Evaluation of Patients with Non-Traumatic Chest Pain Presenting to the Emergency Department: A Prospective Observational Study

Öz

Chest pain (CP) is one of the most common reasons for emergency department visits, and these patients can experience high mortality and morbidity. Out of 87320 visits to our emergency department, 2878 (3.3%) were due to non-traumatic chest pain, and 2,811 patients (97.7%) were included in the study. The percentage of patients with normal EKG findings is 63%, while the rate of patients diagnosed with ST-segment elevation myocardial infarction is 6.3%. The risk of Acute Coronary Syndrome (ACS) is approximately 1.5 times higher in men. The rate of serious cardiac events within one month after discharge is 2.8%. During this period, serious cardiac events and/or death were observed in 18.4% of patients at high risk according to the TIMI score and in 7.7% of those at high risk according to the GRACE score. The most common diagnosis for patients presenting with chest pain is ACS, with unstable angina (UAP) being the most frequently identified subtype. In women, ACS diagnosis was found to be more commonly associated with atypical chest pain. In conclusion, the patients in our study received diagnoses that could lead to high mortality and morbidity, including cardiac causes, pulmonary embolism, pneumothorax, aortic dissection, and even digoxin toxicity. Among patients presenting with atypical pain, 28.5% were diagnosed with ACS, and 33.4% of those whose pain had resolved at the time of admission were also diagnosed with ACS. Therefore, prompt and accurate differential diagnosis of chest pain is of vital importance.

Anahtar Kelimeler

• Chest pain
• emergency department
• acute coronary syndrome

Acil Servise Başvuran Travmatik Olmayan Göğüs Ağrısı Hastalarının Değerlendirilmesi: İleri Dönük Gözlemsel Çalışma

Öz

Göğüs ağrısı (GA), acil servislere en sık başvuru nedenlerinden biri olup bu hastalar yüksek mortalite ve morbidite ile seyredebilir. Acil servisimize 87320 başvurunun 2878’i (%3,3) travma dışı göğüs ağrısı nedeniyledir ve 2,811 hasta (%97,7) çalışmaya dahil edilmiştir. EKG bulguları normal olan hasta oranı %63, ST segment elevasyonlu miyokard infarktüsü tanısı alan hasta oranı %6,3’tür. Akut koroner sendrom (AKS) görülme riski erkeklerde yaklaşık olarak 1,5 kat fazla saptanmıştır. Taburculuktan sonra 1 ay içinde ciddi kardiyak olay görülme oranı %2,8’dir. Bu sürede TIMI skorlamasında yüksek riskli olanlarda %18,4’ünde ve GRACE skorlamasında yüksek riskli olanlarda ise %7,7’sinde ciddi kardiyak olay ve/veya ölüm görüldü. GA ile başvuru yapan hastaların en sık aldığı tanı AKS olup; bu kapsamda en sık unstable angina pektoris (UAP) saptandı. Kadınlarda AKS tanısının atipik göğüs ağrısıyla daha sık ilişkilendirildiği bulunmuştur. Sonuç olarak çalışmamızdaki hastalar başta kardiyak nedenler olmak üzere pulmoner emboli, pnömotoraks, aort diseksiyonu hatta digoksin intoksikasyonuna uzanan geniş yelpazede yüksek mortalite ve morbiditeye neden olabilecek tanılar almışlardır. Atipik ağrı nedeniyle başvuran hastaların %28,5’u, başvuru sırasında ağrısı devam etmeyen hastaların %33,4’ü AKS tanısı almıştır. Bu nedenle göğüs ağrısı ayırıcı tanısının hızlı ve doğru yapılması hayati öneme sahiptir.

Anahtar Kelimeler

• Göğüs ağrısı
• acil servis
• akut koroner sendrom

Kaynakça

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