October 22, 2018

Background: CT coronary angiography (CTCA) is a relatively new technology that has gained popularity over the past few years in evaluating patients presenting with chest pain. CTCA is an anatomic test that has been shown to increase downstream testing and increase healthcare costs but its impact on patient-oriented benefit has been questioned. Early concerns of CTCA including poor image quality in the obese and high levels of radiation exposure have been mitigated by improved technology. Another trial, called PROMISE, also evaluated anatomic CCTA vs functional stress testing in greater than 10,000 patients with symptomatic chest pain with suspected CAD.  In this study an initial strategy of CCTA was not associated with better clinical outcomes compared to functional testing over a median follow-up period of two years, and it was also associated with higher radiation exposure and downstream testing. In this post we will cover the original SCOT-HEART trial published in 2015 [1] and the 5 year follow up of the original SCOT-HEART trial [2].

October 11, 2018

Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of high-risk disease compared to standard physiologic testing.  However, many published trials on CCTA were not adequately powered to evaluate patient oriented end points.  The aim of the current published study was to perform a systematic review and meta-analysis comparing CCTA with other standard of care (SOC) approaches in evaluation of patients with acute chest pain.

October 11, 2018

Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of high-risk disease compared to standard physiologic testing.  However, many published trials on CCTA were not adequately powered to evaluate patient oriented end points.  The aim of the current published study was to perform a systematic review and meta-analysis comparing CCTA with other standard of care (SOC) approaches in evaluation of patients with acute chest pain.

October 4, 2018

Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergency department including calcium channel blockers, beta blockers and digoxin (the optimal choice is still up for debate). Magnesium sulfate may play a role as a supplemental medication based on its ability to decrease the frequency of sinus node depolarization, prolongation of the refractory period of the atrioventricular node, and acting as a calcium antagonist inhibiting calcium currents in cardiomyocytes.  In addition,panerai radiomir replica intravenous magnesium is safe and cheap.  Most previous trials on the use of magnesium sulfate have rather small sample sizes or were performed in post-cardiac surgery patients.  Also, the exact dose of magnesium used in previous studies varied significantly making it difficult to determine which dose would be the most optimal in these patients.  Recently, the LOMAGHI study was just published trying to answer the questions behind many of these issues.

August 2, 2018

Background/Introduction: Acute heart failure is a common diagnosis encountered among patients presenting to the Emergency Department with complaints of shortness of breath. The emergency treatment of these patients has traditionally focused on alleviation of their symptoms of breathlessness and anxiety in addition to optimization of hemodynamics and rapid reduction in both preload and afterload. The treatment of associated symptoms has often included the administration of morphine, which has been posited to have both beneficial physiologic (vasodilation, reduction of preload) and central nervous system (reduction of breathlessness, anxiety, and pain) effects. However, recent experimental and experiential data have pointed to morphine’s potential for effecting negative physiological and CNS responses, thereby raising the possibility of increasing patient morbidity and/or mortality. Additionally, no large randomized controlled trials have been conducted to study the potential risks and benefits of morphine administration in patients presenting with acute heart failure. Despite these factors, a contingent of Emergency Physicians continue to routinely use morphine in the treatment of patients presenting with acute heart failure.