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The Emergency Cardiology Group

Will Parsonage writes…Next week I’ll be presenting on some of our clinical redesign work at this meeting under the title ‘NEATs, SLICs and ACREs’. It is a great opportunity to present to a much wider audience on the rationale, method and outcome of the project we have been conducting with the team at Nambour Hospital to translate our research into practice around patients presenting to emergency departments with chest pain.

The full program for the meeting is here.

I will post a copy of the presentation here following the meeting or for more information please contact me through the blog.

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FOAM4GP

OK, low risk chest pain in the GP clinic setting.  It can be a vexing issue – we always worry about the big, bad diseases we might be missing – but is there a risk (and logistical headache) in doing a thorough workup and serial enzymes / Troponins on all chest pains?

It kinda depends where you practice as to how you will play this one.

Here is a discussion with a few super Smart GP registrars all over the country.
click HERE to listen to the 35 minute brain storm on the topic.

My bottom line – you need to define your background / pre-test probability of badness before embarking on investigation pathways that can lead to invasive, expensive and unpleasant tests in low risk patients.

Enjoy and comment on this is very welcome – there is certainly no right answer here!

Casey

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Cross blogged from our Emergency Cardiology Site…

The Emergency Cardiology Group

There has been lots of media interest in our paper ‘Validation of high-sensitivity troponin I in a 2-h diagnostic strategy to assess 30-day outcomes in emergency-department patients with possible acute coronary syndrome‘ that went online in in the Journal of the American College of Cardiology in the last few days.

Those in Queensland may have heard reference to the study on the ABC Radio news this morning and Louise Cullen has been interviewed today by ABC Radio National and Channel Nine.

We may have lost out to Black Caviar on the Channel Nine News though…

A copy of the press release from the Queensland Government is available here: RBWH media release – improved testing for potential heart attack patient.

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The Emergency Cardiology Group

A/Prof Louise Cullen writes…

The minefield of differences in troponin assays confuses clinicians, in an area of medicine that is already complex. Determining which patients presenting to Emergency Departments (EDs) with symptoms of possible Acute Coronary Syndromes actually have this underlying diagnosis is challenging. Current guidelines recommend lengthy assessment processes generally not achievable in acceptable time frames for patients to remain in the ED, and thus encourage Emergency Physicians to admit ‘all’ who present with possible symptoms of ACS.

Add to this mix the variability in analytical characteristics between troponin assays and information on change values (deltas) and it seems to many clinicians that this is simply getting too tough.

Our latest paper Delta troponin for the early diagnosis of AMI in emergency patients with chest pain’ in the International Journal of Cardiology highlights how early (0 and 2hr post ED presentation) troponin values may be used to…

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This sort of thing has been bugging me for ages…

Old CardioBrief

Don’t believe the the hype! That’s the cardinal rule to obey when reading health news. “Breakthroughs” and “cures” are rare, and should always be viewed with caution and skepticism.

This week was a great example. Last Sunday, the New York Times, the major networks, and a host of other media outlets (including this one) reported on a paper in  Nature Medicine about the discovery of a novel and potentially significant pathway linking red meat to heart disease. Briefly, the research suggested that carnitine, which is found naturally in high concentrations in red meat, can lead to atherosclerosis when it is converted by gut bacteria to a chemical called TMAO. Almost immediately I received a lot of comment from experts who raised serious questions about the research. Then today, a separate study was published with an entirely different perspective on carnitine. Although the two studies don’t directly contradict each other, they…

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