Estimating the likelihood of severe coronary artery disease
Article Abstract:
Chest pain may indicate disease of the coronary arteries, the major blood vessels supplying the heart. However, the decision to refer a patient for further evaluation or for treatment depends on assessment of the patient's symptoms. Coronary artery bypass grafting, a surgical procedure for renewing the blood supply to the heart, improves survival in patients with advanced or severe coronary artery disease (CAD). Coronary angiography, or X-ray of the coronary arteries, is beneficial for patients with severe CAD. Patients suspected of having CAD are initially assessed based on medical history; physical examination; electrocardiogram, a recording of the heart electrical activity; and chest X-ray. The clinical factors that would help to estimate the chance of developing severe CAD were assessed. In addition, the validity of these estimates when used prospectively in different patient groups was determined. A total of 6,435 patients with symptoms of CAD between were examined between 1969 and 1983. The results showed that 11 of 23 clinical factors were important in estimating the probability of severe CAD. These important clinical factors were incorporated into a model, which accurately estimated severe disease in 2,342 patients and in a large series of patients reported in the literature. These findings show that information obtained in the initial evaluation of a patient can help identify those at high risk for CAD. This approach may be more cost-effective in identifying those patients who would benefit from further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis
Article Abstract:
Gallstone disease may be associated with symptoms of pain in the biliary tract, the ducts and organs involved in storing and secreting bile into the duodenum, the first segment of the small intestine. Cholecystectomy, the removal of the gallbladder, may be required to prevent the recurrence of pain. However, the signs and symptoms of cholelithiasis, the formation of gallstones, have not been clarified. The relation of gastrointestinal symptoms and physical findings to gallstone disease was assessed in 300 patients who underwent gallbladder tests. Epigastric pain, pain in the area above the stomach, which lasted at least 30 minutes, occurred in 122 patients with gallstones, compared with the 178 patients without gallstones. Patients with gallstones rarely developed lower abdominal pain, but experienced pain that spread to the upper back. The pain associated with gallstone disease often developed one hour after meals and lasted from one to 24 hours. These signs and symptoms were weak indicators of the disease. The results show that upper abdominal pain is the most common symptom associated with gallstone disease. Supportive of a diagnosis of gallstone disease include pain that radiates to the upper back, has a steady or persistent nature, lasts between one and 24 hours, and begins more than an hour after meals. However, symptoms of gallstone disease are generally nonspecific, and clinical assessment alone is not sufficient to make a diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Usefulness of total 12-lead QRS voltage compared with other criteria for determining left ventricular hypertrophy in hypertrophic cardiomyopathy: analysis of 57 patients studied at necropsy
Article Abstract:
An electrocardiogram is used to measure the electrical activity of the heart and provide information concerning heart function. Previous studies have attempted to use electrocardiograms to identify hypertrophy of the left ventricle, the heart's main pumping chamber; the accuracy and reliability of these results have depended upon the cause of the left ventricular hypertrophy (LVH). The effectiveness of the total 12-lead electrocardiogram is compared with other electrocardiographic criteria for diagnosing LVH in patients with hypertrophic cardiomyopathy (HC) characterized by enlargement of the left ventricle, poor function of the heart muscle and congestive heart failure. The patient's last satisfactory electrocardiogram and postmortem examination data were studied in 57 cases of HC. In studying the QRS phase, left ventricular contraction, with the 12-lead electrocardiogram, an amplitude greater than 175 mm yielded a higher sensitivity of diagnosing LVH in patients with HC than the other criteria tested; in 53 percent of the cases the 12-lead electrocardiogram was used to correctly identify LVH.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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