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Keith A.a. Fox - One of the best experts on this subject based on the ideXlab platform.
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Risk prediction in patients presenting with suspected Cardiac Pain: the GRACE and TIMI risk scores versus clinical evaluation
QJM : monthly journal of the Association of Physicians, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p
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risk prediction in patients presenting with suspected Cardiac Pain the grace and timi risk scores versus clinical evaluation
QJM: An International Journal of Medicine, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p < 0.001) and TIMI scores ( p < 0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major Cardiac events (z = 2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis ( p < 0.001) and duration of hospital stay ( p < 0.001). Discussion: In unselected patients presenting with suspected Cardiac Pain, the GRACE risk score is superior to the TIMI risk score in predicting major Cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.
Robert D. Foreman - One of the best experts on this subject based on the ideXlab platform.
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Mechanisms of Cardiac Pain.
Comprehensive Physiology, 2015Co-Authors: Robert D. Foreman, Kennon M. Garrett, Robert W. BlairAbstract:Angina pectoris is Cardiac Pain that typically is manifested as referred Pain to the chest and upper left arm. Atypical Pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred Cardiac Pain. Spinal Cardiac afferent fibers mediate typical anginal Pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal Cardiac afferent fibers likely mediate atypical anginal Pain and contribute to Cardiac ischemia without accompanying Pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate Cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate Cardiac nociception. Sensory input from other visceral organs can mimic Cardiac Pain due to convergence of this input with Cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish Cardiac Pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with Cardiac Pain.
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Cross-organ sensitization of thoracic spinal neurons receiving noxious Cardiac input in rats with gastroesophageal reflux
American journal of physiology. Gastrointestinal and liver physiology, 2010Co-Authors: Chao Qin, Anna P. Malykhina, Ann M. Thompson, Jay P. Farber, Robert D. ForemanAbstract:Gastroesophageal reflux (GER) frequently triggers or worsens Cardiac Pain or symptoms in patients with coronary heart disease. This study aimed to determine whether GER enhances the activity of upp...
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Neuromodulation of Cardiac Pain and cerebral vasculature: neural mechanisms.
Cleveland Clinic Journal of Medicine, 2009Co-Authors: Robert D. Foreman, Chao QinAbstract:Research using animal models has helped elucidate the neural mechanisms of angina pectoris, sensitization of Cardiac nociceptive stimuli, and neuromodulation of Cardiac Pain and cardiovascular function. Findings over the last 2 decades include evidence of convergence of visceral-somatic input to spinothalamic cells and a major role for the vagus nerve in spinal cord processing. Stress-related glucocorticoids may manipulate amygdala function, inducing hypersensitivity to nociceptive input from the heart via central sensitization of upper thoracic spinal neuronal activity. Spinal cord stimulation may have therapeutic effects, although the underlying mechanism is unclear.
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mechanisms of Cardiac Pain
Annual Review of Physiology, 1999Co-Authors: Robert D. ForemanAbstract:Angina pectoris often results from ischemic episodes that excite chemosensitive and mechanoreceptive receptors in the heart. Ischemic episodes release a collage of chemicals, including adenosine and bradykinin, that excites the receptors of the sympathetic and vagal afferent pathways. Sympathetic afferent fibers from the heart enter the upper thoracic spinal cord and synapse on cells of origin of ascending pathways. This review focuses on the spinothalamic tract, but other pathways are excited as well. Excitation of spinothalamic tract cells in the upper thoracic and lower cervical segments, except C7 and C8 segments, contributes to the anginal Pain experienced in the chest and arm. Cardiac vagal afferent fibers synapse in the nucleus tractus solitarius of the medulla and then descend to excite upper cervical spinothalamic tract cells. This innervation contributes to the anginal Pain experienced in the neck and jaw. The spinothalamic tract projects to the medial and lateral thalamus and, based on positron emission tomography studies, activates several cortical areas, including the anterior cingulate gyrus (BA 24 and 25), the lateral basal frontal cortex, and the mesiofrontal cortex.
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Comprehensive Physiology - MECHANISMS OF Cardiac Pain
Annual review of physiology, 1999Co-Authors: Robert D. ForemanAbstract:Angina pectoris often results from ischemic episodes that excite chemosensitive and mechanoreceptive receptors in the heart. Ischemic episodes release a collage of chemicals, including adenosine and bradykinin, that excites the receptors of the sympathetic and vagal afferent pathways. Sympathetic afferent fibers from the heart enter the upper thoracic spinal cord and synapse on cells of origin of ascending pathways. This review focuses on the spinothalamic tract, but other pathways are excited as well. Excitation of spinothalamic tract cells in the upper thoracic and lower cervical segments, except C7 and C8 segments, contributes to the anginal Pain experienced in the chest and arm. Cardiac vagal afferent fibers synapse in the nucleus tractus solitarius of the medulla and then descend to excite upper cervical spinothalamic tract cells. This innervation contributes to the anginal Pain experienced in the neck and jaw. The spinothalamic tract projects to the medial and lateral thalamus and, based on positron emission tomography studies, activates several cortical areas, including the anterior cingulate gyrus (BA 24 and 25), the lateral basal frontal cortex, and the mesiofrontal cortex.
G. Ramsay - One of the best experts on this subject based on the ideXlab platform.
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Risk prediction in patients presenting with suspected Cardiac Pain: the GRACE and TIMI risk scores versus clinical evaluation
QJM : monthly journal of the Association of Physicians, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p
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risk prediction in patients presenting with suspected Cardiac Pain the grace and timi risk scores versus clinical evaluation
QJM: An International Journal of Medicine, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p < 0.001) and TIMI scores ( p < 0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major Cardiac events (z = 2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis ( p < 0.001) and duration of hospital stay ( p < 0.001). Discussion: In unselected patients presenting with suspected Cardiac Pain, the GRACE risk score is superior to the TIMI risk score in predicting major Cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.
M. Podogrodzka - One of the best experts on this subject based on the ideXlab platform.
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Risk prediction in patients presenting with suspected Cardiac Pain: the GRACE and TIMI risk scores versus clinical evaluation
QJM : monthly journal of the Association of Physicians, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p
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risk prediction in patients presenting with suspected Cardiac Pain the grace and timi risk scores versus clinical evaluation
QJM: An International Journal of Medicine, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p < 0.001) and TIMI scores ( p < 0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major Cardiac events (z = 2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis ( p < 0.001) and duration of hospital stay ( p < 0.001). Discussion: In unselected patients presenting with suspected Cardiac Pain, the GRACE risk score is superior to the TIMI risk score in predicting major Cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.
C. Mcclure - One of the best experts on this subject based on the ideXlab platform.
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Risk prediction in patients presenting with suspected Cardiac Pain: the GRACE and TIMI risk scores versus clinical evaluation
QJM : monthly journal of the Association of Physicians, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p
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risk prediction in patients presenting with suspected Cardiac Pain the grace and timi risk scores versus clinical evaluation
QJM: An International Journal of Medicine, 2006Co-Authors: G. Ramsay, M. Podogrodzka, C. Mcclure, Keith A.a. FoxAbstract:Background: Identifying which patients presenting with undifferentiated chest Pain are at risk of major Cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest Pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected Cardiac Pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected Cardiac Pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major Cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission ( n = 30) within 3 months. Both GRACE ( p < 0.001) and TIMI scores ( p < 0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major Cardiac events (z = 2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis ( p < 0.001) and duration of hospital stay ( p < 0.001). Discussion: In unselected patients presenting with suspected Cardiac Pain, the GRACE risk score is superior to the TIMI risk score in predicting major Cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.