Acil Servise Başvuran Travmatik Olmayan Göğüs Ağrısı Hastalarının Değerlendirilmesi: İleri Dönük Gözlemsel Çalışma
Öz
Göğüs ağrısı (GA), acil servislere en sık başvuru nedenlerinden biri olup bu hastalar yüksek mortalite ve morbidite ile seyredebilir. Acil servisimize 87320 başvurunun 2878’i (%3,3) travma dışı göğüs ağrısı nedeniyledir ve 2,811 hasta (%97,7) çalışmaya dahil edilmiştir. EKG bulguları normal olan hasta oranı %63, ST segment elevasyonlu miyokard infarktüsü tanısı alan hasta oranı %6,3’tür. Akut koroner sendrom (AKS) görülme riski erkeklerde yaklaşık olarak 1,5 kat fazla saptanmıştır. Taburculuktan sonra 1 ay içinde ciddi kardiyak olay görülme oranı %2,8’dir. Bu sürede TIMI skorlamasında yüksek riskli olanlarda %18,4’ünde ve GRACE skorlamasında yüksek riskli olanlarda ise %7,7’sinde ciddi kardiyak olay ve/veya ölüm görüldü. GA ile başvuru yapan hastaların en sık aldığı tanı AKS olup; bu kapsamda en sık unstable angina pektoris (UAP) saptandı. Kadınlarda AKS tanısının atipik göğüs ağrısıyla daha sık ilişkilendirildiği bulunmuştur. Sonuç olarak çalışmamızdaki hastalar başta kardiyak nedenler olmak üzere pulmoner emboli, pnömotoraks, aort diseksiyonu hatta digoksin intoksikasyonuna uzanan geniş yelpazede yüksek mortalite ve morbiditeye neden olabilecek tanılar almışlardır. Atipik ağrı nedeniyle başvuran hastaların %28,5’u, başvuru sırasında ağrısı devam etmeyen hastaların %33,4’ü AKS tanısı almıştır. Bu nedenle göğüs ağrısı ayırıcı tanısının hızlı ve doğru yapılması hayati öneme sahiptir.
Anahtar Kelimeler
Etik Beyan
Yazarlar, bu makalede tartışılan konu veya materyallerle ilgili herhangi bir finansal çıkarı (onur ücreti; eğitim hibeleri; konuşmacı bürolarına katılım; üyelik, istihdam, danışmanlık, hisse sahipliği veya diğer öz sermaye çıkarları ve uzman tanıklığı veya patent lisansı düzenlemeleri gibi) veya finansal olmayan çıkarı (kişisel veya profesyonel ilişkiler, bağlantılar, bilgi veya inançlar gibi) olan herhangi bir kuruluş veya kuruluşla hiçbir bağlantıları veya katılımları OLMADIĞINI onaylar.
Destekleyen Kurum
Yoktur
Kaynakça
- 1. Demiryoğuran Ns, Topaçoğlu H, Karcioğlu Ö. Nonspesifik Göğüs Ağrılı Hastalarda Anksiyete Bozukluğu. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 2005; 19:127-132.
- 2. Rosamond W, Flegal K, Furie Ket al. Heart disease and stroke statistics—2008 update. Circulation 2008; 117:e25-e146.
- 3. Tintinallil J, John M, Yealy D, Meckler G, Stephan S, Cline D. Tintinalli’s emergency medicine: a comprehensive study guide 9th ed: New York (NY): McGraw-Hill, 2019.
- 4. Goodacre S, Morris F, Campbell S, Arnold J, Angelini K. A prospective, observational study of a chest pain observation unit in a British hospital. Emergency Medicine Journal 2002; 19:117-121.
- 5. Ramsay G, Podogrodzka M, McClure C, Fox KA. Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. Journal of the Association of Physicians 2007; 100:11-18.
- 6. Özen M, Serinken M, YILMAZ A, Özen Ş. Acil Servise Başvuran Akut Koroner Sendrom Tanılı Hastaların Sosyodemografık ve Klinik Özellikleri. Turkish Journal of Emergency Medicine 2012; 12.
- 7. Lyon R, Morris AC, Caesar D, Gray S, Gray A. Chest pain presenting to the emergency department—to stratify risk with GRACE or TIMI? Resuscitation 2007; 74:90-93.
- 8. Walker NJ, Sites FD, Shofer FS, Hollander JE. Characteristics and outcomes of young adults who present to the emergency department with chest pain. Academic emergency medicine 2001; 8:703-708.
- 9. Koroner Kalp Hastalığı Riski ve Değerlendirilmesi. Available at: https://www.tkd.org.tr/kilavuz/k11/4e423.htm?wbnum=1604. Accessed Erişim Tarihi: Mayıs 2018.
