, and her pressure decreases to 80/palpation. 24 – 34 Training involves intermittent bouts of walking to moderate-to-maximum claudication, alternating with periods of rest. Isn't it about time we learned how to use blood transfusion in patients with ischemic heart disease?. 2011 May. The risk of recurrent coronary events decreases 50% at 1 year after smoking cessation. This study describes changes in portable oximeter–measured peripheral oxygen saturation (Spo2 or O2sat) in older adults before, during, and after wearing a 3-layer plane-shaped disposable nonmedical face mask widely used to protect against COVID-19. [Medline]. Exploring the role of enoxaparin in the management of high-risk patients with non-ST-elevation acute coronary syndromes: the SYNERGY trial. Medscape Medical News. [Medline]. [Medline]. Comparison of acute coronary syndrome in patients receiving versus not receiving chronic dialysis (from the Global Registry of Acute Coronary Events [GRACE] Registry). Share cases and questions with Physicians on Medscape consult. 128(10):1055-65. Training is performed for a minimum of 30–45 min/session; sessions are performed at least 3 times/wk for a minimum of 12 wk. [4] Other significant predictors of MACE included male sex, older age, family history, hypertension, dyslipidemia, ischemic findings on ECG, and positive troponintests. de Carvalho VDCV, Silva LCA, Araujo RM, et al. 1996 Oct 31. Medscape Medical News. Cochrane Database Syst Rev. O'Riordan M. Ticagrelor bests clopidogrel for reducing stent-thrombosis risk: PLATO. 335(18):1342-9. [Medline]. Steg PG, Harrington RA, Emanuelsson H, et al, for the PLATO Study Group. [Medline]. Mahaffey KW, Ferguson JJ. First, testing criteria among HCWs in our hospital system have remained relatively unchanged during the study period, while testing criteria for the general public in MA have changed over time as testing became more available. Misra D, Leibowitz K, Gowda RM, Shapiro M, Khan IA.  S, Karaca-Mandic Serum F(2)-isoprostane had an optimal cutoff level of 124.5 pg/mL, and serum choline had a cutoff level of 30.5 µmol/L. 2011 Apr 27. recommend “appealing messaging that normalizes mask wearing.”(1) However the major thrust of most arguments to persuade the public about masks is that although the recommended cloth mask may not provide virus protection to the individual wearing it, the mask can prevent transmission to others.  Association of stay-at-home orders with COVID-19 hospitalizations in 4 states. . Lancet. [Full Text]. 63(13):1289-96. [Full Text]. [Full Text]. Choline and F(2)-isoprostane had a positive predictive value of 44% and 57% and a negative predictive value of 89% and 90%, respectively. J Am Coll Cardiol. JAMA. [Full Text]. [Medline]. /> 157(4):599-605. [Full Text]. Ma RC, Tong PC. [Full Text]. Stone GW, Witzenbichler B, Guagliumi G, et al. 55(9):858-64. [Medline]. This website also contains material copyrighted by 3rd parties. Rosenberg S, Elashoff MR, Beineke P, et al, for the PREDICT (Personalized Risk Evaluation and Diagnosis in the Coronary Tree) Investigators.  First experience of COVID-19 screening of health-care workers in England. , Black While in many areas of the world the battle against the SARS-CoV-2 rages in favor of the virus scientists are trying in every way to find a vaccine, a drug, or something else to combat the disease. 126(16):2020-35. [Medline]. . JAMA. 2020;324(7):703-704. doi:10.1001/jama.2020.12897. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-Elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. Jan 11, 2013. This Viewpoint proposes legal and policy options for promoting universal face mask wearing in the US and, recognizing the limits of state-by-state implementation, proposes strengthening the authority, independence, and funding of the CDC to enact responses to this and future comparable public health emergencies. knowing what words immediately follow and precede a word in a sentence). This is one of the most important articles published on COVID-19. The diagnosis of acute myocardial infarction in this setting requires a finding of the typical rise and fall of biochemical markers of myocardial necrosis in addition to at least 1 of the following Circulation. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. N Engl J Med. Eur Heart J. Meune C, Balmelli C, Twerenbold R, et al. [Full Text].  E,
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