The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to...The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.展开更多
Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease.Using digital technologies for education as a part of preventive measures for hypertension is ...Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease.Using digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare access.The coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health inequalities.Virtual education is helpful to improve awareness,knowledge,and attitude toward hypertension.However,given the complexity of behavioral change,educational approaches do not always provide a change in behavior.Some of the obstacles in online hypertensive education could be time limitations,not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior change.Studies regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet,salt restriction,and exercise and should be used adjunct to in-person visits for the management of hypertension.Additionally,to stratify patients according to hypertension type(essential or secondary)would be useful to create specific educational materials.Virtual hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.展开更多
BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causin...BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causing TTC.Rarely it has been reported to occur following an acute envenomation.AIM This review describes the various patterns,mechanisms,and outcomes of envenomation induced TTC.METHODS In this review,we included all studies on“TTC”and“envenomation”published in the various databases before June 2022.To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation RESULTS A total of 20 patients with envenomation induced TTC were identified.Most episodes of envenomation induced TTC were reported following a bee sting,scorpion sting,and snake envenomation.Fear and anxiety related to the sting,direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients.95%of these patients presented with a clinical picture of ACS.Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC.Echocardiographic evidence of Apical TTC was noted in 72%of patients.94%of these patients had clinical improvement following optimal management and 35%of these patients were treated with guideline directed medications for heart failure.CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC.Most reported envenomation related TTC has been due to bee stings and scorpion bites.Common mechanisms causing TTC were fear,anxiety,and stress of envenomation.Most of these patients present with clinical presentation of ACS,ST elevation,and elevated troponin.The most common type of TTC in these patients is Apical,which improved following medical management.展开更多
文摘The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.
文摘Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease.Using digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare access.The coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health inequalities.Virtual education is helpful to improve awareness,knowledge,and attitude toward hypertension.However,given the complexity of behavioral change,educational approaches do not always provide a change in behavior.Some of the obstacles in online hypertensive education could be time limitations,not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior change.Studies regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet,salt restriction,and exercise and should be used adjunct to in-person visits for the management of hypertension.Additionally,to stratify patients according to hypertension type(essential or secondary)would be useful to create specific educational materials.Virtual hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.
文摘BACKGROUND Takotsubo cardiomyopathy(TTC)can be diagnosed in patients presenting with clinical features of acute coronary syndrome(ACS)by using Mayo clinic criteria.Multiple precipitators have been attributed to causing TTC.Rarely it has been reported to occur following an acute envenomation.AIM This review describes the various patterns,mechanisms,and outcomes of envenomation induced TTC.METHODS In this review,we included all studies on“TTC”and“envenomation”published in the various databases before June 2022.To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation RESULTS A total of 20 patients with envenomation induced TTC were identified.Most episodes of envenomation induced TTC were reported following a bee sting,scorpion sting,and snake envenomation.Fear and anxiety related to the sting,direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients.95%of these patients presented with a clinical picture of ACS.Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC.Echocardiographic evidence of Apical TTC was noted in 72%of patients.94%of these patients had clinical improvement following optimal management and 35%of these patients were treated with guideline directed medications for heart failure.CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC.Most reported envenomation related TTC has been due to bee stings and scorpion bites.Common mechanisms causing TTC were fear,anxiety,and stress of envenomation.Most of these patients present with clinical presentation of ACS,ST elevation,and elevated troponin.The most common type of TTC in these patients is Apical,which improved following medical management.