- 10. Goff DC, Lloyd-Jones DM, Bennett Get al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2014; 63:2935-2959.
- 11. Kayhan M, Mamur A, Unluoglu I, seyin Balcioglu H, Acar N, Bilge U. An assessment of initial symptoms in patients admitted to the ER of a tertiary healthcare institution and diagnosed with acute myocardial infarction. Biomedical Research 2017; 28.
- 12. Bakanlığı S. Türkiye Kalp ve Damar Hastalıkları Önleme ve Kontrol Programı (2010-2014). Ankara: Sağlık Bakanlığı 2010.
- 13. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables Available at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf. Accessed Erişim Tarihi: Mayıs 2018.
- 14. Bösner S, Becker A, Haasenritter Jet al. Chest pain in primary care: epidemiology and pre-work-up probabilities. The European journal of general practice 2009; 15:141-146.
- 15. Coşkun SÖ, Parlak İ, Değerli V. ve ark. Acil Servise Göğüs Ağrisi İle Başvuran Hastalarin Akut Koroner Sendrom Oranlarinin Değerlendirilmesi İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 2015; 19:84-94.
- 16. Knockaert D, Buntinx F, Stoens N, Bruyninckx R, Delooz H. Chest pain in the emergency department: the broad spectrum of causes. European Journal of Emergency Medicine 2002; 9:25-30.
- 17. Mendis S, Puska P, Norrving B, Organization WH. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization, 2011.
- 18. Nagarajan V, Fonarow GC, Ju Cet al. Seasonal and circadian variations of acute myocardial infarction: Findings from the Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) program. American heart journal 2017; 189:85-93.
- 19. Mukamal KJ, Mittleman MA. Seasonal variation of myocardial infarct size. The American journal of cardiology 2003; 91:119-120.
- 20. Moschos N, Christoforaki M, Antonatos P. Seasonal distribution of acute myocardial infarction and its relation to acute infections in a mild climate. International journal of cardiology 2004; 93:39-44.
- 21. Hess EP, Perry JJ, Calder LAet al. Prospective validation of a modified thrombolysis in myocardial infarction risk score in emergency department patients with chest pain and possible acute coronary syndrome. Academic Emergency Medicine 2010; 17:368-375.
- 22. Carlton EW, Khattab A, Greaves K. Identifying patients suitable for discharge after a single-presentation high-sensitivity troponin result: a comparison of five established risk scores and two high-sensitivity assays. Annals of emergency medicine 2015; 66:635-645. e631.
- 23. Mistry P, Duong A, Kirshenbaum L, Martino TA. Cardiac clocks and preclinical translation. Heart failure clinics 2017; 13:657-672.
- 24. Davidson A, London B, Block G, Menaker M. Cardiovascular tissues contain independent circadian clocks. Clinical and experimental hypertension 2005; 27:307-311.
- 25. Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE. Application of the TIMI risk score for unstable angina and non‐ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Academic emergency medicine 2006; 13:13-18.
Evaluation of Patients with Non-Traumatic Chest Pain Presenting to the Emergency Department: A Prospective Observational Study
Öz
Chest pain (CP) is one of the most common reasons for emergency department visits, and these patients can experience high mortality and morbidity. Out of 87320 visits to our emergency department, 2878 (3.3%) were due to non-traumatic chest pain, and 2,811 patients (97.7%) were included in the study. The percentage of patients with normal EKG findings is 63%, while the rate of patients diagnosed with ST-segment elevation myocardial infarction is 6.3%. The risk of Acute Coronary Syndrome (ACS) is approximately 1.5 times higher in men. The rate of serious cardiac events within one month after discharge is 2.8%. During this period, serious cardiac events and/or death were observed in 18.4% of patients at high risk according to the TIMI score and in 7.7% of those at high risk according to the GRACE score. The most common diagnosis for patients presenting with chest pain is ACS, with unstable angina (UAP) being the most frequently identified subtype. In women, ACS diagnosis was found to be more commonly associated with atypical chest pain. In conclusion, the patients in our study received diagnoses that could lead to high mortality and morbidity, including cardiac causes, pulmonary embolism, pneumothorax, aortic dissection, and even digoxin toxicity. Among patients presenting with atypical pain, 28.5% were diagnosed with ACS, and 33.4% of those whose pain had resolved at the time of admission were also diagnosed with ACS. Therefore, prompt and accurate differential diagnosis of chest pain is of vital importance.
Anahtar Kelimeler
Kaynakça
- 1. Demiryoğuran Ns, Topaçoğlu H, Karcioğlu Ö. Nonspesifik Göğüs Ağrılı Hastalarda Anksiyete Bozukluğu. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 2005; 19:127-132.
- 2. Rosamond W, Flegal K, Furie Ket al. Heart disease and stroke statistics—2008 update. Circulation 2008; 117:e25-e146.
