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Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department

Chest pain is one of the most common presenting symptoms in the emergency department (ED). Among patients with abnormal troponins, it is imperative to quickly and accurately distinguish type 1 acute myocardial infarction (AMI) from other etiologies of myocardial injury. Although high-sensitivity tro...

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Autores principales: Cavalier, Joanna S., Klem, Igor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Echocardiography 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099580/
https://www.ncbi.nlm.nih.gov/pubmed/33938167
http://dx.doi.org/10.4250/jcvi.2021.0036
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author Cavalier, Joanna S.
Klem, Igor
author_facet Cavalier, Joanna S.
Klem, Igor
author_sort Cavalier, Joanna S.
collection PubMed
description Chest pain is one of the most common presenting symptoms in the emergency department (ED). Among patients with abnormal troponins, it is imperative to quickly and accurately distinguish type 1 acute myocardial infarction (AMI) from other etiologies of myocardial injury. Although high-sensitivity troponin assays introduced a high negative predictive value for AMI, they have exposed the need for diagnostic modalities that can determine the etiology of acute myocardial injury. Cardiac magnetic resonance imaging (CMR) is an effective tool to risk stratifying chest pain among patients in the ED. CMR is non-invasive and has a lower cost of care and shorter length of stay compared to those of invasive coronary angiography. It also provides detailed information on cardiac morphology, function, tissue edema, and location and pattern of tissue damage that can help to differentiate many etiologies of cardiac injury. CMR is particularly useful to distinguish chest pain due to type 1 AMI versus supply-demand mismatch due to acute cardiac noncoronary artery disease. A detailed review of the literature has shown that CMR with stress testing is safe to use in patients presenting to the ED with chest pain, with or without abnormal troponins. CMR is a useful, safe, economical, and effective alternative to the traditional diagnostic tools that are typically used in this patient population. It is a practical tool to risk-stratify patients with possible cardiac pathology and to clarify diagnosis without invasive testing.
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spelling pubmed-80995802021-05-13 Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department Cavalier, Joanna S. Klem, Igor J Cardiovasc Imaging Review Article Chest pain is one of the most common presenting symptoms in the emergency department (ED). Among patients with abnormal troponins, it is imperative to quickly and accurately distinguish type 1 acute myocardial infarction (AMI) from other etiologies of myocardial injury. Although high-sensitivity troponin assays introduced a high negative predictive value for AMI, they have exposed the need for diagnostic modalities that can determine the etiology of acute myocardial injury. Cardiac magnetic resonance imaging (CMR) is an effective tool to risk stratifying chest pain among patients in the ED. CMR is non-invasive and has a lower cost of care and shorter length of stay compared to those of invasive coronary angiography. It also provides detailed information on cardiac morphology, function, tissue edema, and location and pattern of tissue damage that can help to differentiate many etiologies of cardiac injury. CMR is particularly useful to distinguish chest pain due to type 1 AMI versus supply-demand mismatch due to acute cardiac noncoronary artery disease. A detailed review of the literature has shown that CMR with stress testing is safe to use in patients presenting to the ED with chest pain, with or without abnormal troponins. CMR is a useful, safe, economical, and effective alternative to the traditional diagnostic tools that are typically used in this patient population. It is a practical tool to risk-stratify patients with possible cardiac pathology and to clarify diagnosis without invasive testing. Korean Society of Echocardiography 2021-04 2021-03-30 /pmc/articles/PMC8099580/ /pubmed/33938167 http://dx.doi.org/10.4250/jcvi.2021.0036 Text en Copyright © 2021 Korean Society of Echocardiography https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Cavalier, Joanna S.
Klem, Igor
Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title_full Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title_fullStr Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title_full_unstemmed Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title_short Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department
title_sort using cardiac magnetic resonance imaging to evaluate patients with chest pain in the emergency department
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099580/
https://www.ncbi.nlm.nih.gov/pubmed/33938167
http://dx.doi.org/10.4250/jcvi.2021.0036
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