ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ

Selda Özel Coşkun; Vermi Değerli; Gökhan Elçin; Burcu Denizlioğlu; Erman Yıldırım; Neslihan Siliv; Ali Savaş Miran; İsmet Parlak

ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ

Year 2015, Volume: 19 Issue: 2, 84 - 94, 01.06.2015

Selda Özel Coşkun Vermi Değerli Gökhan Elçin Burcu Denizlioğlu Erman Yıldırım Neslihan Siliv Ali Savaş Miran İsmet Parlak

Abstract

Göğüs ağrısı GA şikâyeti, acil servislere AS başvuruların en sık nedenlerinden birisidir. Göğüs ağrısı şikayeti ile başvuran olgularda erken müdahale edilmeyi gerektiren akut koroner sendrom AKS tanısını koymak her zaman mümkün olmayabilir. Bazı hasta grubunda tanıya gidilmesi için hastaların klinik veya Elektokardiyografik EKG olarak izlemi gerekmektedir. Çalışmamızın amacı; Acil Servise tipik yada atipik Göğüs Ağrısı şikâyetiyle başvuran ve iskemik göğüs ağrısı olduğu düşünülen hastaların AKS oranlarının değerlendirilmesidir. AS’e, GA şikâyeti ile başvuran onsekiz yaş üstü ve nontravmatik tüm hastalar çalışmaya alındı. Çalışmaya dahil olmama kriterlerine ise;Travma hastaları,18 yaş altı hastalar, GA tariflemeyen hastalar, ST elavasyon myokart infarktüsü STEMI olan hastalar, kendi isteğiyle çalşmadan ayrılan hastalar, çalışmaya katılmayı kabul etmeyen hastalar, izleminde veri toplama formunda eksiklik olan hastalardan oluşmaktadır. Hastaların Çalışmaya 411 hasta alındı. Çalışmaya alınan hastaların 240’ı erkek %58,4 , 171’i %41,6 kadındı. Hastaların 314’ü %76,4 65 yaş ve altı iken, 97’si %23,6 65 yaş üstünde bulundu. Çalışmaya alınan hastaların 266’ında %73,3 KAH için en az bir risk faktörü varken, 71 hastada %26,7 birden fazla risk faktörü bulundu. Atipik semptomlarla başvuran hastalarda Akut Koroner Sendrom oranı %6,9 olarak saptandı. AKS’lu hastaların ilk geliş EKG’leri %53,9’u normal iken takip EKG'lerinde %16,9’unun EKG’sinde değişiklik saptandı. Tipik göğüs ağrısı olanlardaki AKS varlığı ve EKG değişikliği oranları atipik göğüs ağrısı olanlardaki AKS varlığı ve EKG değişikliği oranlarından yüksek olarak gözlendi p

Keywords

akut koroner sendrom, EKG, troponin, anjina pektoris, acil tıp

References

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EVALUATING THE ACUTE CORONARY SYNDROME RATES OF THE PATIENTS WHO APPLY TO EMERGENCY SERVICE WITH CHEST PAIN

Year 2015, Volume: 19 Issue: 2, 84 - 94, 01.06.2015

Selda Özel Coşkun Vermi Değerli Gökhan Elçin Burcu Denizlioğlu Erman Yıldırım Neslihan Siliv Ali Savaş Miran İsmet Parlak

Abstract

Chest Pain CP is one of the most frequent complaints observed in Emergency Services ES . It may not always be possible to diagnose the Acute Coronary Syndrome ACS , which requires immediate intervention in cases with CP. It is necessary that a clinical or Electrocardiographic ECG observation is performed in some patient groups to be able to diagnose the disease accurately. The purpose of this study is evaluating the ACS rates of the patients who apply to the Emergency Service with typical or atypical Chest Pain and who are considered to have ischemic chest pain. The patients who were non-traumatic and over 18 years of age who applied to the ES with CP complaints were included in the study. The criteria for not being included in the study were; being trauma patients, patients who were below the age of 18, patients whose APs were not defined; patients with ST Elevation Myocardia Infarct STEMI , patients who left the study with their own will, patients who did not want to participate in the study, and patients whose data collection forms had missing points in terms of observations. Doctor’s opinions on the complaints of the patients were determined as Typical Chest Pain or Atypical Chest Pain. The troponin and ECG follow-up of the patients were performed. The patients who were diagnosed according to the high troponin levels and ECG change were evaluated. The patients were examined in terms of gender, age, complaints for applying to the emergency service, background characteristics, TIMI risk factors, latest diagnoses, and the prognostic accuracy of the TIMI risk score. 411 patients were included in the study. 240 of the patients who participated in the study were male 58,4% , and 171 were female 41,6% . 314 of the patients 76,4% were at or below the age of 65, and 97 of them 23,6% were over the age of 65. 266 of the patients 73,3% had at least one risk factor for Coronary Artery Disease CAD , and 71 of them 26,7% had more than one risk factor. The Acute Coronary Syndrome ACS rate in the patients who applied with atypical symptoms was determined as 6,9%. The ECGs of the patients with ACS at the arrival were normal in 53,9%; however, changes were observed in the follow-up ECGs as 16,9%. The ACS existence and ECG change rates of the patients with Typical Chest Pain were observed as being higher than the ACS existence and ECG change rates of the patients with Atypical Chest Pain p