- 3. Tintinallil J, John M, Yealy D, Meckler G, Stephan S, Cline D. Tintinalli’s emergency medicine: a comprehensive study guide 9th ed: New York (NY): McGraw-Hill, 2019.
- 4. Goodacre S, Morris F, Campbell S, Arnold J, Angelini K. A prospective, observational study of a chest pain observation unit in a British hospital. Emergency Medicine Journal 2002; 19:117-121.
- 5. Ramsay G, Podogrodzka M, McClure C, Fox KA. Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. Journal of the Association of Physicians 2007; 100:11-18.
- 6. Özen M, Serinken M, YILMAZ A, Özen Ş. Acil Servise Başvuran Akut Koroner Sendrom Tanılı Hastaların Sosyodemografık ve Klinik Özellikleri. Turkish Journal of Emergency Medicine 2012; 12.
- 7. Lyon R, Morris AC, Caesar D, Gray S, Gray A. Chest pain presenting to the emergency department—to stratify risk with GRACE or TIMI? Resuscitation 2007; 74:90-93.
- 8. Walker NJ, Sites FD, Shofer FS, Hollander JE. Characteristics and outcomes of young adults who present to the emergency department with chest pain. Academic emergency medicine 2001; 8:703-708.
- 9. Koroner Kalp Hastalığı Riski ve Değerlendirilmesi. Available at: https://www.tkd.org.tr/kilavuz/k11/4e423.htm?wbnum=1604. Accessed Erişim Tarihi: Mayıs 2018.
- 10. Goff DC, Lloyd-Jones DM, Bennett Get al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2014; 63:2935-2959.
- 11. Kayhan M, Mamur A, Unluoglu I, seyin Balcioglu H, Acar N, Bilge U. An assessment of initial symptoms in patients admitted to the ER of a tertiary healthcare institution and diagnosed with acute myocardial infarction. Biomedical Research 2017; 28.
- 12. Bakanlığı S. Türkiye Kalp ve Damar Hastalıkları Önleme ve Kontrol Programı (2010-2014). Ankara: Sağlık Bakanlığı 2010.
- 13. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables Available at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf. Accessed Erişim Tarihi: Mayıs 2018.
- 14. Bösner S, Becker A, Haasenritter Jet al. Chest pain in primary care: epidemiology and pre-work-up probabilities. The European journal of general practice 2009; 15:141-146.
- 15. Coşkun SÖ, Parlak İ, Değerli V. ve ark. Acil Servise Göğüs Ağrisi İle Başvuran Hastalarin Akut Koroner Sendrom Oranlarinin Değerlendirilmesi İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 2015; 19:84-94.
- 16. Knockaert D, Buntinx F, Stoens N, Bruyninckx R, Delooz H. Chest pain in the emergency department: the broad spectrum of causes. European Journal of Emergency Medicine 2002; 9:25-30.
- 17. Mendis S, Puska P, Norrving B, Organization WH. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization, 2011.
- 18. Nagarajan V, Fonarow GC, Ju Cet al. Seasonal and circadian variations of acute myocardial infarction: Findings from the Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) program. American heart journal 2017; 189:85-93.
- 19. Mukamal KJ, Mittleman MA. Seasonal variation of myocardial infarct size. The American journal of cardiology 2003; 91:119-120.
- 20. Moschos N, Christoforaki M, Antonatos P. Seasonal distribution of acute myocardial infarction and its relation to acute infections in a mild climate. International journal of cardiology 2004; 93:39-44.
- 21. Hess EP, Perry JJ, Calder LAet al. Prospective validation of a modified thrombolysis in myocardial infarction risk score in emergency department patients with chest pain and possible acute coronary syndrome. Academic Emergency Medicine 2010; 17:368-375.
- 22. Carlton EW, Khattab A, Greaves K. Identifying patients suitable for discharge after a single-presentation high-sensitivity troponin result: a comparison of five established risk scores and two high-sensitivity assays. Annals of emergency medicine 2015; 66:635-645. e631.
- 23. Mistry P, Duong A, Kirshenbaum L, Martino TA. Cardiac clocks and preclinical translation. Heart failure clinics 2017; 13:657-672.
- 24. Davidson A, London B, Block G, Menaker M. Cardiovascular tissues contain independent circadian clocks. Clinical and experimental hypertension 2005; 27:307-311.
- 25. Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE. Application of the TIMI risk score for unstable angina and non‐ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Academic emergency medicine 2006; 13:13-18.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Acil Tıp |
| Bölüm | ORİJİNAL MAKALELER / ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Mayıs 2025 |
| Gönderilme Tarihi | 5 Mart 2025 |
| Kabul Tarihi | 14 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 47 Sayı: 3 |