Management of acute cardiac syndromes in the Emergency Department of Health Center-General Hospital of Kythera

Postgraduate Thesis uoadl:1310103 391 Read counter

Unit:
Κατεύθυνση Μονάδες Εντατικής Θεραπείας και Επείγουσα Νοσηλευτική
Library of the School of Health Sciences
Deposit date:
2014-05-09
Year:
2014
Author:
Κοντομάρη Μαρία
Supervisors info:
Μάργαρη Νικολέττα
Original Title:
Αντιμετώπιση επειγόντων καρδιολογικών προβλημάτων στο Τμήμα Επειγόντων Περιστατικών του Κ.Υ.- Γενικού Νοσοκομείου Κυθήρων
Languages:
Greek
Translated title:
Management of acute cardiac syndromes in the Emergency Department of Health Center-General Hospital of Kythera
Summary:
Introduction: The patients involved in diseases of cardiac derivation, which
visit the Emergency Department (ED) of any hospital, are in need of acute
diagnosis and emergency treatment.
Aim: To evaluate the methodology that was followed in order to achieve the
accurate diagnosis, as well as the methodology of the emergency treatment that
was applied, by the hospital physicians, of a small rural hospital according to
the Clinical Guidelines of the European Society of Cardiology (ESC).
Methods: The study was conducted during the period between 1/1/2012 until
1/1/2013. In the study were enrolled all the patients (102) that visit the ED
and were diagnosed with Acute Coronary Syndrome (ACS), Acute Heart Failure
(AHF) and Rhythm Disorders. It is a retrospective study, and the data measured
were collected by questionnaire and by the data presented in the medical
records of the patients. Demographic, clinical and other characteristics were
included, along with characteristics related to the methodology of the
diagnosis and the applied pharmacological treatment. As level of significance
(α) was appointed 0,05. The package used for the statistical analysis was SPSS
17.0.
Results: Of the 102 patients that were enrolled in the study 57,8% were men and
42,2% female. According to the diagnosis made during their stay at the ED,
23,5% was diagnosed with ACS, 32,4% with AHF and 44,1% with Rhythm Disorders.
As for the patients with ACS, 70,8% were men, with prior Coronary Disease
(p=0,02) and 29,2% were women. The diagnosis was posed according to the
standards of the ESC, as STEMI (33,3%), Non-STEMI (50%), Unstable Angina
(12,5%), while 16,7% was diagnosed as chest pain of non cardiac derivation. The
emergency treatment applied relied on the guidelines, class I, of the ESC,
irrespective of the sex of the patient (p>0,05). As for the patients diagnosed
with AHF, 60,6% were men, mean age of 79,2±12,5 years with comorbidities
(p<0,05), while 39,4% women mean age of 86,3±7 years. The most frequent cause
was hypertension (33,3%). The emergency pharmacological treatment was based on
the guidelines, class I, posed by ESC, on consideration of the measurement of
Ejection Fraction (EF) (91% of the patients). Women (92,3%) appeared to respond
more effective to treatment compared to men (80%), as they were identified to
have higher EF (46±5,1%) compared to men (34,8±6,8%) p=0,00. As for the patiens
diagnosed with Rhythm Disorders, women (51,1%) slightly outclassed men
(48,8%).The most common disorder was Atrial Fibrillation (AF) (55,5%), mainly
in women (72%) mean age of 78±10 years, while men were 28% of the population
mean age of 61±18,6 years (p=0,007). 84% of the patients was diagnosed as
having paroxysmal AF. Rate control was applied to 92,5% of the patients,
according to the guidelines, class IA, of the ESC. Restoration to sinus rhythm
was achieved to 86,4% of the patients that were treated with pharmacological
cardioversion, while 13,6% failed to convert to sinus rhythm that related
statistical to older age (p=0,004).
Conclusions: Rhythm Disorders constitute the most frequent disease of cardiac
origin that is in need of emergency treatment among the regional population.
Despite of the older age, women appear to carry less comorbidities, while much
better systolic function of the Left Ventricular, compared to men, across the
total population of the study. The diagnoses, as long as, the emergency
treatments applied were guided by the clinical guidelines of the ESC, while the
pharmacological treatment relied almost exclusively on the guidelines with
level of recommendation IA-IB. The treatment applied in the ED concluded to be
successful, with only 5 patients (5,8%) deceased of a total of 102 patients.
Keywords:
Acute coronary syndromes, Acute heart failure, Atrial fibrillation, Emergency department
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
84
Number of pages:
121
File:
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