Keywords

acute coronary syndrome, ECG, troponin, angina pectoris, emergency medicine

References

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) Weingarten SR, Ermann B, Riedinger MS. Selecting the best triage rule for patients hospitalized with chest pain. Am J Med 1989; 87(5): 494.
) Sönmez Demiryoğuran N, Topaçoğlu H., Karcıoğlu Ö. Nonspesifik Göğüs Ağrılı Hastalarda Anksiyete Bozukluğu. DEÜ Tıp Fakültesi Derg. 2005; 19(2): 127–32.
) O’Rourke RA, Shaver JA, Silverman ME. Hikaye, Fizik Muayene ve Oskültasyon. In; Hurst’s The Heart, 10. baskı,Türkçe. Fuster V, Alexander RW, O’Rourke RA (eds) (çeviri ed: Yılmaz Y, Sahinbas E) McGraw-Hill 2002;193
) Solinas L, Raucci R, Terrazzino S et al. Prevalence, clinical characteristics, resource utilization and outcome of patients with acute chest pain in the emergency department. A multicenter, prospective, observational study in north-eastern Italy. Ital Heart J 2003; 4(5): 24.
) Eslick GD, Fass R. Noncardiac chest pain: Evaluation and treatment. Gastroenterol Clin North Am 2003; 32(2): 52.
) Karlson BW, Wiklund I, Bengston A, Herlitz J. Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain. Chest 1994; 105(5): 1442-7.
) Hollander JE. Cardiovascular disease: Acute Coronary Syndromes: Unstable Angina, Myocardial Ischemia, and Infarction. In; Tintinalli JE, Kelen GD, Stapczynski JS (eds). Emergency Medicine; A Comprehensive Study Guide; 5th ed. North Carolina: McGraw-Hill; 1999:pp –366
) Hecht HS, DeBord L, Sotomayor N, et al. Truly silent ischemia and the relationship of chest pain and ST segment changes to the amount of ischemic myocardium: 44 evaluation by supine bicycle stress echocardiography. J Am Coll Cardiol. 1994; (2):369–76.
) Hamilton GC. Acute chest pain. In Emergency Medicine an approach to clinical problem-solving. Hamilton G, Sanders AB, Strange GR, Trott A (eds). WB Saunders Company; Philadelphia (3th ed) 1991,pp.173–
) Braunwald E. Examination of the patient: The History. In: Braunwald E. eds; Heart Disease: A Textbook of Cardiovascular Medicine (5th ed.) Pennsylvania: W.B. Saunders Company 1997,pp.1–15.
) Noeller T.P. Risk Stratification in Acute Coronary Syndromes. In; Hoekstra J.W. “Handbook of Cardiovascular Emergencies” Lippincott Williams & Wilkins, Philadelphia (2nd ed.) 2001; 111:118-20.
) Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KAA, et al. Management of acute myocardial infarction inpatients presenting with ST-segment elevation The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003; 24(1): 28–66.
) Biasucci LM. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: clinical use of inflammatory markers in patients with cardiovascular diseases: a background paper. Circulation 2004; (25): 560-7.
) Schindler TH, Nitzsche EU, Olschewski M, Magosaki N, Mix M, Prior JO et.al. Chronic inflammation and impaired coronary vasoreactivity in patients with coronary risk factors. Circulation. 2004; 110(9): 1069-75.
) Tomai F, Crea F, Gaspardone A, Versaci F, Ghini AS, Chiariello L. et. al. Unstable angina and elevated C- reactive protein levels predict enhanced vasoreactivity ofthe culprit lesion. Circulation. 2001; 104(13): 1471-6.
) Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340(2):115-126.
) Eriksson S, Wittfooth S, Pettersson K. Present and future biochemical markers for detection of acute coronary syndrome. Crit Rev Clin Lab Sci ; 43(5-6):427-95. ) Spagnoli LG, Bonanno E, Sangiorgi G, Mauriello A.Role of inflammation in atherosclerosis. J Nucl Med. ; 48(11): 1800-15.
) Davies MJ. The pathophysiology of acute coronary syndromes. Heart. 2000; 83(3): 361-6.
) Schaar JA, Muller JE, Falk E, Virmani R, Fuster V, Serruys PW, et.al. Terminology for high-risk and vulnerable coronary artery plaques. Report of a meeting on the vulnerable plaque. Eur Heart J. 2004; (12): 1077-82.
) Braunwald E. Unstable angina: an etiologic approach to management (editorial).Circulation 1998; 98(21): 22.
) Lloyd-Jones D, Adams R, Carnethon M, ve ark. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119 (3): 480-6.
) Theroux P, Fuster V. Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction. Circulation 1998; 97(12): 1195-206.
) Davies MJ. The composition of coronary-artery plaques. The New England journal of medicine 1997; (18):1312-4.
) Sampson J, Eliaser MJ. The diagnosis impending of acute coronary artery occlusion. Am Heart J 1937; 13(6): 86.
) Feil H. Preliminary pain in coronary thrombosis. Am J Med Sci 1937;193(1):42-8.
) Scanlon PJ, Nemickas R, Moran JF, ve ark. Accelerated angina pectoris. Clinical, hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation 1973; 47(1): 19-26.
) Vakil RJ. Preinfarction Syndrome-Management and Follow-Up. Am J Cardiol 1964; 14: 55-63.
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Primary Language	Turkish
Journal Section	Research Article
Authors	Selda Özel Coşkun This is me Vermi Değerli This is me Gökhan Elçin This is me Burcu Denizlioğlu This is me Erman Yıldırım This is me Neslihan Siliv This is me Ali Savaş Miran This is me İsmet Parlak This is me
Publication Date	June 1, 2015
Published in Issue	Year 2015 Volume: 19 Issue: 2

Cite

APA	Coşkun, S. Ö., Değerli, V., Elçin, G., Denizlioğlu, B., et al. (2015). ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi, 19(2), 84-94.
AMA	Coşkun SÖ, Değerli V, Elçin G, Denizlioğlu B, Yıldırım E, Siliv N, Miran AS, Parlak İ. ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ. İzmir EAH Tıp Der. June 2015;19(2):84-94.
Chicago	Coşkun, Selda Özel, Vermi Değerli, Gökhan Elçin, Burcu Denizlioğlu, Erman Yıldırım, Neslihan Siliv, Ali Savaş Miran, and İsmet Parlak. “ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ”. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi 19, no. 2 (June 2015): 84-94.
EndNote	Coşkun SÖ, Değerli V, Elçin G, Denizlioğlu B, Yıldırım E, Siliv N, Miran AS, Parlak İ (June 1, 2015) ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 19 2 84–94.
IEEE	S. Ö. Coşkun, V. Değerli, G. Elçin, B. Denizlioğlu, E. Yıldırım, N. Siliv, A. S. Miran, and İ. Parlak, “ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ”, İzmir EAH Tıp Der, vol. 19, no. 2, pp. 84–94, 2015.
ISNAD	Coşkun, Selda Özel et al. “ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ”. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 19/2 (June 2015), 84-94.
JAMA	Coşkun SÖ, Değerli V, Elçin G, Denizlioğlu B, Yıldırım E, Siliv N, Miran AS, Parlak İ. ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ. İzmir EAH Tıp Der. 2015;19:84–94.
MLA	Coşkun, Selda Özel et al. “ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ”. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi, vol. 19, no. 2, 2015, pp. 84-94.
Vancouver	Coşkun SÖ, Değerli V, Elçin G, Denizlioğlu B, Yıldırım E, Siliv N, Miran AS, Parlak İ. ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN HASTALARIN AKUT KORONER SENDROM ORANLARININ DEĞERLENDİRİLMESİ. İzmir EAH Tıp Der. 2015;19(2):84-9.

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